ICP L15 fissure sealing

Question 1

what is a fissure sealant

Answer 1

material placed in pits + fissures of teeth to prevent or arrest the development of caries
material obliterates the fissures + removes sheltered env where caries thrives

Question 2

why are surfaces with pits + fissures more vulnerable to caries

Answer 2

complex morphology of enamel which favours plaque accumulation -> enamel doesn’t get same level of protection from fluoride

Question 3

when is fissure sealing appropriate (7)

Answer 3

Patient selection
- kids with special needs
- kids with extensive caries in primary dentition
- kids with caries in permanent molars
Tooth selection (6s, Es, 4s, 5s, 2s)
- molars with deep pits + fissures
- incisors with deep cingulum pits
- molars with complex fissure patterns
- molars with stained fissures

Question 4

what are the 3 materials that can be used as fissure sealants

Answer 4

unfilled resin
filled resin
GIC

Question 5

what is the most preferred material for fissure sealants + why

Answer 5

unfilled resin

flows better in the fissures

Question 6

describe what unfilled resin looks like + how it is cured

Answer 6

light/chemical cure

clear, tinted or opaque

Question 7

describe what filled resin looks like + how it is cured

Answer 7

light/chemical cure
clear, tinted or opaque
contains filler particles ( little effect on clinical results)

Question 8

what material would you use for fissure sealants when child has salivary/moisture control problems

Answer 8

GIC

Question 9

When would you use GICs mostly for fissure sealants

Answer 9

useful when isolation is problematic -> less isolation

partially erupted teeth in high caries risk child

Question 10

what are the main stages when doing fissure sealants

Answer 10

clean tooth
isolate
etch
wash + dry
(re-isolate)
seal

Question 11

what are 2 points to remember when cleaning tooth for fissure sealants

Answer 11

advisable if abundant plaque present, use prophylaxis (cleaning treatment)

Question 12

how do you isolate a tooth you are doing a fissure sealant on

Answer 12

cotton wool rolls + suction + dry guard

Question 13

what do you use to etch on the teeth for fissure sealant prep + how long

Answer 13

37% phosphoric acid for 20 secs

Question 14

how long do you wash + dry the tooth during prep and what does it look like after

Answer 14

10-15 secs with 3 in 1

white frosted appearance

Question 15

why might you have to re-isolate the tooth after wash + dry the tooth

Answer 15

salivary contamination allows precipitation of glycoproteins onto enamel surface -> ↓ bond strength of sealant
re-etch if necessary

Question 16

what c`n be done if complete isolation is not possible

Answer 16

place bonding agent onto wet enamel prior to placing sealant

Question 17

what are the steps done when applying the last stage of applying the sealant

Answer 17

• apply FS to cover all fissures/pits/grooves up to 1/3rd of cuspal incline
• light cure for 20secs as close to tooth surface without touching tooth
• inspect + remove any excess with probe. check occlusion
• follow up + review per patient

Question 18

why are fissure sealants considered cost effective

Answer 18

pits + fissures recognised as high susceptible to caries -> least likely to benefit from systemic or topical fluoride
FS can prevent caries

Question 19

what does cost effectiveness of fissure sealants depend on?

Answer 19

• caries in population
• tooth to be sealed (molars more cost effective than pre-molars)
• retention of FS or if re-sealing is necessary

Question 20

what percentage of fissure sealants are intact after 3 yrs of placement

Answer 20

75%

Question 21

what percentage of sealants are effective in caries prevention compared to unsealed

Answer 21

70%

Question 22

what percentage of teeth will become carious after 4 yrs of eruption if fissure isn’t sealed

Answer 22

33%