pits and fissure sealants 2012

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Slide 1 : Pits and Fissure Sealants Presenter:- Rabi Raj Satyal RDH, BPH Himal Dental Hospital and Institute of Dental Sciences 2012
Slide 2 : Learning Objectives Describe the purpose of dental sealants. Describe the clinical indications for dental sealants. Describe the contraindications to dental sealants Discuss the rationale for filled and unfilled sealant materials. Demonstrate the steps in the application of dental sealants. Describe and Demonstrate the safety steps necessary for the patents and the operator. Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 3 : Dental caries is defined as a progressive irreversible microbial disease affecting the hard parts of tooth exposed to the oral environment, resulting in demineralization of the inorganic constituents and dissolution of the organic constituent, thereby leading to a cavity formation. Background Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 4 : Current Trends In developed countries, caries prevalence declined in last decade, causes are multifactorial. Eg: communal water fluoridation. The main case for the increased prevalence of dental caries in developing countries, is the increased uses of refine carbohydrates Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 5 : Susceptibility Upper and lower first molar ? 95% Upper and lower second molar ? 75% Upper second bicuspid ? 45% Upper first bicuspid ? 35% Lower second bicuspid ? 35% Upper central and lateral incisor ? 30% Upper cuspids and lower first bicuspid ? 10% Lower central and lateral incisor ? 3% Lower cuspids ? 3% Teeth farthest back in the mouth are more frequently carious. Caries susceptibility of individual tooth surface occlusal > mesial > buccal > lingual Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 6 : Preventive Programme (for dental caries) Use of fluorides Dietary considerations Plaque control Regular dental examinations. Pits and Fissure Sealants(today)
Slide 7 : Pit and Fissure Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 8 : Pit and Fissure Sealants A thin plastic coating placed in the pit and fissures of the teeth to act as a physical barrier to decay. Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 9 : Why Pits & Fissure Sealants Needed Bacteria produces acid which causes decay “Demineralization” Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 10 : Why Sealants Tooth Morphology Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 11 : Tooth Morphology Why Sealants Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 12 : Tooth morphology Why fissures are caries susceptible Why Sealants Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 13 : Type of Sealants Types of sealant material currently available include filled, unfilled, and fluoride-releasing filled cyanocrylates; polyurethane resin; and bisphenol-A-glycidyl (bis- GMA) resins. Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 14 : Polymerization There are currently two methods of polymerization for resins:- 1)Self-cured or auto polymerized (second-generation) 2) Light cured or photo polymerized (third generation). Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 15 : Fluoride Release Fluoride-releasing resins were developed to increase caries resistance. They are thought to remineralize incipient caries, Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences Filled resins are opaque, and are available in tooth-colored or white shades. Unfilled resins are a colorless or tinted transparent material. Color
Slide 16 : Indications Deep fissures Incomplete or ill formed pits Newly erupted teeth High caries rate Children Molars Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 17 : Contraindications Shallow Fissures Fluoride rich enamel Low caries rate Occlusal or proximal caries Adults Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 18 : Should this tooth be sealed? Clinical Evaluation Occlusal caries Sound No caries Incipient, no caries in dentine Questionable Surface Proximal or occlusal caries Evaluate radiographs No No deep groove Yes No Deep Dental retentive groove Restore Yes Seal Restore No If normal translucency not present.or explorer resists removal Seal Re- evaluate Normal translucency and color and no resistance to the explorer Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 19 : Wear Personal Protective Equipment(PPE) Gloves Mask Safety glasses/visor Protective clothing Closed toed shoes Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 20 : Infection control Disinfect unit Disinfect sealant syringes Throw away brush tips used in patient’s mouth Sharp tips need to be placed with sharps container Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 21 : Wear personal protective equipment - patient Safety glasses Pt. glasses should be tinted (colored) when using a curing light. (operator/assistant should have tinted glasses on shields) Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 22 : Position patient Mandibular Maxillary Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 23 : Position the patient Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 24 : Setup for Sealants Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 25 : Prepare the tooth Bristle brush or rubber cup and plain pumice Sharp explorer to clean out debris Rinse Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 26 : Isolate tooth/teeth Rubber dam Cotton rolls Cotton roll holders Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 27 : Apply acid etch 15-20 seconds Use blue micro tip or brush tip Apply only in pit and fissures For liquid – dab but do not rub Re-etch 10 seconds if saliva contamination Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 28 : Apply acid etch - continued Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 29 : Apply acid etch Etch pit and fissures Extend 1-2 mm beyond pit and fissures Avoid cusp tips Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 30 : Acid etch - continued Etch longer Deciduous teeth Saliva contamination Air abrasion or prophy jet used Highly mineralized teeth Do not use explorer Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 31 : Rinse tooth/teeth Use a/w syringe Proper – usually 20 seconds rinse Avoid saliva contamination Re-isolate Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 32 : Dry tooth/teeth Should appear chalky or frosty white if etched If not, re-etch for another 10 seconds if not contaminated with saliva Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 33 : Apply drying agent Use brush tip Apply and leave for 5 seconds Gently blow air to dry DON’T RINSE Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 34 : Apply bond agent A bond agent will improve retention Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 35 : Apply sealant material Most posterior tooth first Extend 1-2 mm beyond pit and fissures Gently work into pits and fissures Don’t overfill “pop” bubbles in sealant with explorer or brush tip before curing
Slide 36 : Light cure for 20 seconds 20 seconds each tooth Don’t touch tip of cure light to sealant material Don’t let saliva contaminate the field…..yet Note: sealant will appear shiny/wet
Slide 37 : Check sealed teeth Use explorer Tooth should be smooth but not soft Re-apply sealant, if necessary (Remove uncured sealant with wet cotton roll) Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 38 : Remove isolation materials Moisten Dri-angle Rinse the patient’s mouth Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 39 : Check occlusion & contact Articulating paper Dental floss Ask patient how it feels Dental Hygienist can adjust with bullet-shaped finishing bur or polishing stone Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 40 : Give instructions to patient The sealant is hard so you don’t have any restrictions on eating If it feels “high” after you go home – you can come in to get it adjusted We will keep checking the sealant at subsequent appointments (if using unfilled composite sealant the bite will self adjust in 2-3 days) Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 41 : Discussion ???? Rabi Raj Satyal RDH, BPH Research and development officer, Himal Dental Hospital and Institute of Dental Sciences
Slide 42 : Thank you for your Attention

 


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