The term pit and fissure sealant (PFS) is used to describe a material, i.e., introduced into the occlusal pits and fissures of caries-susceptible teeth, thus forming a micromechanically bonded, protective layer cutting access of caries producing bacteria from their source of nutrients.1 Buonocore’s classic study of 1955 marked the start of a major revolution in the clinical practice of dentistry. The first clinical benefit from Buonocore’s work was the introduction of the first dental PFS, Nuva-Seal (LD Caulk) in February 1971, along with its curing initiator, and ultraviolet light source, the Caulk Nuva Lite
it took several more years before the sealant technique, and other clinical innovations that have resulted from Buonocore’s work, began to be adopted in clinical dentistry to any significant degree. Still, more than 30 years after the introduction of PFS to the dental market place, the profession has not embraced the procedure to the extent that available scientific data would expect.2 While levels of tooth decay (dental caries) in children and adolescents have declined in many parts of the world in recent decades, caries remains a public health problem in many countries.
CLINICAL INDICATIONS FOR PFS Indications • The occlusal surfaces of permanent teeth having welldefined pit and fissures and/or deep fossae. Occasionally, primary molars with significantly deep grooves or pits may be sealed • Stained or slightly white pit and fissure, especially in patients with high caries incidence • Buccal and lingual grooves when only the appropriate teeth have erupted sufficiently to be free of gingival and operculuctum contact • Incisors with lingual pits. Contraindications • Synthetic porcelain restorations • Veneers • Amalgam restorations • Gold foil restorations, inlays, onlays, or crown • Evidence of caries on occlusal or interproximal surfaces • Teeth that cannot be sufficiently isolated • Sealing margins of existing nonresin restorations • Vital dentin, which is more sensitive than enamel and has a much poorer retention rate • In children who are too young to cooperate during the procedure.
Follow-up and Review All sealed surfaces should be regularly monitored clinically and radiographically. Bitewing radiographs should be taken at a frequency consistent with the patient’s risk status, especially where there has been doubt as to the caries status of the surface prior to sealant placement. The exact intervals between radiographic reviews will depend not only on risk factors, which may change over time, but also on monitoring of other susceptible sites, e.g., proximal surfaces.20 RECOMMENDATIONS • Apply sealants to the permanent molar teeth of children and youth who are identified at risk by a caries risk assessment. • Place sealants on teeth as soon as possible after eruption; however, the length of time after eruption should not be a barrier to placement of sealants. • Use resin-based sealant materials to seal teeth, for increased retention of dental sealants. • Disseminate the review findings to peel dentists, dental hygienists, level II dental assistants, and other health care providers to promote the use of PFS.
CONCLUSION Most of the carious lesions that occur in the mouth occur on the occlusal surfaces. Which teeth will become carious cannot be predicted; however, if the surface is sealed with a pit and fissure sealant, no caries will develop as long as the sealant remains in place. Sealants are easy to apply, but the application of sealants is an extremely sensitive technique. So only trained staff should be allowed to place the sealants