Sealants Flashcards
Caries Lesions represent a continuum of net mineral ____
loss
What is another name for noncavitated lesion?
initial caries development
Initial caries are characterized by change in…
-Color
-Glossiness
-Surface Structure
Inital caries occur via..
a result of demineralization and represent areas with net mineral loss before there is macroscopic breakdown in surface tooth structure
Are initial caries reversible?
Considered Reversible with remineralization
What are cavitated lesions?
Loss of surface integrity with inability to biologically replace the loss of hard tissue
Whats the difference between moderate and advanced caries?
Moderate Caries
-Extend into the middle third of dentin layer
Advanced Caries
-Extend into the inner third or dentin layer
What are the tooth surface sites or origins?
- Pit & Fissure
- Approximal
- Cervical and Smooth Surface
- Root
What are the main caries detection techniques?
- tactile
- radiographs
- newer techniques
What are radiographs especially good for in terms of caries detection?
Especially for interproximal lesions
What are new techniques for caries detection?
Laser fluorescence, transillumination, or combo of laser luminescence and photothermal radiometry
What is ICDAS 0
clinically sound
What is ICDAS 1-2
clinically detected “intact” enamel lesions (intial stage decay)
What is ICDAS 3-4
clinically detectable early, shallow, or microcavitations (moderate decay)
What is ICDAS 5-6
clinically detectable late or deep cavitations (extensive decay)
What do you make a caries management plan for a patient based on?
- ICDAS
- inital patietn assessment
- lesion detection, activity, and appropraite risk assessment
- synthesis and decision making
- clinical treatmetns with prevention
What are the high risk characteristics for caries?
- Sugary food or drinks
- Eligible for government programs (WIC, Headstart, age 0-6)
- Caries experience of caregiver (age 0-14)
- Special health care needs
- Chemo/Radiation therapy
- Restorations/Cavitated carious lesions in the last 24 months
- New Noncavitated (incipient) lesions in the last 24 months
- Teeth missing due to caries
- Severe dry mouth
What are different caries prevention and risk management strategies?
-Behavioral Modification
-Topical Fluoride Application
-Pit and Fissure Sealants
What are ways of behavioral modification to manage caries?
-Limiting sugary foods and drinks
-Chewing sugar-free gum with xylitol
-Brushing with fluoride toothpaste 2x/day
-Cleaning between teeth 1x/day
What are different ways of topical fluoride application?
-Placement of fluoride varnish (2.26%)
-Placement of fluoride gel (1.23% acidulated phosphate)
-Daily use of 0.09% fluoride mouthrinse
-Silver Diamine Fluoride (38%) for arrest of dental caries
Are pit and fissure sealants effective?
-Effectively penetrating and sealing these surfaces with dental material (sealants) has been proven effective in preventing and arresting caries in permanent molars of children and adolescents
Why do pit and fissures need sealants sometimes?
Anatomical grooves (aka pits and fissures) of teeth trap food particles and promote presence of bacterial biofilm, increasing the risk or caries
When should you place sealants?
-Sealants are placed on pit and fissure areas only on noncavitated teeth
When is the best time to seal permanent molars?
overall higher prevalence of untreated carious lesions in 12-19 year olds (15%) compared to 6-11 year olds (6%), so best to seal soon after permanent molar eruption
What are the different options of sealant materials?
- Resin-based
- Glass Ionomer
- Polyacid-modified resin
- Resin-modified glass ionomer
What is the most common type of sealant used?
Resin-based
What are resin-based sealants?
-Urethane dimethacrylate (UDMA) or bisphenol A-glycidyl methacrylate (bis-GMA) monomers polymerized by either chemical activator and initiator or light or specific wavelength and intensity
What are the pros of resin-based sealants?
- Good retention
- can control working time (light-cured)
- wear-resistant
What are the cons of resin-based sealants?
- moisture-sensitive
- require cleaning/etching of tooth surface prior to placement
What are glass ionomer sealants?
Cements with an acid-base reaction between fluoroaluminosilicate glass powder and polyacrylic acid solution
What are the pros of glass ionomer sealants?
- Moisture-friendly
- No need for pretreatment of tooth surface due to chemical bonding to tooth surface
- Continuous release of fluoride
What are the cons of glass ionomer sealants?
- Poor retention
- Cannot control working time (chemical reaction)
What are polyacid-modified resin sealants?
Combine resin-based material with fluoride releasing and adhesive properties of glass ionomer
What are the pros of polyacid-modified resin sealants?
- Continuous release of fluoride
- Controlled working time
What are the cons of polyacid-modified resin sealants?
- Lower amounts of fluoride release
vs. GI - retention lower than resin
- moisture-sensitive
- require etching prior to placement
What are resin-modified glass ionomer sealants?
-Glass Ionomer sealants with resin components
What are the pros of resin-modified glass ionomer sealants?
- Similar fluoride-release properties as GI
- longer working time than GI
- less water sensitivity than GI
- does not require etching prior to placement
What are the cons of resin-modified glass ionomer sealants?
- Lower retention than resin
- lower wear-resistance than resin
What are the sealant placement steps?
-Always recommend dry environment (especially resin-based)
-Clean pits and fissures with pumice and prophy brush, air abrasion, hydrogen peroxide, or enameloplasty
-Important to not use prophy paste to clean tooth because fluoride and oil interferes with etching process
-Place acid etch for 15-20 seconds, rinse, and dry (resin-based sealants only)
-Place sealant material of choice and light cure if necessary (resin sealant materials)
-Check occlusion and adjust if necessary
What is the difference between PRR (preventitive resin restorations) and sealants?
-PRR’s are done on teeth that have initial caries present (not in dentin)
-PRR’s are meant to last forever, while sealants generally come out after a number of years
What is the technique for preventitive resin restorations (PRR)
-Remove caries (usually with small round bur or can use air abrasion)
-Etch for 15-20 seconds, rinse, and dry
-Place bonding agent, air dry, and light cure
-Place flowable resin composite, and light cure
-Check occlusion and adjust if necessary
How is the technique for preventitive resin restorations (PRR) different from sealants?
-Caries must be removed prior to placement
-Bonding agent and flowable resin composite are used
What are some things to consider about sealants?
- sealants may be placed by either
dentist, hygienist, or assistant
-Isolation can be difficult for sealants, so staff members may require assistance
-Always remember your staff is working under your license, so check teeth before and after sealants placed
-Most dental insurance only covers sealants for minors (age limits vary)
-PRR’s can only be placed by dentist
-PRR’s generally covered by insurance with similar reimbursement as sealant
