This document discusses the use of dental sealants in adults as an underutilized preventive measure. It notes that while fluoride has been effective on smooth surfaces, sealants provide additional protection for pits and fissures which are more vulnerable to caries. Studies show sealants reduce caries by 52-82% over time. The document advocates expanding sealant use to adults, especially those at high risk, both to protect erupting teeth and improve longevity of restorations by sealing margins. Regular evaluation and repair of sealants is recommended to maintain their protective benefits over many years.

1. The use of dental sealants in
adults: a long-neglected
preventive measure
David R. Gore
International Journal of Dental
Hygiene 8, 2010

2. Introduction
• Sodium fluoride and its use of tablets,
toothpastes, and mouth rinses are
introduced in1945
• Sealant placement vs. application of
fluorides onto the surfaces of teeth
– Cost-effective vs. 4 times a year
• Sealant can be extended to the adult
population

3. Introduction
• Susceptible areas to caries attack
– Occlusal surfaces of molars and premolars
– Lingual grooves and pits of Maxillary molars
and incisors
– Buccal pits of mandibular molars
• Prevalence of dental sealants can inhibit
the advancement of caries

4. Background
• ADA accepted sealant as a safe and
effective method of preventing dental
caries in 1976
• Fluoride has been effective in reducing
carious lesions on the smooth surfaces of
enamel, while sealant has been effective
on the occlusal pits and fissures, too – pits
and fissures are 8 times more vulnerable

5. Background
• NHANES III(Third National Health and
Nutrition Examination Survey)-sealants
– 5% of 18~24 yrs old adults
– 2% of 25~39 yrs old adults
• Effectiveness of sealants
– 82% reduction of caries after 1 year
– 52% reduction of caries after 15 year

6. Rationale for sealant use in adults
• Sealant forms a physical barrier between
the tooth and any invading bacterial
species
• The idea of applying sealants is especially
important during tooth eruption, and
application of sealants in suspected
fissure is advisable in older patients with a
high caries risk

7. Rationale for sealant use in adults
• Secondary recurrent caries is the primary
reason for the failure and replacement of
restorations in the adult population
• Sealing of amalgam restoration margins
right after placement can improve the
longevity of the final restoration (by Mertz-
Fairhurst)

8. Caries risk and caries reduction
• Focus in reducing caries should be on
prevention
• Aggressive use of sealants against pit and
fissure carries has a potential for
eradicating caries in children, adolescents,
and adults
• The use of dental sealants tripled over 4-
year period resulting in a decrease in
amalgam restorations in military

9. Caries risk and caries reduction
• Caries actually does not progress as long
as the pit and fissure remains sealed and
intact
• Sealed, radiographically evident caries did
not progress over a 10-year period

10. Improving dental sealant retention
in adults
• The complete retention rates of dental
sealants after 1 year are 85% or better,
and after 5 years the number is at least
50%
• Sealant should be routinely repaired each
year
• Adult prophylaxis appointment should be
expanded to include evaluation and repair
of sealants

11. Evidence-based research for
sealant use in adults
• ADA defined EBD as an approach to oral
health care requiring clinical decision-making
based on the integrationof systematic
assessments related to the patient’s oral and
medical condition and history, the dentist’s
clinical knowledge, and the patient’s
treatment needs and preferences
• Concern for future caries in a fissure or
groove on a tooth can easily be resolved by
using a sealant

12. Future direction
• The use of dental sealants in adult
dentition has proven to be an effective oral
health preventive measure
• The patient benefits from improved oral
health care