and all have shown that sealants arrest or slow the rate of caries progression. We are
not at the point where sealing of active caries is recommended by most authorities but
the maxim if in doubt seal is good advice. The surface should then be monitored
clinically and radiographically at regular intervals until its status is confirmed. One
instance where actively sealing over caries is to be recommended is in the pre-
cooperative patient where the placement of sealant may help acclimatization of the
patient, with the added benefit of controlling the caries, until a definitive restoration
can be placed.
Sealants are also effective at preventing pit and fissure caries in primary teeth.
Primary teeth have more aprismatic enamel than permanent teeth, and doubt about the
effectiveness of etching deciduous enamel lead to a belief that they required
prolonged etching times. This has been demonstrated not to be the case and the
technique for sealant application to primary teeth is identical to that employed with
permanent teeth.
Although the effectiveness of fissure sealants is beyond doubt, to be used cost
effectively their use should be targeted. Guidelines for patient selection and tooth
selection have been published by the British Society for Paediatric Dentistry, and
these are summarized below.
Patient selection
- Children with special needs. Fissure sealing of all occlusal surfaces of permanent
teeth should be considered for those who are medically compromised, physically or
mentally disabled, or have learning difficulties, or for those from a disadvantaged
social background. - Children with extensive caries in their primary teeth should have all permanent
molars sealed soon after their eruption. - Children with carious-free primary dentitions do not need to have first permanent
molars sealed routinely; rather these teeth should be reviewed at regular intervals.
Tooth selection
- Fissure sealants have the greatest benefit on the occlusal surfaces of permanent
molar teeth. Other surfaces should not be neglected, in particular the cingulum pits of
upper incisors, the buccal pits of lower molars, and the palatal pits of upper molars. - Sealants should normally be applied as soon as the selected tooth has erupted
sufficiently to permit moisture control. - Any child with occlusal caries in one first permanent molar should have the fissures
of the sound first permanent molars sealed. - Occlusal caries affecting one or more first permanent molars indicates a need to
seal the second permanent molars as soon as they have erupted sufficiently.
Since their development in the mid-1960s there have been a number of advances in