--- Organic polymer that bonds to enamel by mechanical retention (etching)?
Pit and Fissure Sealants
What is another name for mechanical retention?
Etching
A polymer is a?
Plastic
What is the purpose of applying pit and fissure sealants?
-Acts as a barrier to prevent bacteria from collecting and creating an acid environment which is essential for carries
What are the indications for use of Pit and Fissure Sealants?
-A preventive measure to seal hard to clean deep pits and narrow fissures or primary and newly erupted (less then 4 years) permanent teeth
-Used on patients who have had a high incidence of caries to prevent future decay.( NOT A PATIENT WITH CARIES)
What surfaces are sealants used on?
-Occlusal surfaces (primary place for sealants because of pits and grooves)
-Buccal PITS of Mandibular Molars
-Lingual GROOVE by Cusp of Carabelli (fifth cusp on first molar)
-Cingulum Pits (on lateral and central incisors, on the anterior lingual side th
What is the primary place for sealants?
Occlusal Surfaces
Why are Occlusal surfaces the primary place for sealants?
because of pits and grooves
What are the contraindications for a sealant placement?
-The occlusal surfaces are well coalesced, wide and easy to clean
-Occlusal Surface is decayed (unless its a incipient carry they are small enough that they will decrease with a properly placed sealant)
-The proximal surface is decayed (the occlusal surfa
--- flat with no deep grooves.
Coalesced
What does a decayed occlusal surface need?
A restoration (composite or amalgam) NOT a sealant!
If M or D surface of a tooth needs a restoration can the occlusal surface of the tooth be sealed?
NO! because the occlusal surface will be involved when restoring the interproximal surface
If a restoration is already in place can you put a sealant on top of it?
No!
--- A very small amount of carry that is not all the way through the enamel and not at all in the dentin. carry only in enamel.
Incipient Caries
What is used to check for incipient caries?
Explorer or a Caries Detector
What is the chemical composition of sealants?
BIS-GMA is the chemical composition of the resin Diamethaccrylate that comes in filled or unfilled resins
What is another name for thick resins?
Filled Resins
What is another name for thin resins?
Unfilled Resins
If we use thick flowable material that is a -- resin?
Filled resin
--- Makes resins less viscous (thick)?
Dilutent
Dilutent is only found in --- resins?
Unfilled resins because it makes the resin less thick
What ingredient is used to activate polymerization for chemical cured sealant material?
Activator (Light Cured)
Why are tinted or opaque sealants preferred?
They are easier to work with because you can see tem.
What is included in the armamentarium for dental sealants?
- Basic set up (mirror, explorer, cotton pliers)
-Prophy brush with non-fluoridated flour of pumice
-Handpiece and appropriate burs (We cannot legally use burs dentist must do) or hydrogen peroxide
-Rubber dam or cotton rolls, cotton roll holder for lower
Etching agent is made up of?
35%-50% Phosphoric Acid
How much phosphoric acid is in the etching agent we use?
37%
How is etching agent supplied?
In a liquid (syringe) or a gel (brush)
What does autopolymerization mean?
chemically activated when mixing two pastes together starts the curing process
What does Photopolymerization mean?
Light Activated
What forms does sealant come in?
-Filled or Unfilled Resins
-Autopolymerization (chemically activated) or Photopolymerization (Most common, Light Activated)
Why are dappen dishes and syringes for sealants black?
So the sealant wont set if it is the light cured Photopolymerization sealant
For Autopolymerization sealants do the dappen dishes need to be black?
No because this type of sealant is chemically activated and not activated by light
Can Dental Assistants adjust the occlusion for filled resins?
Yes we can use white and green stones or finishing burs first articulating paper to check the occlusion and then sand down
-Use finishing burs if the occlusion needs to be adjusted on filledresins (thicker wont wear down)
Do unfilled resins need to be adjusted for occlusion ever?
No because they will wear down on their own
Do filled resins need to be adjusted for occlusion ever?
YES always check and adjust the occlusion if necessary on unfilled resins because they wont wear down on their own
We use --- Sealant which turns creamy when light cured.
Clinpro Sealant
What usually works better for applying sealant brushes or syringes?
Syringes because brushes may incorporate air
Why are the syringes and their tips for sealants black?
So light doesn't go through
How do unfilled resins wear down?
By normal Occlusion
How do filled resins wear down?
By fine white stones or finishing burs
List the steps for applying sealants?
Clean teeth, Isolate tooth, Dry teeth with the air syringe for a minimum of 30 seconds, Etch, Rinse with oil free water (lines should be checked for oil contamination), Dry etched surfaces, Apply sealant, Check Area, Remove Cotton Rolls and Rinse, Check O
What should be used to clean the teeth before applying sealant?
-A prophy brush and fluoride free pumice (flour of pumice)
-or swab the tooth with hydrogen peroxide
-or the Dentist will roughen the area with burs we CANNOT do this
-or the Dentist will preform enamelplasty- he will remove a small amount of enamel becau
Why should fluoride free pumice be used to clean the teeth before applying sealants?
Because the fluoride neutralizes the acidity of the acid etch and reduces the formation of resin tags effecting bonding
-If use flouriode pumice= Failure the sealant will just fall out wont stick in the mouth
Are commercial polishing pastes advised to clean the teeth before applying sealants?
NO! because generally they contain glycerin, oils, flavoring agents, and fluoride which interfere with bonding
What should be removed when the teeth are cleaned with fluoride-free pumice before applying sealants?
Some Stains and Debris
After using the fluoride free pumice to clean the teeth what is the next step?
Rinse the teeth and check with an explorer to make sure the pumice is all cleared away
What is the preferred way to isolate the tooth for the placement of sealants with a one person technique?
Rubber dam
What is the function of a rubber dam for the placement of sealants?
Isolates the tooth, keeps it dry, and protects the patient from the acid etch
When is the rubber dam applied to the tooth for the application of sealants?
It may be applied before the tooth is cleaned with fluoride free pumice or right after the tooth is cleaned with fluoride free pumice
What can be used to isolate the teeth for sealants?
-Rubber Dam
-Cotton Rolls, Cotton roll holders and dry angles
What should be done if a cotton roll becomes saturated during a sealant procedure?
NEVER REMOVE THE SATURATED COTTON ROLL, instead place a new roll over the wet one or suction excess moisture from the cotton roll
What will happen if a saturated cotton roll is removed during a sealant procedure?
Everything will be contaminated and you will have to start over
Where should the dry angle be placed if using cotton rolls to isolate the maxillary molars during a sealant procedure?
Place the dry angle over the PAROTID GLAND buccal side of the maxillary molars
After the teeth are cleaned and isolated in the sealant procedure how long should they be dried with the air syringe for?
Dry for a minimum of 30 seconds
What must be done with the air water syringe before using it to dry the teeth in a sealant procedure?
The air syringe should be checked to make sure it is free of oil contamination and spray the air to make sure it is free of moisture
Etch may be applied with?
A brush, cotton pellet, or directly with a syringe
How should etchant be applied with a brush?
DO NOT PAINT rub or burnish the surface that will create a smooth surface with no tags and closed pores need tags for sealant to stick to the enamel.
-continously dab the surface to create enamel tags
Does dabbing the etchant damage the fragile enamel lattice work formed during etching?
NO it opens the pores of the enamel so that the next material the etchant will adhere to the surface
How should gel etchant be applied to the enamel?
Apply according to manufacturers directions
Does the gel etchant require continous application like the liquid etchant?
No!
Where should etchant be applied?
Apply onto occlusal surfaces, into grooves up to marginal ridges about 2 to 3 mm beyond the area to be sealed. it may include buccal and lingual pits.
Should etchant be applied beyond the area to be sealed?
Yes! Apply etchant about 2-3 mm beyond the area to be sealed.
How far beyond the area to be sealed should etchant be applied?
Etchant should be applied about 2-3 mm beyond the area to be sealed
Avoid placing the etch on any tissue or it will?
etch will burn if placed on tissue
Do you have to use cotton rolls or a dental dam while doing sealants?
Yes!
How long should permanent teeth be etched?
etch for 15 seconds to 1 minute
(we etch for 30 seconds)
Do primary teeth need to be etched for a shorter or for a longer time then permanent teeth?
Primary teeth must be etched for a LONGER time then permanent teeth
How long should primary teeth be etched for?
1 1/2 minutes
Why are primary teeth etched longer then permanent teeth?
Because primary teeth have more resistance to acid then permanent teeth
Do fluorosed teeth require a greater etching time then permanent teeth?
Yes because they have a greater acid resistance
Should you rinse the tooth after etching using oil water?
No must use oil free water to rinse the teeth after etching. The lines should be checked for oil contamination
After etching a tooth surface what should be done?
Place the evacuator over the etched surface of the tooth to pick up the excess etchant
How long should you rinse the etchant off the tooth for just using water?
15 - 30 second
When rinsing the tooth for 15- 30 seconds after etchant is placed into the mouth what must be done with the aspirator tip?
place the aspirator tip against the tooth to prevent the saturation of cotton rolls and the spread of the acid
Water only should be sprayed onto the tooth after the etchant is placed until?
for 15 -30 seconds and until all the etchant showing on the tooth's surface is gone
When rinsing the tooth after etchant is removed it is very important to maintain a?
Dry area
If a dry area is not maintained during rinsing of the etchant off of the tooth then?
Put a dry cotton roll over the saturated one
How should a dry etched surface appear?
The surface should appear Dull, Frosted, Chalky, Whitish, and Satiny
What should one do if saliva contamination occurs on a dry etched surface?
It is needed to reisolate, rinse, dry, and repeat etch for 10 seconds (less etching required than the first time)
What may be used to dry the etchant surface in order to ensure complete evaporation of moisture?
Drying agent or primer may be used. We want the surface as dry as it can be so the sealant sticks.
What should be done after a tooth is etched and dried?
Apply the sealant!
Is autopolymerization - Chemically activated sealant common?
No!
Autopolymerization requires mixing a --- and ---- together
Base and a Catalyst
What is usually the curing time for autopolymerization sealants?
about 1- 3 minutes (according to manufacturers directions)
How should autopolymerization sealants be applied?
Use a brush, a sponge, or an instrument of choice
The working time for autopolymerization sealants is?
Limited must work fast have a 1-3 minute curing time according to manufacturers directions
When applying photopolymerization sealants what tooth surface should you start with?
Start with the most distal surface of the tooth
Sealant should be applied to?
all etched surfaces fllowing into the pits and fissures and filling the natural fossa, blend the sealant into the marginal ridge covering the lingual or buccal pits (DO NOT COVER RIDGE OR CUSP TIPS) only cover pits and grooves
When sealing teeth should you cover the marginal ridge?
NO! only the pits and grooves in the ridge but do not cover the ridge itself
What could happen if a sealant was overfilled?
Material could go into the contact areas interproximally
Should sealants be placed interproximally?
No!
What should be done after filling the tooth with sealant material?
Trace the fissures with an explorer to enable the air bubbles to rise
How long should photopolymerization sealant be exposed to light?
expose to light 20 to 30 seconds per tooth or according to manufacturers instructions
(We do 30 seconds)
How far should the light source tip be held away from the photopolymerization sealant?
hold light tip 1mm - 2 mm away from the sealant
What is the step after the sealant has cured?
Check area: Pass the explorer over the sealant to check for hardness and make sure the sealant is intact
What should you check for using the explorer after the sealant has hardened?
check for hardness and make sure the sealant is intact
What are usually the hardest teeth to seal and why?
The twelve year molars on the maxillary arch Because all of the saliva flows back their. Make sure when sealing these teeth to put on the distal side first and move forward
Why would a sealant come off?
A sealant would come off if it was contaminated with etchant or if it was not etched long enough
What should be done if a bubble is found in the sealant after the sealant is cured?
Sealant may be added and recured
What should be done if a contaminate is found in the sealant after the sealant is cured?
If theres a contaminate such as saliva the start over
What should be done if a bubble is found in the sealant after the sealant is cured and their is contamination in the sealant?
start over
Once the sealant is cured and checked and if everything looks correct what should be done next?
-Remove the cotton rolls and rinse the patients mouth
-Wipe the sealed surfaces with a moist cotton pellet
After the cotton rolls are removed and the sealant surfaces are wiped with a moist pellet what should be done next in the sealant procedure?
Check the patients occlusion using articulating paper to check for high spots (blue spots) on the sealant
Is it legal for the dental assistant to adjust the occlusion on FILLED RESINS?
Yes! Use slow speed hand piece and fine white or green stones or a finishing bur. when done grinding down the occlusal surface make sure to recheck with the articulating paper
What should be done after checking and adjusting the occlusion of the sealants?
Use dental floss interproximally to make sure no sealant is their
What should be applied over a completed sealant to cover any areas that were etched but not sealed?
Fluoride
How often should sealants be checked?
You should go to the dentist every 6 months to have your sealants checked
If a sealant replacement is necessary is re etching the tooth required?
Yes!
What must a patient wear when etching, curing and rinsing?
Safety glasses
How many people should preform a sealant procedure?
It is recommended to have two people one operator and one assistant but the procedure can be done with one person
How should sealant material be stored?
-If light cured store in darkness
-AWAY from EUGENOL products - it effects the sealants from setting
If sealant is expired what will occur?
Material may not flow properly or cure properly
What four factors determine the retention success of sealants?
-Maintain a dry area
-Accurate timing of Etching, Rinsing, Curing
-Proper sealant placement
-Follow manufactures directions
Is the retention rate of sealants much better on the maxillary arch or on the mandibular arch?
On the mandibular arch because of the better accessibility easier to see
Can decay still occur on teeth with sealants?
yes especially proximal decay
Is a tooth that once had sealant but it has become lost or defective more prone to carries then a tooth that has never had a sealant?
No!
Are sealants part of a caries preventive program?
Yes but patients should be advised that sealants are only part of a preventive program and brushing and flossing is still needed to prevent caries
--- Is the space where we floss and sealant may get stuck?
Embrasure
Should a normal tooth with good surfaces get a sealant if radiographs found proximal or occlusal caries?
No a restoration is needed
Should a normal tooth with good surfaces get a sealant if the tooth has deep pits andd grooves?
Yes!
Should a normal tooth with good surfaces get a sealant if radiographs found caries in the enamel that had not yet reached the dentin?
Yes these are called incipient caries and can be removed and then sealed
List the armamentarium for sealant application?
Basic setup, Prophy brush with fluoride free pumice, Appropriate burs or hrdrogen peroxide, Rubber dam or cotton rolls, cotton roll holders, and a dry angle, ethcnig agent, sealant, dappen dishes, applicator brush, explorer, articulating paper, fine stone
Prior to the application of sealants the teeth are cleaned with?
Prophy brush and fluoride free pumice
Which are etched longer permanent or primary teeth?
Primary teeth (more resistant to acid) etched for a minute and 30 seconds
What is the composition of etching material?
35-50% Phosphoric acid (we use 37% phosphoric acid)
What is the preferred isolation technique when applying sealants?
Dental Dam
What must be done if there is saliva contamination during the etching procedure?
repeat steps: Reisolate, Rinse, Dry, Repeat etch for 10 seconds only (etch for less time because tooth will still be somewhat etched compared to the start)
Describe characteristics of an etched surface?
Dull, Frosted, Chalky, Whitish, Satiny
List Contraindications for sealant placement?
Well colasced occlusal surfaces, occlusal or proximal surface is decayed, A restoration is already in pace on that tooth CANNOT put sealant over it, Insufficient eruption of tooth
How is gel-etching agent applied?
According to manufacturers directions
List the indications for sealant placement?
Occlusal surfaces with pits and grooves (Primary reason), Buccal pits of mandibular molars, Lingual groove by the cusp of carabelli, Cingulum pits
How is liquid etchant applied? Why?
It is continously dabbed over the surface to open the enamel pores and create enamel tags so that the sealant can stick if not the sealant will fall out