Sealants are a right of passage for most of us. We have them placed as kids and our worries are gone. They are liquidy filling material that travels into the deep groves of our molars, blocking them off and protecting the tooth from a cavity. It’s like a protective coat of armor for decay-prone groovy surfaces. That’s great, the pinnacle of conservative dentistry. And you can find many dentists who would agree with the statement. Can you feel the ‘but…’ coming? I suppose the title was a pretty good hint about that. There’s a huge problem with sealants, and the dental profession has been remarkably slow to address, let alone recognize it exists. Let me walk you through it.
Sealants Are Commonly Applied in Childhood
When a sealant is placed properly it should successfully seal the tooth for 5-10 years, then fall out. At that point you are beyond the cavity-risk years and all is well. A few points to consider: the proper technique for a sealant involves placing a rubber dam over a tooth to isolate it, then cleaning, etching, sealing, bonding the tooth. The whole process is involved.
Sure, there are dentists out there who follow these steps to the letter and produce beautiful sealants. But let’s face it, millions of these are done by assistants on squirming little kids who are thrashing around, won’t stay open, drooling everywhere, and so on. The majority of sealants are not done properly under ideal circumstances. The sloppier a sealant is placed, the greater the chance it is going to leak. The second problem is these don’t fall out when they have out-lived their usefulness. How many of you in your 20s and 30s still have your sealants? Yeah, that’s not good.
Where’s the Issue?
Why is this an issue? It’s very simple – the sealant once protected the tooth from a cavity. But when it leaks fluid and bacteria find their way under the restoration, where they are able to begin the decay process under the protective umbrella of the very sealant meant to protect the tooth! The cruel irony; the sealant that once protected your tooth from cavities is now a barrier protecting the cavity from the dentist.
It is really difficult to look at a sealant and know whether there’s a cavity under it. Most dentists when checking your teeth will scan over the tooth, say ‘ok you’ve got a few old sealants here, we’ll keep an eye on those’ and move along. So for years the cavity continues to burrow down and rot out the tooth while from the surface things appear dandy. By the time someone recognizes a problem the cavity is far larger than it ever should have been. I’ve seen innocent sealants turn into crowns and root canals.
What Do You Do About Your Old Sealants?
We do have some good ways to evaluate sealants. Boulder Dental Arts has infrared Carivu technology that can help see under existing restorations. We also rely on the work we’ve done to predict what’s going on with other areas. If we treat one suspicious sealant and discover a huge blown out cavity, it is wise to look at the 5-6 other sealants innocently sitting there. Likely they were all placed around the same time by the same person and one has failed horribly then you should probably get the rest of those removed.
If you never had sealants would the tooth have gotten a cavity? Sure, probably. But someone would have spotted it and done a small filling. A failed sealant that’s been in an adult for 20 years masks decay and allows it to grow. Why are people still placing sealants? My guess is the people who placed it are dead or retired by the time you are getting your root canal and crown from the sealant. And you probably aren’t calling them to let them know about it either. So there’s no feedback to those people. The 20 year delay doesn’t help either. Plus sealants are a big chunk of some dental offices’ income, so there’s that.
My solution? I haven’t placed a sealant in years. And I strongly advise you consider having yours removed if you are in your 20s or 30s.