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Sealants: The Added Link in Prevention

Course Number: 673

History of Sealant Use

Protecting the natural pits and fissures of newly erupted teeth from dental decay is not a new concept. There have been numerous references to reducing the decay susceptibility of pits and fissures since 1923 when H. T. Hyatt suggested a technique called prophylactic odontonomy. Subsequent approaches have used various materials and chemicals.

A breakthrough came in 1955 with Buonocore’s “acid-etch technique” which allowed for sufficient bonding between the resin material and enamel.

The acid-etch technique offered promise for the one area of the human tooth that was particularly susceptible to dental caries. By 1955 there was a sufficient amount of research to support the use of fluoride in public water systems and topical application by dental professionals. Along with the use of fluoride, it was widely recognized that the reduction of fermentable carbohydrates in the diet, routine dental examinations, routine dental care, and the daily removal of plaque from the teeth reduced the incidence of tooth decay. At the same time it was apparent that the pits and fissures that form the occlusal surfaces of the human teeth remained vulnerable. Acid-etch technique provided the basis for further development of effective materials to seal the pits and fissures and thus dental sealants offered an added link in preventive dentistry.

In 1983 the National Institutes of Health published a report entitled, “Consensus Development Conference Statement on Dental Sealants in the Prevention of Tooth Decay.” This report recommended the use of pit and fissure sealants as a safe and effective method of preventing pit and fissure decay. In addition, it addressed significant roadblocks to sealant use such as availability, insurance coverage, and questions of enamel maturation.

Following the publication of this report, many states changed their dental practice acts to allow dental auxiliaries to place pit and fissure sealants. Currently all state practice acts allow dental hygienists to place pit and fissure sealants, and the majority of states allow dental assistants to perform this procedure. This information also resulted in many dental insurance companies looking at sealant placement not as an experimental procedure but as a cost-effective prevention measure.

Continued review of the dental literature indicates ongoing documentation of successful sealant retention rates, reduction of occlusal caries, and the economic impact of a caries-free population. Both public health programs and private practice surveys give positive results for the placement of pit and fissure sealants.

An added benefit of placing pit and fissure sealants is the positive dental experience it provides for children. Almost without exception, the placement of pit and fissure sealants is painless and non-traumatic. Pit and fissure sealants provide both primary prevention by averting the onset of caries and secondary prevention by averting the progression of early caries to cavitation.