Fissure sealants have been recommended to be placed on the occlusal surface of permanent teeth to decrease the caries risk. Newly erupted permanent teeth are the best candidates to receive fissure sealants. The first molar tooth that erupts at 6 years of age distal to the deciduous teeth best benefits from fissure sealants because children at this age do not have the required skill to brush their posterior teeth. In addition, due to their playful nature and fatigue at the end of the day, they either go to bed without brushing or brush their teeth rapidly and inefficiently before going to bed.
The occlusal surfaces of teeth become carious for several reasons.
Firstly, the enamel of newly erupted teeth is still immature, with relatively high organic content, and is more permeable, making them susceptible to caries attack.
Secondly, the fissures and crevices on the occlusal surfaces provide a proper environment for the retention and proliferation of bacteria. The tooth enamel is thinner in the fissures and crevices and might rapidly lose its mineral content. In addition, the full eruption of molar teeth takes a relatively long time (1.5–2.5 years), possibly interfering with proper and adequate oral hygiene because the toothbrush bristles cannot easily reach the occlusal surface of teeth that are lower than the occlusal plane of other teeth. In addition, fluoride is less effective in decreasing caries on occlusal surfaces than on smooth surfaces. Therefore, placing fissure sealants on the occlusal surfaces of molar teeth is useful to decrease caries rate in children.
How Do Fissure Sealants Prevent Caries in Fissures?
In this technique, tooth-colored thin resin materials are used to cover deep fissures and porosities on the occlusal surface of teeth, where >70% of dental caries begin. First, the tooth surface is cleaned with a motor-driven brush. Then the fissure sealant is placed on the tooth surface, like glue, without preparing the tooth, and light-cured in the same session. The optimal age for placing fissure sealants is 6–12 years of age in the newly erupted first and second molar teeth. Fissure sealants significantly decrease the caries rate in children. However, brushes, dental floss, and regular dental visits are necessary, along with fissure sealants.
Deep and narrow fissures are usually present on the occlusal surfaces of molar teeth. Due to the retention and impaction of many cariogenic foodstuffs and snacks (including chocolates, cakes, biscuits, etc.) and colonization and activity of cariogenic bacteria in these areas that are not easily cleaned with the natural salivary flow and even toothbrushes, dental caries usually begins on these surfaces. Therefore, fissure sealant therapy is an effective preventive measure for occlusal surface caries.
It should be pointed out that teeth receiving fissure sealants should be examined every 6 months so that any fractures or chipping of a part of the fissure sealant can be repaired.
