Fissure sealing for children

What fissures are and why they are a problem

The biting surface of a molar is not flat: it has grooves and hollows called fissures. In some children they are shallow and wide, in others narrow and deep as a crack. A narrow fissure is thinner than a brush bristle — food gets in, the brush does not. That is why decay in children’s molars usually starts exactly there, and not where a parent can see it.

Sealing means filling that hollow with a thin layer of material that bonds to the enamel. The surface becomes smooth and easy to clean. The tooth is not drilled or ground in the process; nothing is taken away from it.

When it is done

• The first permanent molars come through at around six, behind the last milk tooth, often unnoticed because nothing falls out.
• The second permanent molars come through at around twelve.
• Sealing is done soon after the tooth appears, while the fissure is still free of decay.
• Milk molars are sealed when the fissures are deep and the child is prone to decay.

If decay has already entered the fissure, sealing is not enough: the place is first cleaned and then filled. That is no longer sealing but a filling, and it is charged as one. What is needed is seen at an examination.

What the visit is like

1. The tooth is cleaned and dried; the child sits in the chair with their mouth open, no needles and no drill.
2. The surface is prepared with a gel that stays on for a few seconds and is then rinsed off.
3. The material is placed in the fissure and set with a lamp, a few seconds per tooth.
4. The bite is checked, so that the sealant is not in the way when the child bites down.

A tooth takes a few minutes. The child can eat and drink straight away. Several teeth are usually sealed in one visit, so the price is per tooth.

How long it lasts and what follows

Over the years a sealant wears and chips here and there, so it is checked at routine visits and topped up where needed. That is not a failure but the expected course: the material takes the same load as the tooth does when chewing.

Sealing protects the fissure, not the whole tooth. Decay can still start between the teeth and along the gum line, so brushing and cleaning between the teeth stay exactly where they were. Sealing often goes together with a fluoride application, which strengthens the enamel over the whole surface.

If the child is frightened

Sealing is often a child’s first procedure, and it helps that it is short and needle-free. The child may hold a parent’s hand, see the instrument before it comes close, and say when they have had enough. If this is a first visit to a dentist, it helps to make that visit an examination only and seal next time; how to prepare a child is in a separate article.

Does the child feel anything?

The tooth is not drilled, so no anaesthetic is needed. The child feels that the tooth is dry and that something rests on it for a few seconds.

Can an adult have it done?

Yes, if the fissure is free of decay and the tooth is otherwise sound. In adults decay has more often already entered, so a filling is done instead.

Does it change the colour of the tooth?

The material is clear or whitish and sits only in the hollow. From the outside it is hardly noticeable.

How many teeth are sealed at once?

As many as have come through and as many as the child manages in one visit. With small children two shorter visits are better than one long one.