Author: Dr. Don Goudy
Let’s start with the basics. There is one main rule in dentistry. If you can keep it clean, you can keep it. Brushing and especially flossing go a long way in the prevention of cavities and gum disease. What happens if a tooth is not cleanable? I have to make it cleanable or the inevitable cavity and/or gum disease will ravage the tooth. There is a design flaw in teeth, grooves on the tops of back molars that do not allow for the tooth to be cleaned naturally or with a brush. These un-cleanable areas were formed during the development of the tooth and trap food and bacteria deep inside them. The grooves are what a dentist seals with a dental sealant. Dental Sealants are thin plastic coatings that are applied to the grooves on the chewing surfaces of the back teeth to protect them from tooth decay. This makes them more cleanable naturally and with a brush. Food is less likely to get chewed down in to them. You need three things to develop a cavity: Tooth structure, bacteria, and sugar. If you can prevent these three things from coming together and having a party, you can prevent cavities. This is the basic premise of sealants, preventing the party. Click here for dental insurance and health insurance rates.
Pro’s of Sealants:
- Prevent food and bacteria from getting trapped in the grooves of a tooth.
- Make the tooth more cleanable.
- Relatively inexpensive.
- No anesthetic required.
- No tooth removal required.
- Can be placed by dentist or hygienist.
Con’s of Sealants:
- Only last 1-3 years on average. Some don’t even make it to the car.
- If there is decay in a tooth, the sealants cover it up.
- Very difficult to do in a sterile environment.
- It is much more difficult to monitor decay growth.
- Decay can become catastrophic before detected.
OK, I am not a big fan of sealants. I have seen more sealant failures than successes. I am a big believer in eliminating the decay in a tooth prior to placing any sort of dental restoration. My procedure of choice on a young groovy tooth is a conservative white composite filling when decay is detected.
Pro’s of white composite fillings:
- Prevents food and bacteria from getting trapped in the grooves of a tooth.
- Makes the tooth more cleanable.
- Ensures there is no decay in the grooves before you cover them up.
- Much more durable and longer lasting, up to 10 times as long.
- Less expensive in the long run.
Con’s of White composite fillings:
- Initially more expensive in the short term.
- More technique sensitive (requiring strict isolation with a RUBBER DAM).
- Often requires anesthetic and can only be done by a dentist.
- A small amount of tooth structure is removed .
- They take longer, often requiring multiple appointments to complete a mouth.
I have seen more sealant failures than successes, some being so catastrophic that the tooth needed a root canal and crown. OK, that event is less common and usually occurs when a patient avoids their checkups for a prolonged period of time, but it happens. What is more commonly found is a significant amount of decay growing undetected beneath the sealant. I would have to say at least 80-90% of the time I find cavities under sealants when they are removed. I have to remove way more tooth structure to fix them than if the original choice would have been a conservative filling.
My advice is to choose small, conservative white fillings when decay is detected instead of sealants. However the keys to the success of this philosophy: 1. Make sure your children are going to the dentist every 6 months for routine exams, and 2. Your dentist has a density testing machine called a Diagnodent. It detects cavities much earlier than the old fashioned visual identification. Catch them and fix them early, at dental exams. You should not have to worry about those teeth for a long time.
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