To seal or not to seal? What are fissure sealants?

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Naturally deep grooves or ‘fissures’ occur primarily in the back teeth (molars and premolars) in both the primary and permanent dentition.  Despite our best toothbrushing efforts, these teeth can retain food and plaque (bacterial build-up) placing them at a much higher risk of developing tooth decay.  One way to help prevent decay from developing in these teeth is to place a ‘fissure sealant’.

What is a fissure sealant?

Fissure sealants are a protective coating placed over these deep fissures to cover and protect these vulnerable areas from damage caused by prolonged exposure to food and plaque.  They make the tooth surface smoother, flatter and easier to clean, sealing out food debris and decay-causing bacteria.  Fissure sealants are placed before decay develops in a tooth and are designed to reduce the risk of more expensive and invasive treatment (such as a filling) being required in the future. 

Who can have a fissure sealant?

Fissure sealants can be placed in any tooth at any age if there is an increased risk of decay developing.  They are most commonly placed in the newly erupted molars and/or premolars of children and adolescents. This is the optimal time for placement as the teeth are new to the oral environment and haven’t been exposed for long periods to the damage caused by food and decay-causing bacteria.  Effective oral hygiene (toothbrushing and flossing) is often limited in this age group which further increases the risk of decay developing in these hard-to-clean areas.  Molar teeth which are difficult to keep clean like those with enamel defects including hypomineralisation (sometimes called ‘chalky teeth’) can benefit greatly from fissure sealants.

What is involved?

Placing a fissure sealant is a non-invasive procedure.  No local anaesthesia (numbing) is required and usually, very little preparation of the tooth surface is involved as fissure sealants are a surface coating placed before decay starts to develop.  If decay is discovered during sealant placement, then the decay must be removed before a filling is completed instead.  The deep fissures are cleaned to remove food debris and bacteria and to confirm that no decay is present before the fissure sealant is placed.  The material used is similar to that used when a ‘white’ composite resin filling is placed.  The material has a much thinner consistency which allows it to spread into the deepest fissures to completely seal off the tooth surface.  

What are the risks?

Fissure sealants are a non-invasive procedure but require co-operation to keep the tooth surface being worked on as dry as possible whilst the sealant is placed.  This presents the main challenge as the age group who benefit from fissure sealants the most may often struggle to open wide enough or for long enough to allow a high-quality sealant to be placed.  In some situations, your Dentist, Dental Hygienist or Oral Health Therapist may advise delaying the placement of fissure sealants to allow for better access or cooperation to ensure a good result.  As fissure sealants are a thin, surface coating in an area used for heavy chewing they can be lost or damaged over time and require maintenance (repair or replacement).  Fissure sealants should be checked every six months in the same way that fillings and other dental treatments are monitored during the routine examination process.  Fissure sealants placed in teeth with enamel defects sometimes require more frequent replacement due to changes in tooth structure affecting how well fissure sealant material is able to adhere.

Fissure sealants are a fantastic tool in our decay prevention toolbox.  Placed well and checked regularly, they can help us keep our teeth healthy and free from decay for life!