Dental Health International Nederland
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Chapter 6 - Glass-Ionomer Used as a Sealant
Besides being used as a restorative material, glass-ionomer can also be used as a sealant. The ART approach uses the same glass-ionomer for both restorations and sealants. This chapter describes the rationale, indications and procedures for using glass-ionomer as a sealant.
Rationale
It is not always easy to see early dental caries. Its progression can be rapid, particularly in young people who have already untreated cavities and/or restorations. If nothing is done, early dental caries can develop to a cavity in less than 1 year.
Sealing pits and fissures with glass-ionomer can control dental caries and prevent it from occurring. The presence and viability of microorganisms under pit and fissure sealants has been investigated. It has been shown that when the sealant remains intact, the number of viable microorganisms left beneath the sealant decreases with time. The destructive activity of the remaining bacteria is reduced, leaving the bacteria incapable of causing tooth destruction. This is logical since remaining bacteria are now cut off from their source of nutrients. There is convincing evidence that pit and fissure sealants are capable of arresting the carious process.
Even when glass-ionomer sealants have been partly or completely lost, there is usually a benefit to the patient because the fluoride released from the material will have made the enamel harder.
Indications
As glass-ionomer sticks chemically to enamel, it is useful as a sealant. It also releases fluoride into the enamel and this may stop further development of caries. Experience has shown that sealants of glass-ionomer remain in the deeper pit and fissures that are most at risk for decay. In contrast, sealants may be lost rather quickly in shallow pits and fissures.
Therefore, only place sealants in deep pits and fissures, which show signs of early tooth decay.
Do not place sealants in pits and fissures, which are deep and colored dark. The dark color is usually a sign that caries has come to a halt. It can, however, also be a superficial stain. You only should place a sealant when the dark colored pits and fissures are surrounded with a clear whitish discoloration. The latter is a sign of early tooth decay.
Procedures
Place the sealant only in the pit and fissures. Take care not to cover the cusps of the tooth.
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Isolate the tooth with cotton wool rolls. Keep the treatment area dry.
Clean the surface from debris with a cotton wool pellet dipped in water.
Gently remove debris from deepest parts of pit and fissures with an explorer.
Apply dentine conditioner or diluted glass-ionomer liquid into the pits and fissures for 10-15 seconds.
Immediately wash the pits and fissures, using wet cotton wool pellets to clean off the conditioner. Wash 2-3 times.
Dry the pits and fissures with cotton wool pellets.
Mix the glass-ionomer and apply it in all pits and fissures with the blunt blade of the applier/carver. Overfill slightly.
Rub some petroleum jelly on the gloved index finger.
Put the index finger on the mixture, press and remove finger sideways after a few seconds.
Remove visible excess of mixture with a large excavator.
Wait 1-2 minutes till the material feels hard, whilst keeping the tooth dry.
Check the bite using the articulation paper and adjust the amount of sealant with the carver if needed.
Apply a new layer of petroleum jelly.
Remove cotton wool rolls.
Ask the patient not to eat for at least one hour.
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