Success with pit and fissure sealants. (President's Page).

This article focuses on the techniques used for successful pit and fissure sealant application by the dental assistant.

Pit and fissure sealants first were utilized in 1967 (1) and formally recognized by the American Dental Association in 1971 (2). Since that time, many product developments have been introduced to increase their effectiveness and ease of use. Finding adequate time in the schedule for the application of sealants is a significant challenge for most dental practices.

In some practices, the hygienist applies the sealants. However, if the hygiene schedule is backlogged with patients requiring other preventive care, the individuals requiring sealants are transferred to the doctor's schedule. Since sealant procedures normally do not produce a high fee, they are not necessarily the most productive use of the doctor's time. If there is one assistant working with the doctor in the treatment room at all times, and at least one other assistant who works independently of the doctor (fabricating provisional restorations and providing other services to patients where allowed by state law), it makes sense to delegate sealant application to the chairside assistant. Currently there are 24 states that allow application of pit and fissure sealants by dental assistants. (See Table 1)

Success with pit and fissure sealants is very dependent on technique. Table 2 lists the steps in the application procedure. Product selection is the first step in sealant application. Use of light cured materials provides the assistant with more control over working time. Using materials with very fine applicator tips helps the assistant to better control the placement of material in the pits and fissures. (Figure 1)

[FIGURE 1 OMITTED]

Good isolation to keep the teeth dry is critical to sealant retention. Using a dental dam (Figure 2) to isolate the teeth will provide the best isolation, however, using various types of cotton roll holders also will work. In addition, products such as Dri-Angles[TM] or Dry-Tips[TM] are also excellent for isolation and keeping the area dry. If the tooth surface becomes wet after the etching, the etch procedure must be repeated for good retention of the sealant material.

[FIGURE 2 OMITTED]

Sometimes air bubbles may be incorporated into the sealant material during application. This can be avoided by keeping the applicator tip immersed in the sealant material while moving the applicator tip across the tooth surface. If bubbles still form, the applicator tip or the tip of an explorer can be used to gently remove the bubbles, taking care not to displace any of the sealant material.

Finally, adequate curing of the material also is critical for success. The assistant must always review the product directions to determine the manufacturer's recommended curing time and follow that guideline. The curing light (Figure 3) also should be tested monthly to make certain that the intensity level is optimal.

[FIGURE 3 OMITTED]

One new development in sealant material is color change technology. These sealants are tinted, which allows for better visibility of the sealant material during application. As the material is light cured, it then changes into an opaque tooth color (Figures 4 and 5). The tinted color of the sealant allows the operator to be sure all needed area of the occlusal or other surfaces are covered. Since proper coverage during application is one of the key elements in the successful retention of the sealant, this technology provides a significant benefit to both the patient and the dental team.

[FIGURES 4-5 OMITTED]

If a particular state does not allow assistants to apply sealants, the assistant can still play an important role in the sealant program in a practice. Patient education is a function allowable in all states for assistants to perform. The assistant can fulfill a need for both patients, and parents of pediatric patients, to be informed about the importance and success of sealant application. In addition, the dental assistant can research materials and techniques for sealant application and help both the doctor and hygienist keep abreast of new developments.

Photo Credit: Figures 2, 4 and 5 courtesy of Chris Bryant, B.Sc., DMD.

Table 1--Sealant Application
by Dental Assistants

States that allow         Training, examination
application of sealants   or credential required

        Alaska                     No
        Arizona                    No
        Colorado                   No
        Florida                    Yes
        Georgia                    Yes
        Idaho                      Yes
        Illinois                   Yes
        Kentucky                   No
        Massachusetts              Yes
        Michigan                   Yes
        Minnesota                  Yes
        Mississippi                No
        Montana                    No
        Nevada                     No
        New Hampshire              Yes
        New Mexico                 Yes
        North Carolina             No
        Ohio                       Yes
        Oklahoma                   No
        Oregon                     No
        Rhode Island               Yes
        South Carolina             No
        South Dakota               Yes
        Vermont                    Yes
        Washington                 No

Source: American Dental Association

Table 2--Sealant Application Procedure

Step 1    Select or identify teeth to be sealed--if a small carious
          area is detected, it can be removed by the doctor using a
          fissurotomy bur, if the area is large, the tooth should be
          restored, not sealed.

Step 2    Select appropriate product (i.e. tinted vs. clear, filled
          vs. unfilled, etc)

Step 3    Remove plaque and/or debris from tooth (pumice polishing with
          occlusal brush, air polishing *, or air abrasion *)

Step 4    Rinse all polishing material from tooth

Step 5    Isolate tooth with cotton rolls, Dri-Angles(tm) or
          Dry-Tips(tm) (If dental dam isolation is used, place the dam
          prior to polishing.)

Step 6    Dry tooth and apply acid etch gel or liquid for
          manufacturer's recommended time

Step 7    Rinse tooth well, remove isolation materials and replace with
          dry ones. Air dry tooth surfaces to be sealed. The tooth
          structure should appear frosty white, not shiny.
          If tooth becomes wet, repeat steps 6 and 7.

Step 8    Apply sealant material with the applicator supplied by the
          manufacturer.

Step 9    Cure the sealant for the manufacturer's recommended curing
          time, or wait for the manufacturer's recommended curing time
          for chemically (self) cured sealants.

Step 10   Remove isolation materials and rinse the area well.

Step 11   Check patient's occlusion with articulating paper.
          Adjust as necessary. **

* In some states, dental assistants are not allowed to perform this
function.

** If occlusal adjustment is necessary, this must be performed
by the doctor, using a handpiece and a finishing bur.

References

(1.) Cueto El, Buonocore MG. Sealing pits and fissures with an adhesive resin: It's use in caries prevention. JADA 1967; 75:121-128.

(2.) Waggoner, WF, Siegel M. Pit and fissure sealant application: Updating the technique. JADA 1996;127:151-159.

Mary Govoni, CDA, RDA, RDH, has over 30 years of varied experience in the dental profession. She is the owner of Clinical Dynamics, a consulting company dedicated to the enhancement of the clinical and communication skills of dental teams, and past president of the ADAA. Ms. Govoni is a columnist for Dental Equipment and Materials magazine.