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Look, Mom! Now they can paint away tooth decay; applied at an early ages, pit and fissure sealants can reduce cavities on molar surfaces by 95 percent.


It was six-year-old Jane's first visit to the dentist. Her face was grave as she fought back tears. "Is it gonna hurt?" she asked. A half-hour later Jane left the dentist's office with a broad smile on her face. "It really didn't hurt," she told her mother, "but it tasted awful."

Jane had been treated with a pit and fissure sealant, a recent innovation in cavity prevention. The treatment leaves a temporary "yucky" taste in a child's mouth, but it also keeps tooth decay away. The sealants have been so successful in preventing dental decay that the American Dental Association now recommends the simple procedure for all children, even those who receive topical applications of fluoride or those who live in communities with fluoridated water.

Fluoride is not nearly as effective in fighting decay on the pitted chewing surfaces of the back molars as it is on the smooth surfaces of teeth, because the molars have microscopic grooves and depressions where food and bacteria can be trapped. A National Dental Caries (cavities) Prevalence Survey revealed that 84 percent of the cavities found in 5- to 17-year-old children occurred in these pit and fissure surfaces of the teeth.

Pit and fissure sealants are thin layers of clear or tooth-colored plastic film painted on children's back teeth. They are applied only to the top, grooved surfaces because they will not adhere to the smooth sides of the tooth. The layers fill in the microscopic grooves and form a smooth, impenetrable barrier that keeps food debris, plaque, and acid from touching the tooth's surface.

"Pit and fissure sealants are the most dramatic advance in dental decay prevention to come along since the advent of fluorides," says Dr. Hazel Harper, a Washington, D.C., dentist and a consumer adviser for the American Dental Association.

Dr. Dan Arnold, a pediatric dentist from Fort Lauderdale, Florida, who has been using sealants for eight years, agrees. "Sealants have had a dramatic impact on the amount of filling work that I have to do on permanent molars. I've sealed thousands of children's teeth, and the longer I use this material, the more I use it to prevent cavities. I find it extremely effective. In fact," he says, "I've had a greater than 95 percent reduction in the number of cavities on the surfaces of the sealed teeth of my patients."

For most children, the sealants are long lasting and wear resistant, but they should be checked every six months for cracks and for spots that have worn thin. Reapplication is recommended when the pressures of chewing wear away the sealed surfaces.

The sealants are applied in a simple procedure. First, the tooth is isolated with cotton rolls, cleaned, and carefully dried. Then a diluted solution of phosphoric acid is applied to help the sealant bond to the chewing surface. The solution, after remaining on the tooth for one minute, is washed away. The tooth is dried again before the sealant is painted on with a small brush. Each tooth takes only a few minutes to complete. On the average, it takes half an hour to do all four molars.

Sealants are especially effective on the four 6-year molars and the four 12-year molars. In children susceptible to cavities, a dentist will also apply the sealant to the premolars, called bicuspids, or to a baby's primary teeth.

The ideal time to seal a tooth, says Dr. Arnold, is when the chewing surface first erupts from the gums--before decay has time to start in the pits and fissures. "I like to get the molars coated as quickly as I can," he says. "Waiting longer can mean the child might get cavities before he comes back for his next six-month checkup."

By preventing decay in the molars, the sealant preserves intact the clean, healthy tooth structure and prevents painful drilling, the trauma of Novacaine injections, and possibly, future root-canal work, all caused by cavities. The sealant also provides an aesthetically pleasing smile, unmarred by silver-coated amalgam fillings.

Dr. Lee Baigelman, a Florida pediatric dentist and a former assistant professor at the New York University College of Dentistry, says there is only one problem dentists and parents should watch for. "If the layers of coating are too thick, they can affect the child's bite. But," he adds, "you will never have this problem as long as the bite is checked with articulating paper [which shows where the teeth touch during biting] before the patient leaves the office."

Baigelman has used sealants for ten years; he highly recommends them to his patients. He says the worst thing that can happen if sealants are not used is that the patient can get a cavity that will have to be filled. "But people are not sharks," he says. "They only get two sets of teeth, and if they get filled, they are filled for life."

Sealants are also less expensive than fillings, and if properly applied, they last up to five years. According to the ADA, the average price for sealing one tooth is $11--at least half the price of an average amalgam filling.

"The time has come that, with proper preventive care, you can almost count on children graduating from high school with no dental decay," says Dr. Jerry Klein, a pediatric dentist and a past president of the Florida Society of Dentistry for Children. "In the long run," he adds, "preventive care is also less expensive."

Preventive care includes two visits a year to a dentist, the regular use of fluorides, brushing and flossing the teeth daily, and limiting the consumption of foods rich in sugar. These measures, used in conjunction with sealants, will put a smile, instead of tears on your child's face.
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Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Author:Senz, Laurie S.
Publication:Saturday Evening Post
Date:Sep 1, 1986
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