Prepare for a Visit

While front teeth are used to tear food, back teeth are used to chew food. Back teeth have broader biting surfaces with deep pockets with many crevices (also known as pits and fissures). Small pits and fissures can be difficult or impossible to clean, which can lead to plaque, tartar, and tooth decay.

Sealants are resin coatings generally applied to the chewing (occlusal) surfaces of permanent back teeth. Sealants help to prevent food, plaque, and acids from starting tooth decay. When properly placed, sealants are barely visible, and there is evidence that they are safe and effective at preventing tooth decay for many years.¹

It is important that sealants are placed properly. If they are placed improperly, bacteria and decay can form under the sealant that may go undetected and become worse as a result.

After getting sealants, it is important to continue to visit the dentist regularly. Even properly placed sealants can break or eventually wear down. A dentist needs to continuously monitor the sealants to ensure that any problems are caught early and addressed quickly.

To properly place a sealant, a dentist will take the following steps:

Before the procedure

• Review your health status: You will share information to ensure that your dentist and their staff can provide safe and effective treatment and provide appropriate post-care guidance. Get important information here: Health history and current health status.
• Treatment review: The dentist will review the procedure with you, including its risks, benefits, and options. Understanding the process will lead to the best treatment outcome. Ask any questions you have before the procedure is started.

During the procedure

• Exam: The dentist will check for deep pits and fissures using a dental explorer, tooth decay detection dye, and/or a laser tooth decay detection device to ensure that the teeth are free of plaque and tooth decay.
• Preparing the site: The dentist or hygienist will isolate the sealant areas from moisture, preferably with a rubber dam. If teeth are not thoroughly cleaned and dry, the sealant has an increased risk of failure.
• Tooth surface preparation:
  • Frequently, the deepest part of the pits and fissures will be cleaned with a stream of abrasive micro-particles to remove any accumulated organic material.
  • Next, an acid will be applied to roughen the enamel surface of the pits and fissures. The acid produces microscopic, finger-like projections across the enamel surface into which the sealant material will flow.
• Applying the sealant material: Sealant material is initially a liquid resin. Only the etched enamel is covered. Sealant resin extending beyond the etched area will not adhere. This can cause the sealant to leak, leading to the sealant's failure and tooth decay.
• Curing the sealant: Typically, the dentist will harden the sealant with a special type of blue light, although self-curing resins are available.

After the procedure

• The dentist will give you instructions on how to take care of the sealed areas.
• It is important that your dentist continuously monitors the sealants to ensure that any problems are caught early and addressed quickly.

• Sealants only protect the chewing (occlusal) surfaces of teeth from decay. Do not relax your or your child's nutrition and oral hygiene routines by assuming sealants make teeth immune to tooth decay.
• X-ray images may be taken to look for decay that cannot be seen visually. A dentist may not be able to accurately determine through other means if a sealant has failed and is leaking. This makes it difficult for a dentist to detect early stages of tooth decay under a sealant. Tooth decay under a sealant may become severe before it can be detected and require additional treatments such as a filling, inlay, onlay, or crown.
• Properly placed sealants are removable without affecting healthy tooth structure. However, improperly placed sealants may require treatment that requires removing additional healthy tooth structure.
• Sealants can partially or fully break, particularly if the sealant is placed improperly. If this occurs, the sealant will no longer be effective.
• Sealants may deteriorate over time. Even so, their decay-preventing abilities can still remain effective in the deep pits and fissures of teeth. The dentist will need to continuously monitor sealants at each exam to ensure they remain intact and show no signs of "leakage." Deteriorated or leaking sealants will need to be replaced.

• If the dentist reaches the tooth's dentin layer when preparing the tooth for a sealant, a filling may be required instead of a sealant.
• Some states allow qualified dental staff other than the dentist to place sealants. If this is the case, you should feel comfortable asking about the staff member's experience conducting this procedure.

Deep pits and fissures may be treatable in other ways.

• The dentist may perform a fissurotomy to mechanically widen a tooth's pits or fissures to prevent food from collecting and make it easier for toothbrush bristles to clean them.
• A dentist may apply a fluoride varnish to harden the tooth's enamel surface.

Failure to protect the deep pits and fissures in teeth can lead to a greater chance of tooth decay.

• Not all teeth can benefit from sealants. Will you take photographs to help me understand which teeth may be good candidates for sealants?
• Will you check for plaque and decay and clean it out before the sealant is placed?
• Are there options to sealants? What are the pros and cons of those options?
• What could go wrong with a sealant?
• How will you control moisture when placing the sealant to help prevent the sealant from leaking?
• How do you monitor teeth to ensure decay is not forming under the sealants?
• What is your office's replacement policy if a sealant leaks or fails?