Download - Pit and Fissure Sealant Application
Pit and Fissure Sealant Application
Rules / Regulations
Must be EFDA Expanded Function
Dental Assistant. Certified by: DANB
Dental Assisting National Board
CE class required Lecture / lab 6 hours
Pt. must have exam by Dentist.
Sealant must be indicated / prescribed.
Placed within 45 days. “Indirect supervision”
A dentist must be on the premises while the procedures are performed.
Pt. Health History
We’re only doing sealants…..why check the health history????? Medications…? Allergies……..?
Latex Can cause: Anaphylactic shock
Severe allergic reaction that can cause death.
Review / update At every visit. Should be current. Pediatric pts.
Review w/ parent or guardian.
Other health considerations…?
Emotional Psychological Behavioral
Infection Control
Universal precautions Treat / assume
All patients as if they are infectious.
Family Friends Seniors Kids Co-workers
That they have; Any and all
diseases.
Disease transmission Cross contamination
Contamination = Presence of an
infectious agent (pathogen).
Cross contamination The spreading of an
infectious agent. Direct contact Indirect contact Inhalation
Personal Protective Equipment
Gown Fluid resistant
Laundered Disposable
Mask Earloop or tie
Should protect mucus membranes.
Doesn’t work if worn below the nose or under the chin.
Personal Protective Equipment
Goggles / Safety glasses / eye protection. Should be shatter
resistant. Face shield is OK. Side shields on Rx
eyeglasses. Pt’s should be offered /
encouraged to use. Orange UV Tinted
Personal Protective Equipment
Gloves Must be worn anytime
working in the oral cavity.
Handling any item expected to be used in the oral cavity.
Latex Vinyl Nitrile
Latex
Vinyl (synthetic)
Nitrile
What are pits and fissures?
Areas in the fossa’s and grooves that have failed to form
Found on occlusal surfaces of posterior teeth
Found on lingual surfaces of anterior teeth
Narrow and deep grooves Can’t be reached by
brushing Acid producing bacteria in
these areas cause demineralization
What do Sealants do?
Act as a barrier Used to arrest incipient
decay Blocks carbohydrates Used with good oral
hygiene habits and fluoride provides and effective method of preventing tooth decay
Diagnosing / Indications
All Dx must be done by a licensed dentist.
Indications (reason to use, do) Non-invasive Deep pits / fissures Recently erupted teeth Hx of high # of occlusal
caries. Preventive Tx. Acts as a
barrier to plaques and bacteria
Seals composite margins
Contra-indications
Reasons not to use or do something. No caries
Four or more years Shallow grooves Blended pits and
fissures Caries present Restoration present Primary tooth will be
lost soon Poor cooperation
Blended Fissures
Caries
Restoration
Enamel Sealant Material
Most common BIS-GMA bisphenol A
diglycidylether methacrylate
Main component of dental composites and sealant material.
Diluted to allow “flow-ability”
Clear, opaque, color changing.
Other Material Glass ionomer
Used for restorative Contain fluoride Wear down faster
Filled Contains small
particles to add strength
Must adjust occlusion
Un-filled Will wear down 2-3
days
Enamel Sealant Material
Light cure Single component No mixing required Control set time
Cure light Aka ‘light cure unit’ Causes…..?
Polymerization Hardening of the
material
Enamel Sealant Material
Chemical cure Aka (self-cure)
Two components Base and catalyst
Must mix together Will polymerize in
about 1minute. Dual cure
Will start to polymerize chemically, can finish with a cure light.
Isolation
Necessary to: Keep acid etch from
contacting other tissue Keep saliva from
contaminating the tooth surface.
Keep the tooth dry. Essential for the
retention of the sealant
Rubber dam Preferred method Especially for
partially erupted teeth
Cotton rolls May have to change
if saturated or pack / add dry
cotton rolls on top of the saturated ones
Acid Etch / Conditioning
Steps necessary to retain the sealant. Phosphoric acid
Gel Liquid
Microscopically roughens the enamel surface.
Creates “mechanical” retention.
Not chemical
Gel
Liquid
Non-etched
Etched Frosty dull
Acid Etch / Conditioning
Tooth should be isolated. Rubber dam Cotton rolls
Dried Air-water syringe
Apply etch According to Dr. or
manufactures directions.
Acid Etch / Conditioning
Application Brush Cotton pellet Applicator tip Small sponge Should extend beyond
area (2-3mm) of where sealant is placed.
Motion Dabbing DO NOT RUB
Rinse 30 sec. (HVE)
Evaluation of the etch Tooth should appear
Frosty Dull Chalky
If not, Re-etch for 15 – 30
seconds. Re-etch if saliva
contacts the tooth Rinse 30 seconds
With HVE
Sealant Placement
With an applicator Place material so it
flows into Pits Fissures Etched area of the
tooth An applicator tip Or an explorer
Can be used to move the material and prevent air bubbles.
Evaluating the Sealant
After the sealant has cured. Check for…..
Hardness Smoothness Voids Irregularities Retention Occlusion Contacts
Adjustments Re-cure
If not set Re-isolate
If sealant comes off Re-etch
If area is contaminated
Re-apply If void or irregularity
Evaluating the Sealant
Occlusion Articulating paper
Have pt. bite and grind Evaluate for ‘high’
spots Filled material
Assistant can adjust With a slow-low speed
handpiece Round bur / Stone bur
Unfilled Will wear down 2-3
days (chewing)
Floss Sealants are usually
applied to Occlusal of post. teeth Lingual of ant. teeth Buccal or lingual
grooves or pits. So why floss……?
To ensure material did not get into the proximal area and close a contact.
Post operative instructions.
Preventative treatment. (only temporary) Should last 5-7 years Can brush / floss Eat anything.
(Hard stuff too) (do not have to wait 24 hrs. etc)
Pay attention to ‘bite’ Call office if any questions or concerns.
Success vs. Failure
Success depends on good isolation
Failure can be due to moisture contamination
Success depends on a good mechanical bond
Failure can be due to incomplete etching
Conclusion
Placing sealants is a treatment / procedure. You are the provider.
Be aware of laws, rules and regulations regarding sealant placement.
Never diagnose any treatment. Don’t be afraid to ask questions or ask for
help. Any questions…….?