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Dentist suggests a sealant for molarsDear Dr. Reitz: My daughter's dentist suggested sealants be placed on her permanent molars. He said there wasn't decay, but that sealants were a good preventive measure. She is only 7 years old and has never had a cavity. In addition to the expense, I don't want to put her through an unnecessary procedure. Are sealants routinely placed on everyone, or is there an indication for their use? - Julie Dear Julie: I have witnessed firsthand the effectiveness of preventive dentistry. When indicated, placing a sealant is a very cost effective procedure. By now your daughter's permanent teeth are erupting and candidates for sealants. Deciding which teeth will benefit from sealant placement should be based on your dentist's judgment. One misconception of sealants is that they prevent the entire tooth from getting decay. This is not about putting a protective coating all over the tooth. That procedure doesn't exist. A sealant is the placement of plastic like material into the fissures on the chewing surface of a tooth. These fissures are ideal breeding areas for bacteria that cause tooth decay. Placing a sealant lowers the risk of decay. Sometimes a fissure is so deep that the tooth may begin to decay as soon as it erupts and before a sealant has been placed. That's when the dentist must use both judgment and sometimes electronic instrumentation to determine if the decay must be removed by drilling and filling instead of placing a sealant. When in doubt some dentists will use special drills, air abrasion, or other instruments to slightly open the fissure to get a better look before deciding how to treat the tooth. There was a time that it was believed that sealing over decay would stop its progression. We now know that a percentage of those sealed teeth continued to decay, often causing the sealant to come off. It's recommended that only fissures devoid of decay are candidates for sealants. Sometimes nature makes a tooth with an intact chewing surface without a visible fissure. In that case placing a sealant would be of little value. Most sealants are made of a material similar to the white composite used to fill teeth. Some contain the ingredient fluoride with the hope that it will make the fissure more resistant to decay. Some companies are marketing sealants that contain amorphous calcium phosphate (a chemical found effective at remineralizing teeth), so if the sealant wears off the fissure will still remain closed to bacteria. If you want to continue to keep your daughter free of cavities, it may be necessary to seal those molars as they erupt. The column is written by John Reitz, DDS, and does not represent the opinion of the Pennsylvania State Dental Board. Dr Reitz answers questions from readers. E-mail them via his Web site at reitzdds.com or mail to John Reitz, DDS, 30 Commerce Drive, Wyomissing PA 19610 John
V. Reitz, D.D.S., F.A.G.D. Copyright
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