Dental sealants: I love to hate 'em

July 28, 2021
A mid-20s female presented for a new-patient exam. She had sealants on all her molars, never had a cavity in her life, and her mom is a hygienist. Dr. Stacey Gividen had to give her the bad news, but an intraoral camera made it easier.
I’d like to think that anyone I’ve ever put a sealant on would never need a filling. I’d also like to think that anyone with a sealant whom I’ve done a new-patient exam on would never need a filling. Unfortunately, that’s not the case. And I know I’m not alone.

A priceless tool

Enter a mid-20s female who presented for a new-patient exam. She had sealants on all her molars, never had a cavity in her life, and her mom is a hygienist (on the East Coast). I had to be the one to tell her she had cavities under some of the sealants that had chipped and worn away. Say, what? Both mom and daughter were skeptical, but after showing my patient the pictures, she gave permission to move forward with the restorative dentistry.

This is where the most priceless tool you can have comes into play: an intraoral camera. If you don’t have one, get one. I’ve written about this topic numerous times, and there really isn’t a reason for you not to have one. ZERO.
As expected, this patient’s dental caries were very deep. I took quick pics to show the patient, and once again, she was amazed at what was going on in her mouth. She had been told for the longest time that any “lines in her teeth” had been stain. There’s probably some truth to that, but I suppose experience is the best teacher. Unfortunately, this wasn’t my first rodeo with sealants.

Why do I love to hate sealants?

It’s situations like this that make me cringe. It’s as if we have to convince our patients that something is wrong with a restoration that was placed to prevent the very thing we’re telling them they need to address. Sketchy talk? You bet.

Oh, I know there are seminars, tips and tricks for placing sealants, CE courses, and a billion things to read about these vexing restorations—from case selection, placement, materials to use, who can/can’t and should/shouldn’t
place them, utilizing a rubber dam...all the way to the Isolight and wads of 2x2’s and cotton rolls. For something so simple, is it really?

I’m not trying to convince you to change or stop doing what you’re already doing. I’m just merely pointing out my frustration over these restorations and wondering if there is a solution to the conundrum that I’m not seeing. The problem isn’t just with my patients; it’s with patients I see from other practices all over the map.

Want to know the apropos part of all this? I have 16 sealants on my teeth and have never had a cavity in my life. Maybe it was my mom’s numerous refusals to give me a penny so I could get the coveted pink sugar gumball out of the gumball machine when I was little, or her holding our pillows hostage at night until we brushed our teeth. Those were the good ol’ days, and yes, I know I’m dating myself. Wouldn’t trade it for the world. Thoughts? 

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.