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Implementing the Program

Implementing the Program

Technique

The technique used to apply dental sealants varies depending upon the type of sealant material used (see Selecting Dental Sealant Materials in Step 4). Using self-curing sealant material under ideal conditions, a half-mouth of sealants (two to eight sealants) can be applied from one mix of sealant material, with all the sealants curing in about 1 minute. Cooler temperatures slow curing time, and warmer temperatures accelerate it. While the setting time of light-cured sealant can be controlled, each tooth has to be individually cured, which can take more time.

Technique also varies depending upon the type of isolation used. Cotton rolls with and without cotton roll holders and dry angles are usually used. While cotton roll holders may seem cumbersome at first, most dental hygienists and assistants become accustomed to using them and eventually find that they make it easier to maintain a dry environment. Cotton roll holders are particularly important when sealing a half mouth at a time. Most teams that do not use cotton roll holders seal a quadrant at a time.

Before dental sealants are applied, be sure to read the manufacturer’s instructions carefully, since different brands of sealants may require slightly different application techniques. The basic procedure for applying sealants is as follows:

Step 1. Thoroughly clean teeth to be sealed
Step 2. Isolate the teeth
Step 3. Etch tooth surface
Step 4. Rinse and dry
Step 5. Place sealants
Step 6. Polymerize sealants
Step 7. Inspect sealants
Step 8. Remove unpolymerized BPA from sealant

Step 1. Thoroughly Clean Teeth to Be Sealed
School-based dental sealant programs have achieved satisfactory retention rates using a dry toothbrush to remove any debris that may remain on the teeth after the student has brushed. The teeth are thoroughly rinsed before they are isolated.

Thoroughly Clean Teeth, Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S

© Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S., University of Maryland School of Dentistry

Step 2. Isolate the Teeth
Effective saliva control can be achieved by positioning the student so that the teeth to be sealed are visible and accessible. The student’s head can be tilted so that saliva pools on the opposite side of the mouth from the side with teeth being sealed. A high-volume evacuator should be used. Cotton rolls or cotton roll holders and dry angles should be positioned as desired. Dry angles are most effective if placed over the parotid gland’s duct opening. Some teams like to place a dry angle between the cotton roll holder and the lingual surface of the mandibular teeth to create an additional barrier for the tongue. Once the cotton rolls are in place, the teeth should be thoroughly dried.

Isolate the teeth, Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S

© Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S., University of Maryland School of Dentistry

Step 3. Etch Tooth Surface
The cleaned and dried tooth surfaces are etched with phosphoric acid for at least 20 seconds. A small cotton pellet, mini-sponge, or brush can be used to apply the etchant. Etchants are available in liquid and gel form. The type used is a matter of personal preference. Acid should be placed widely over the enamel surface so there is no chance that the sealant margin is placed on un-etched enamel. The most common error is to limit the acid to the pits and fissures. If the acid inadvertently comes in contact with soft tissue, it needs to be rinsed immediately and thoroughly.

Acid Etch  Surface, Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S

© Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S., University of Maryland School of Dentistry

Step 4. Rinse and Dry
After 20 seconds, the etchant is thoroughly rinsed off the teeth. It is critical that saliva not come into contact with the prepared tooth surfaces during this step. Excess moisture is removed with the high-speed evacuator. Sometimes dry cotton rolls or dry angles are placed over the moist ones to maintain a dry field. When dry, a properly etched surface will have a dull matte or frosty appearance, in contrast to the glossy appearance of un-etched enamel. Should salivary contamination occur after this point, the surface must be washed, dried, re-etched for 10 seconds, and washed and dried again before the next sealant-application step.

Rinse and Dry, Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S

© Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S., University of Maryland School of Dentistry

Step 5. Place Dental Sealants
Since the application step will vary according to the product selected, the dental hygienist should follow the manufacturer’s instructions. The student’s head should be positioned so that the occlusal plane is parallel to the floor to prevent the sealant from flowing distally, leaving the mesial pits underfilled. The dental sealant should be placed into the fissured surface, flowing from one end of the fissure carefully through the fissure complex to avoid air bubbles, and covering only the fissures and a small area of the fissure walls. If more than one tooth in a quadrant is being sealed, the most posterior tooth should be treated first, since maintaining dryness is more difficult in the back of the mouth.

Place Sealants, Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S

© Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S., University of Maryland School of Dentistry

Step 6. Polymerize Dental Sealants
If light-cured dental sealant material is used, it is important that the curing light is set at the correct intensity and that the manufacturer’s instructions on the length of time the sealant should be exposed to the curing light are followed. With autopolymerized sealants, sufficient time must be allowed so that the depth of the polymerization reaches the tooth surface under the sealant.

Polymerize Dental Sealants, Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S

© Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S., University of Maryland School of Dentistry

Step 7. Inspect Dental Sealants
Isolation of the teeth should be maintained until the dental sealants are checked visually and with the sealant application tip or end of a cotton tip applicator to make sure coverage of the pits or fissures is complete. If there is a surface air bubble, more sealant material can be applied if the tooth has remained uncontaminated. Otherwise, the tooth must be re-etched for 10 seconds, washed, and dried before sealant material is applied. The isolation materials can then be removed, and the student can rinse.

If unfilled or partially filled dental sealant material is used, the student should be told that the sealants may feel “high” but that the student’s own teeth will wear them down during the next few days. If a high-fill sealant material is used, the student’s occlusion may need to be adjusted to remove any “high” spots.

When bonding agents are used, an additional step needs to be added between steps 5 and 6 in the dental sealant-placement process. Once the tooth surface has been etched and thoroughly dried, the bonding agent should be placed on the tooth, and the agent should be air thinned before the sealant is applied. This step helps the sealant material flow into the deep fissures, helps bonding in areas of inadvertent moisture contamination, and improves sealant retention.1

Inspect Sealants, Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S

© Copyrighted photo courtesy of Norman Tinanoff, D.D.S., M.S., University of Maryland School of Dentistry

Step 8. Remove Unpolymerized BPA from Dental Sealant
To avoid the unlikely event of BPA toxicity, the surface layer of the dental sealant should be treated to remove unpolymerized BPA remaining on the tooth. This can be done using any one of the following techniques:

  • Wipe the sealant surface using a mild abrasive, such as pumice, either on a cotton applicator or in a prophy cup.
  • Have older students who are able to gargle with tepid water for 30 seconds.
  • Rinse the surface of the sealant for 30 seconds with an air/water syringe, and suction the fluid and debris from the student’s mouth using a four-handed technique.2

 

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