Dental Sealants: What to Expect

Most parents have taken their children to the dentist and have been told that they should consider placing sealants on their child’s teeth, but what does that mean? Why should the sealants be done? As teeth form, they form in sections and fuse together. These areas of fusion leave pits and fissures on the biting surfaces of the newly erupted permanent teeth, which unfortunately are weak points that can form tooth decay, or cavities. Sealants are a liquid version of resin filling material that are placed into these grooves on the biting surfaces of teeth. They are meant to seal these pits and fissures shut to try to protect these weak spots. Placing this material has been proven to decrease decay in the treated teeth and has not been linked with any harmful side effects or problems. There has been some controversy about sealants containing BPA, a material found in some plastics, and its safety. The FDA has done extensive research on the materials contained in sealants and have deemed them safe. However, many sealants now have non-BPA formulations, which we at Blue Ridge Family Dentistry currently use.

When having sealants placed, you need to have realistic expectations. They will not last forever. They can last anywhere from less than a year to 10 years depending on the child.  You should anticipate that they will need to be touched up and replaced periodically in order to maintain their protection as chewing will wear them down over time. Also, particularly sticky foods can pop them out, and grinders tend to wear them out much more quickly. There are occasionally kids that really will not get as much benefit from sealants due to the way their teeth formed. These children generally received one of the best benefits of drinking fluoridated water in that their teeth formed with very shallow pits and fissures. In other words, their teeth are too flat to maintain any sealants. While water fluoridation has decreased the depth and number of pits and fissures, most kids can still benefit from sealant therapy as the pits and fissures still exist and are still weak spots for future cavities. 

Children that have had sealants may see an increase in decay as they get older if the sealants are not maintained. This happens simply because as the sealants disappear, these weak areas become exposed to the bacteria in the mouth. Therefore, regular dental care and maintenance is required to prevent future problems. Even if sealants do not last a lifetime, they were there to prevent the decay during childhood when placing fillings may be harder on both the child and the parent allowing the child to mature before many discussions of dental work have to be incurred.

Most insurances cover sealants at 100% for permanent molars. There are a few exceptions that cover them at 80% and even some plans that will cover sealants for permanent premolars as well. There can also be frequency limitations if sealants need to be replaced. You should check your policy limitations to find out the restrictions if you have any questions.  Most plans do have age limitations that do not cover sealants on adults, even though adults can benefit from placement on posterior teeth that have not already been filled. Adults can still receive dental sealants, they just may have to pay out of pocket for them. 

Importance of baby teeth and when children should see the Dentist

Tooth Eruption Chart

Although baby teeth will be lost, it is still important to maintain a healthy set in order to maintain space for the permanent teeth that will come in to replace them and to prevent active infection from spreading and causing pain and health problems. The American Dental Association recommends that when the first tooth comes in, that should be the child’s first visit to the dentist. Not all children will open their mouths at this age however, so I suggest bringing them to your or their older siblings cleaning appointments so they can get used to the environment and work their way up to seeing the dentist to let the dentist “count” their teeth. Most children begin to understand and allow this to happen around age 3 or so as long as they see the cleanings as no big deal. Make the trip exciting and something fun for them. Take pictures of them in the chair at their first dental exam. Do not make it fearful by talking about pain or using a visit to the dentist as a treat. Allow the dentist and hygienist to explain what they are doing and going to do. Most fear happens due to things that happen and are said outside the office, not what actually happens in the dental chair.

Eruption Sequences for permanent and baby teeth

Deciduous, or baby teeth, generally start coming in around 6 months of age starting with the two front lower, then the two front upper, the next two lower incisors, then the next two upper incisors. By around 1 ½-2 years of age, most children get their upper and lower canines, then the first molars, followed by the second molars by 2-2 ½ years of age. While this is the general order, not every child follows this sequence or time frame so some variation can occur. Permanent teeth begin coming in around 6 years of age with the loss of the lower front two incisors and the eruption of the permanent molars behind the last baby molar. No baby teeth are lost for the eruption of the permanent molars as we slowly increase our tooth number from 20 baby teeth to 32 adult teeth including the wisdom teeth. Upper front teeth and the other two lower incisors are usually lost around the same time, between 6 ½ and 7 years, and the other two upper incisors are usually gone by 8. There is some variation with baby canines and first molars, but lowers of both are usually lost first and all these are generally lost between 9 and 11 years. The last set of baby molars are usually gone by 12 years when the second set of permanent molars are coming in. The wisdom teeth come in last, if at all, most commonly between the ages of 17 and 21, but there is a great deal of variation in this.

Fluoridation benefits on tooth development

While fluoridated water has some benefits for all age groups, children receive the greatest benefit during tooth development. Permanent teeth begin forming at or shortly after birth and continue to form throughout childhood. Studies have proven that children that consume fluoridated water at 1 ppm during tooth development, have more shallow pits and fissures forming in their teeth and have a decrease in dental decay due to this. Shallower grooves means fewer places for bacteria to build and cause decay. This small amount of fluoride also will not cause fluorosis or mottling of the tooth enamel and has not been linked to any long term ill effects. The 1 ppm level is the standard level placed in community water systems since few areas have any naturally occurring fluoride in their water. As with anything else, fluoride should be consumed in moderation as high doses can cause ill effects. However, community water systems are monitored and the few areas that have naturally occurring fluoride in their water (a few areas in Texas, for example) do not have additional fluoride added. Fluoride containing toothpaste also helps prevent tooth decay in children, but it is not recommended putting a child on it until they are able spit the toothpaste out rather than swallow it. Unfortunately consuming large amounts of toothpaste can cause quite a stomachache, but thankfully, that can be treated with a glass of milk if your child thinks eating an entire tube seems like a great idea!

Specialized treatment for children

Most treatment on children is the same as that done on adults except for a few exceptions, the first being pulpotomies. This is a root canal done on a baby tooth, however, only half the root canal can be completed. The nerve can be removed once decay gets into it, but the canals cannot be filled in the roots due to the fact that a child needs to resorb the roots in order to shed the tooth later. Therefore, since only half of the root canal is done, the treatment is not long term. The goal is simply to try to maintain the tooth until the permanent is ready to come in. Due to needing to maintain space for the permanent tooth, space maintainers may be placed in a child’s mouth to hold the space open if a baby tooth is lost early. Also, occasionally habit breaking devices such as thumb-sucking devices need to be made to prevent or correct problems with bone development in children. There are several devices that may also be needed by children to try to correct developmental defects, as well.