Have teeth sealed in children?

Tooth seals help reduce tooth decay. Dentists explain whether and which teeth should be sealed

The dentist assesses whether and which teeth should be sealed

Parents often only notice it when it is already there: the first permanent molar. Mostly from the age of six, the so-called six-year molars slide behind the last milk teeth. Viewed from above, each one resembles a small mountain range with four or five peaks and rivers buried between them. Sometimes more, sometimes less deep.

Dentists see potential fissures and cavities for caries in the fissures and dimples. As a rule, doctors advise plastic sealing, because thorough brushing is often not enough on its own. What parents should know:

When doctors advise sealing

Teeth that have just broken through are considered to be very susceptible to caries. Their enamel is still not very resistant. A seal would do that "mountains" level something. Whether the tooth surface of the first permanent molars should be sealed or not, three things play an important role: "How the child feeds, how well the teeth are brushed and how their anatomy is, how deep the fissures are and whether they may form cavities in which bacteria feel comfortable", explains private lecturer Dr. Cornelia Frese. The senior doctor at the Polyclinic for tooth preservation at the Heidelberg University Hospital conducts advanced training courses in fissure sealing for the Baden-Württemberg Chamber of Dentists.

"I recommend sealing the caries-free molars especially if the child already has caries on other teeth", says Dr. Elena Schaub-Langner, who is a children’s dentist in Munich. The seal can effectively reduce the risk of caries in new, still healthy teeth. Because at least one of the above-mentioned points can be critically assessed for almost every child, fissure sealing is considered sensible for most children. It becomes almost imperative when the little ones wear sturdy braces that make thorough brushing difficult. It is hardly surprising that the share of twelve-year-olds with sealed molars is almost 80 percent.

This is how teeth are sealed

Very important: Before the seal, the teeth must be free of caries. Otherwise, the bacteria will continue to rage undetected under the seal. At the beginning of every seal there is therefore a basic examination by the dentist. Incidentally, they do not have to do the sealing themselves, but can also leave this to dental specialists.

"After the basic examination, the teeth are cleaned thoroughly and the enamel is etched with phosphoric acid", explains pediatric dentist Schaub-Langner. In her practice, she always seals herself. Then the tooth to be treated is drained, either by means of cotton rolls or a so-called rubber dam.

This is an elastic film that is pulled over the teeth and fastened with a clip. "The choice of method depends on how far the tooth has broken and how the child is participating. The rubber dam can be uncomfortable and often requires anesthesia to the gums", says Schaub-Langner.

If the tooth is dry, thin-bodied plastic is applied, which spreads on the tooth surface and flows into the depressions (see below). The plastic either hardens itself or with the help of a special light. Finally the tooth is polished and a fluoride gel is applied.

Each seal lasts between ten and 20 minutes. Whether all four posterior molars are done in one or more sessions depends on how well the children take part. "Parents should motivate them and not be afraid themselves", says Cornelia Frese.

These risks involve dental seals

The greatest danger is that the dentist overlooks caries and spreads under the seal. This can also happen if there are gaps or air pockets in the seal or if it does not completely cover the fissures.

Older studies have shown that material loss occurs in up to half of the sealed teeth, especially in the first half of the year. This is mainly due to processing errors, according to the guidelines for fissure and dimple sealing of the German Society for Dentistry, Oral and Maxillofacial Surgery and the Federal Chamber of Dentists (from 2010, validity currently expired). Cornelia Frese and Elena Schaub-Langner point out that seals must be checked by the dentist every four to six months and, if necessary, resealed.

Parents usually don’t have to worry about the toxic or allergic effects of the plastic. "Allergic reactions occur very rarely", says Elena Schaub-Langner. It has only been scientifically proven that light-curing plastics, when hardened, form potentially harmful substances in their outermost layer. "We therefore remove this layer with the polish", says Schaub-Langner.

What seals cost

Sealing the first permanent molars in children has been a standard benefit of health insurance companies since 1993 and is free of charge for parents. Rarely do dentists advise to seal the milk molars already.

In theory, sealing is also possible on canines and incisors if they have very deep notches on the back. In that case, however, health insurance patients have to bear the costs of around 30 euros per tooth.

Care for the teeth further

"The fact that a tooth is sealed does not mean that it no longer needs to be cleaned", emphasizes Elena Schaub-Langner. For parents, this means: cleaning properly, even in primary school. "The children still lack the motor skills to do this well enough", says Cornelia Frese.

Should be cleaned with fluoride-containing children’s toothpaste. In addition, Frese recommends applying a highly concentrated fluoride gel to newly broken teeth once a week in children from the age of six in order to prevent tooth decay as well as possible.