Paeds S5

Question 1

What is a fissue sealant?

Answer 1

A protective plastic coating used to seal fissures and pits to prevent food and bacteria getting caught in them and causing decay.

Question 2

Why are fissures vulnerable to caries?

Answer 2

• Fissures are less protected by fluoride than interproximal or smooth surfaces.
• It is not possible to clean the base of fissures with a tooth brush.
• Enamel is reduced at the base of a fissue

Question 3

What material do we use for fissure sealants?

Answer 3

• Mostly bis-GMA resin applied following acid etch of the fissure pattern.
• Occasionally we use glass ionomer cement (see indications for this later).

Question 4

What are indications for fissue sealant placement?

Answer 4

• Medically compromised children, children with learning difficulties or those with physical and mental disabilities (high risk) should all have teeth sealed.
• High risk for caries
• Guidance from SIGN 138 and SCDEP– seal all pits and fissures of permanent molars in children as soon as possible after eruption.

Question 5

What teeth should be selected for fissue sealant?

Answer 5

• Greatest benefit on occlusal/pit of permanent molar teeth.
• Should also seal cingulum pits of upper incisors, buccal
• Sealing of primary molars may be advised in high caries risk children.
• Any child with caries in 1st permenant should have 2nd sealed on eruption

Question 6

How should you isolate for fissue sealant?

Answer 6

single tooth dental dam

Question 7

How should enamel look after etch?

Answer 7

white frosted apperance

Question 8

What can be used to apply the resin?

Answer 8

Can use brush, micro- brush or small excavator.

Question 9

How would you check that a fissure sealant has been placed correctly?

Answer 9

• Check that sealant is firmly adhered- use sharp probe to try and dislodge.
• Check there are no air-blows present. If present remove part of sealant and re-do.
• Check that no material has flowed interproximally- if it has remove with a sharp probe and dental floss.
• Check that there is no excess material distal to the tooth in the soft tissues.

Question 10

What are the indications for glass ionmer fissure sealant?

Answer 10

• Where good moisture control cannot be achieved – High risk children with partially erupted molars
  – Special needs children
  – Poorly cooperating children
• Where there is a high degree of sensitivity due to developmental or hereditary enamel defects. In these cases drying the tooth can be extremely painful.
• Useful as release fluoride but are poorly retained and require regular reapplication.

Question 11

How to place a glass ionmer fissue sealant? (steps)

Answer 11

• Attempt to dry tooth with air or cotton wool.
• Apply GI from applicator.
• Smooth into fissures using gloved finger or thumb.
• Keep finger over GI until set or place petroleum jelly to decrease moisture contamination until set.