The grooves (fissures) and pits on the biting surfaces of children's teeth can be particularly at risk from dental decay. A fissure sealant is a plastic coating which, when applied to these grooves and pits, can protect them from decay.
Fissure sealants and sealant restorations are applied to the permanent back teeth (the molars and premolars). Deciduous teeth (milk teeth) are not normally treated. If a small amount of decay has already occurred in part of a groove the decay must be removed. Provided the resulting cavity is small, a sealant restoration can still be used to fill the hole and seal the remaining grooves.
Not all back teeth need sealing. Where the grooves and pits are particularly deep, or a child has already experienced dental decay in one of their adult back teeth, or their milk teeth have been severely affected by decay, then fissure sealants are indicated. Sealants are usually applied as soon as the permanent back teeth come through (from around six years of age), provided the child is old enough to tolerate the procedure.
Where early decay is spotted on the biting surface of a child's permanent back tooth then a sealant restoration may be appropriate.
Fissure sealing on decay-free teeth is a completely painless process and will not require anaesthetic.
The tooth is polished, washed and dried before being conditioned with a special etching gel. Once etched, it is essential that the tooth surface does not become moistened with saliva before the procedure is completed. As this can be difficult to prevent, a rubber sheet is sometimes applied around the tooth to keep it free of saliva. The sealant is painted on to the prepared tooth surface and flows into the grooves and pits. The sealant is either clear or white in colour. An intense blue light is shone on to the sealant to make it set. This way the setting process takes as little as 20 seconds.
Where early decay is identified or suspected then the groove or pit must first be widened with a small drill. The amount of decay present determines whether a local anaesthetic is needed; very shallow cavities can normally be prepared painlessly without anaesthetic. Once any decay has been removed the procedure for a sealant restoration is the same as for a fissure sealant, though an underlying layer of tooth-coloured filling material is also required.
Dentists and dental hygienists can provide fissure sealants. Dentists will carry out sealant restorations.
A sealant restoration or fissure sealant reduces the risk of decay occurring on the biting surface of a tooth. The sides of the tooth are still at risk of decay and, in time, decay could still occur under the sealant. Regular checking of the sealant will help to identify if the seal needs to be topped up, repaired or replaced.
To avoid decay, regular cleaning using fluoride toothpaste is essential; so too is a sensible diet, avoiding sugary snacks and drinks.
Fissure sealants and sealant restorations are relatively inexpensive forms of treatment. By reducing the risk of a child needing fillings at a later date they can help to reduce future dental bills. When clinically necessary, fissure sealants may be available on the NHS.