Sealants for kids: Are they safe?

Recently both my children had their teeth sealed. This procedure was not explained to me and not presented as an option. The next day they both woke up feeling sick and complained of mouth pain. Why would the dentist put sealant on their teeth and what are the benefits as well as risks of having this done?

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Sealants have been available for almost 25 years, but many dentists do not take full advantage of them. They received approval from the American Dental Association (ADA) Council on Dental Materials in 1976.

Studies have shown that sealants are very effective in preventing dental decay. For example, one study of first permanent molars (a.k.a. six year molars) showed that 15 years after sealant placement, 69 percent had sound occlusal (chewing) surfaces. Only 17 percent of first permanent molars without sealants had sound occlusal surfaces. Sealants prevent initial restorations and they can prevent subsequent, more extensive re-restorations.

Sealants are composed of various resin systems which may include cyanoacrylates, polyurethanes and BIS-GMA products. The most commonly used products are generally comprised of BIS-GMA and are similar to composite resins used as tooth colored filling materials. Many studies have been done over the last 20 years to determine the safety and efficacy of these products. A recent study did raise questions regarding the estrogenic potential of one ingredient found in some sealant products. However, the only current documented adverse effect of dental sealants and their placement is allergic reaction.

In order to bond with tooth structure, the tooth must be clean. Etching the tooth surface is required. The acid used to etch teeth is usually phosphoric acid. This can be used in varying strengths, but the most commonly used strength is 37 percent. The acid etch serves several purposes. It removes debris from the tooth surface, provides better wetting capability of the enamel for the resin and selects dissolution of the enamel surface. Enamel is normally porous but etching does remove some of the calcium salts to increase microspaces. These allow "tags" of resin to penetrate the enamel for better bonding. If a surface of enamel inadvertently is etched, generally polishing the enamel surface is sufficient to repair this area.

Sealants vary somewhat in their longevity. Part of this depends upon the bond achieved. Isolation and a dry area are needed to achieve a solid bond. The tooth location and patient hygiene habits also influence how long sealants will last. In my experience, the average life of a sealant is approximately three-to-five years. Chewing ice and sticky foods may decrease the life of sealant. Every patient who has had sealants placed should be examined when they return for hygiene visits. If sealants are missing, they should be reevaluated to determine if replacement is necessary.

The two most common comments I hear from children following placement of sealants are remarks about the taste and the feel. I always check the occlusion (bite relationship of the upper and lower teeth) when I finish placing sealants as they can change this relationship. If the occlusion appears to be heavy, I will polish the sealants to reduce the bite. Most often after eating a few meals, the taste and small bite discrepancies will generally disappear.

I am not sure why your children both felt sick. I have personally placed many thousands of sealants. I have never had a patient experience any ill feelings. It is possible this is just a coincidence rather than a cause of the sealants. If the sealants still feel painful to your children, they should see their dentist as soon as possible. Possibly, a simple occlusal adjustment will alleviate their discomfort.

Finally, if treatment was rendered without your knowledge, you should discuss this issue with the dentist. All treatment plans should be discussed and approved by the patient, parent, or legal guardian before any treatment is initiated!

References:

"An ADA report on dental sealants," Journal of the American Dental Association, April 1997, pp. 485-488.

Newbrun, Ernest, "Preventing dental caries: current and prospective strategies," Journal of the American Dental Association, May 1992, pp. 68-72.

Waggoner, William, "Managing occlusal surfaces of young permanent molars," Journal of the American Dental Association, Oct. 1991, pp. 72-76.

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