Chapter 12

Fissure sealants

WHAT IS A FISSURE SEALANT?

A fissure sealant is a plastic resin material that is placed in the pits, fissures and buccal grooves of molar teeth (less common in premolars), and the cingulums and palatal grooves of incisors, in order to prevent or arrest the development of caries.

Fissure sealants were first developed in the 1970s as a preventive measure. Unlike amalgam restorations, there is no preparatory cutting or drilling of the enamel surface of the tooth unless caries is present.

Reasons for using fissure sealants

Fissure sealants make teeth easier to clean and protect surfaces from plaque. Fissures in newly erupted permanent molars are too small to be penetrated by toothbrush bristles and plaque is often trapped there, leading to the development of caries [1].

Caries of the first permanent molars (sixes) in 12-year-old English schoolchildren accounts for the majority of tooth decay at this age [2], and caries of the occlusal surfaces accounts for 50% of decay in first molars [3].

Enamel is not fully hardened by the time of eruption. Maturation (hardening) of the enamel takes several years to complete and the probability of a caries attack reaches a peak at 2–4 years post-eruption. However, maturation is more rapid in the presence of fluoride, so all children should use fluoride toothpaste to assist this process as well as to help prevent caries. Fluoride applied topically helps strengthen enamel and interferes with bacterial reproduction (see Chapter 11).

When and where to seal

Fissure sealing can be carried out in older children and adults, and is most effective when placed during the early months after eruption (i.e. when the enamel is not fully mature). Fissure sealants are sometimes carried out in teenage children, as soon as the second molars (sevens) erupt.

Fissure sealants are most commonly used in the following cases:

• Newly erupted teeth (usually 6s and 7s) – which should be fully erupted with no flaps or contamination from saliva, which could result in failure of the sealant.
• Sticky fissures susceptible to food debris and bacteria in children.
• Deep cingulums and buccal or palatal grooves.
• Patients susceptible to caries (family history of caries in deciduous teeth).
• Patients with a serious medical condition (e.g. congenital heart disease, haemophilia) who need to avoid dental extractions.
• Patients who are unable to cope with adequate cleaning and dental treatment.

Fissure sealant materials/systems

Sealants are divided into two groups: filled and unfilled. Some sealants, which are filled with lithium alumina silicate, are more resistant to abrasion, have a prolonged life and are easier to see in the tooth [4].

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