Welcome to this video presentation of the placement of resin dental sealants,
specifically by school dental sealant programs. This video is intended for the
professionals placing the sealants and for those who assist with the procedure.
Programs should all always follow the manufacturer's guidelines for the
specific sealant material they use. This video demonstrates the use of ClinPro
unfilled sealant material. School dental sealant programs should use a sealant
material that is less than ten percent filled so the sealant will self-adjust.
Materials over 10 percent filled may require adjustment with the handpiece
and that handpiece must then be sterilized.
There is no statistically significant difference in the effectiveness or
retention of filled versus unfilled sealant material. Note that the main
cause of sealant failure is saliva contamination. Saliva is not to contact
the tooth surface from the beginning of the procedure until the end.
That means the provider must ensure there is adequate isolation, that the
truth is dried before the etchant, re isolated and dried before the sealant
and that the patient is not allowed to swallow or to close at any time during
the procedure. You first want to check the air water syringe to ensure there is
no moisture coming through the air line. Just spray air on the mirror or on the
patient's bib until you can be sure the air line is completely clear. Select the
teeth to be sealed. Screening only can be conducted with one gloved hand if the
ungloved hand does not touch the patient. Once the patient situation is assessed,
preparation for sealants can begin. The occlusals of the teeth must first be
thoroughly cleaned with a toothbrush. The provider must then check the surface for
cleanliness by using an explorer appropriately as recommended by the
American Dental Association, in other words, use the explorer to check gently
the cleanliness or texture of the tooth without scratching or damaging the tooth's
surface. Prior to etching, isolate the tooth and dry the occlusal surface; some
research suggests drying for 20 seconds. The point is that the tooth must
be thoroughly dried before etching. Then apply a generous amount of etchant. The
etchant is to extend two to three millimeters past the intended margin of
the sealant. Don't skimp on the etchant! Notice how much etchant is used on the
ClinPro application video. Apply the etchant and gently and continually tap
the etchant down into the pits and grooves of the occlusal surface for at
least 20 seconds to ensure the etchant contacts the deepest areas. Etchant is
often viscous and may just sit on the surface, leaving unintended voids
underneath. Tap the etchant down into the tooth gently but don't scratch it in as
that can damage the tooth surface. Rinse off the etchant thoroughly, remove excess
water, then re-isolate. You can do this by either adding a cotton roll if that's
comfortable for your patient or you can add a cotton roll and then use forceps
to slip out the old wet cotton roll from underneath.
Do not allow saliva contamination when re-isolating. When the tooth is securely
re-isolated, dry thoroughly. The surface should have a dull frosty appearance.
Then place the sealant. Sealant material should be placed in all vulnerable
grooves and pits, occlusals, buccals and linguals. Occlusals are the most
common surfaces to decay but buccals and lingual are the second most common, even
decaying more often than interproximal surfaces. Make the most of this
opportunity to protect all accessible surfaces. Run the sealant tip through the
sealant to remove voids or bubbles. If necessary, remove excess sealant material
with a sponge tip applicator. An overfilled sealant is more likely to be
lost due to constant occlusal interference. Cure the sealant for as
long as recommended by the cure light manufacturer, as the recommended times
may vary. Use a curing light meter periodically to
test the intensity of your curing light. Several curing light meters are
available at a reasonable cost. The older halogen lights require a
greater length of curing time compared to the newer LED rechargeable lights.
After curing, use an explorer to evaluate the sealant for retention. Remove any
residual flashing. Check for bubbles. It is really only necessary to add sealant
material if the bubbles are at the margin of the sealant. Brush with a smear
of toothpaste to remove the Bisphenol A. Even though the sealant manufacturer
may list only Bis-GMA or -DMA as ingredients, the American Dental
Association says that BPA is still likely to be present in trace amounts.
Using the smear of toothpaste will also remove any residual bad taste for your
patient. Note that this is not adequate isolation. In the first photo, the tongue
is not adequately blocked. In the second photo, the cheek will surely wick saliva
onto the tooth. In the third photo, the glove will wick saliva so ensure a cotton
roll is between the glove and the tooth. And in the fourth photo, there is a need
for a cotton roll or dry aid on the cheek side. This is one way to isolate
tooth number three, with the hygienist holding the dry aid with a mirror and
the assistant using the saliva ejector or high vac to block the tongue. There's
no need to press on the tongue. Just ask the child not to touch the suction with
her tongue. There are a couple options for tooth number 14, the most difficult
tooth to seal. Have the assistant hold the dry aid and the suction inside the cheek
where there's often not enough room or have the assistant hold the section up
and over coming in from the patient's right side out of the hygienist line of
sight but also blocking the tongue. For tooth number 19, the hygienist holds the
lingual cotton roll, the assistant the buccal cotton roll. As for all sealants
the suction should remain in the mouth as often as possible, and ideally, the lower lip
should be retracted to increase the field of vision. In conclusion, remember
that the most common cause of sealant failure is saliva contamination at any
time, from the beginning of the procedure to the end. We hope this video was useful
for you as you move forward to provide this very important preventive service
in the schools.