As dental hygienists, we strive to prevent disease and promote health. Pit and fissure sealants are a commonly recommended preventive strategy and many of our clients benefit from their successful placement. Sealant retention is synonymous with sealant success.
The pit and fissure sealant material is typically a lightly- or unfilled low viscosity composite resin, and behaves and is treated as such.
Below are some tips that might complement or enhance future sealant placement.
1. Adhere to the Dental Hygiene Process of Care (DHPC)
The placement of pit and fissure sealants is a valuable component of the implementation phase in the DHPC, but skipping any of the other components may lead to sealant failure.
Consider the level of caries risk and caries activity of the client. Tooth characteristics to appraise include anatomical features that are conducive to caries formation, recent eruption, and operculum proximity. Be sure to assess buccal pits of mandibular molars, lingual pits of maxillary molars, and lingual pits of maxillary anterior teeth, in addition to the occlusal surfaces of posterior teeth. As many sealant clients are children, you may also contemplate behaviour management strategies to be utilized during the procedure.
2. Follow the Manufacturer’s Instructions
Reading instructions is always time well spent. Thoroughly reviewing the product characteristics will provide valuable insight as various products behave differently in the oral environment. For example, some products may be applied in a semi-wet field, whereas others require a moisture-free field. Variations in curing times and types will also alter the manipulation of the resin material.
3. Prophy with a Prophy Jet
More debris will be removed with a prophy jet than with a slow speed handpiece and prophy brush. The less contaminated the tooth is, the better the retention.
4. Overetch - Apply Etch to Extend Beyond Where the Sealant is Expected
Overetching will help to ensure that the entire area to be sealed is etched. Unetched areas will not retain the sealant properly and the sealant may fail.
5. Dispense the Sealant Material Into a Dappen Dish and Apply it to the Tooth with a Microbrush
This can help to improve infection control, by not placing a sealant syringe into a client’s oral cavity. As well, the clinician may find improved control by applying the material with a microbrush. If too much sealant material has inadvertently been placed on the tooth, simply wick the excess material with the readily accessible microbrush. Consider placing the resin in the mesial pit first and then guide it to the distal, as this flow is naturally supported by anatomy and gravity.
6. Guide the Sealant Material Into the Pits and Fissures with an Explorer
After the correct amount of sealant material has been placed on the tooth, gently guide the resin into the pits and fissures with a clean explorer to help improve contact and retention.
7. Evaluate the Integrity of the Sealant Immediately After Placement
Evaluate for air bubbles or voids with the explorer and if found, correct them immediately. Attempt to dislodge the sealant with the explorer. A properly placed sealant will adhere to the tooth and cannot be displaced with gentle pressure.
8. Apply Fluoride After the Sealant Procedure
This helps to remineralize the overetched areas of enamel. Remember that acidulated phosphate fluoride is contraindicated on sealants, as they are type of composite resin; consider neutral sodium fluoride instead.
9. Educate the Client About the Purpose, Limitations, and Expectations of a Pit and Fissure Sealant Before and After the Procedure
Clients (and parents) will need to be informed that:
- the pit and fissure sealant does not prevent interproximal decay, so flossing daily is still required
- the pit and fissure sealant will deteriorate faster with poor oral hygiene, so excellent oral hygiene is still needed
- the pit and fissure sealant won’t last indefinitely, but excellent oral hygiene and following professional recommendations for continuing care will prolong it
- the pit and fissure sealant is not a replacement for a noncariogenic diet and fluoride therapy
- the pit and fissure sealant will not improve the condition of the gingiva
10. Practice Four-Handed Pit and Fissure Sealant Placement
Utilization of an assistant to place sealants allows for improved efficiency, better field maintenance, and reduced clinician anxiety.
What do you think? Do you have any other tips that you find improves the success of your pit and fissure sealants? Please share them!
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