downside dental sealants

 Why I don’t like sealants

There is a popular saying on dentaltown about sealants; “dental sealants work great on people that don’t need them”.  The basic idea of taking our worst material, flowable has the highest contraction rate, and bonding it to an impossible to fully clean surface due to deep grooves is flawed from the start.  Add to the fact that it is a very technique sensitive procedure and all the studies have been completed under a rubber dam by a dentist with an assistant but in the real world a hygienist is trying to do it with a cotton roll and no assistant. The results will never be the same.  It’s ludicrous!

2 studeis would give me more confiedne in selansts. 

#1 Split mouth study.  Sealants left for x years without being allowed to be repaired (since in the real world not all will be).  Then at x years remove all sealant material and take a diagnodent or similar reading.  All decay from both sides must be substantiated with diagnodent.  Tooth should be scanned with intraoral scanner before decay removal and after and software used to determine amount destruction caused by decay.  The area removed would show which method results in ultimately saving more tooth structure. 

#2 Split mouth study over the course of 40 years.  Hard to do due to time period needed but possible if can use insurance data information and track back.  Get 10,000 children that had not and same number that had sealants placed 10, 20, and when possible 30 and 40 years ago from real life practices.  Then find as many of these patients as possible and simply calculate the amount of dentistry that has been done on those teeth.   

Studies

If your goal is to delay, or I feel hide, decay for 4 years then by all means place sealants.  The decay found under sealants is massive because they are not preventing anything, only hiding it.  

Cochrane review – “Sealants compared with no sealants, on the occlusal surfaces of
permanent molars in children and adolescents, are effective at reducing
caries up to 48 months. There is less evidence for longer term follow-up
and little for the relative effectiveness of sealing in less high
caries risk children. No conclusions could be drawn on the relative
effectiveness of different types of sealants.”

Most RCTs are like this one.  Useless because of their short term and because a sealant hides the grooves thus leaving the dentist guessing as to if the material is leaking and there is active decay below the surface.  I use sealants for one purpose only, to delay the onset and maybe the identification, of decay in children prone to decay until the child is old enough to mentally deal with a IAN block injection.  

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