Success with pit and fissure sealants.

May/June 2002 This article focuses on the techniques used for successful pit and fissure sealant application by the dental assistant. Pit and fissure sealants first were utilized in 1967 and formally recognized by the American Dental Association in 1971. Since that time, many product developments have been introduced to increase their effectiveness and ease of use. Finding adequate time in the schedule for the application of sealants is a significant challenge for most dental practices. In some practices, the hygienist applies the sealants. However, if the hygiene schedule is backlogged with patients requiring other preventive care, the individuals requiring sealants are transferred to the doctor’s schedule. Since sealant procedures normally do not produce a high fee, they are not necessarily the most productive use of the doctor’s time. If there is one assistant working with the doctor in the treatment room at all times, and at least one other assistant who works independently of the doctor (fabricating provisional restorations and providing other services to patients where allowed by state law), it makes sense to delegate sealant application to the chairside assistant. Currently there are 24 states that allow application of pit and fissure sealants by dental assistants. (See Table 1) Success with pit and fissure sealants is very dependent on technique. Table 2 lists the steps in the application procedure. Product selection is the first step in sealant application. Use of light cured materials provides the assistant with more control over working time. Using materials with very fine applicator tips helps the assistant to better control the placement of material in the pits and fissures. (Figure 1) Good isolation to keep the teeth dry is critical to sealant retention. Using a dental dam (Figure 2) to isolate the teeth will provide the best isolation, however, using various types of cotton roll holders also will work. In addition, products such as Dri-AnglesTM or Dry-TipsTM are also excellent for isolation and keeping the area dry. If the tooth surface becomes wet after the etching, the etch procedure must be repeated for good retention of the sealant material. Sometimes air bubbles may be incorporated into the sealant material during application. This can be avoided by keeping the applicator tip immersed in the sealant material while moving the applicator tip across the tooth surface. If bubbles still form, the applicator tip or the tip of an explorer can be used to gently remove the bubbles, taking care not to displace any of the sealant material. Finally, adequate curing of the material also is