Dentistry/Pit and Fissure Staining
QUESTION: Hello Dr. Dalin
I was wondering if you could help me or offer me some advice? I know you can't really diagnose anything unless you look into my mouth, but I will explain my situation as best as I can. I will also give you a short summary of my dental health.
I am a 22 year old female and I have 2 silver filling. I got them when I was fairly young. I got one when I was about 6 or 7 and the other when I was about 11 or 12. I haven't had a cavity since then and I'm not really counting the small hole that I detected recently. This hole was so small that it must have been the width of a really thin needle. I had no pain and there wasn't any brown or black stuff in or around the hole.
I went to my dentist, who I have been going to since I was 8 years old. I told him about the hole and he took a look. This hole was so small that my dentist couldn't even see it. He had to take out a magnifying glass in order to see it. He then stuck his probe in it. He asked me if that hurt and I said no. He said that it wasnt bad at all and that it was really shallow. That it didn't reach the dentin at all.
He then took out some composite. He said that he was going to clean it and seal off the hole with the same composite he uses for deep fillings. I asked if he was going to drill and he said that there was no need. So he sealed off the hole and said that this should prevent the whole from progressing.
After that, he looked at my bottom molars and said that they were pretty deep and that I had some staining on them. He said that this staining could turn into a cavitated lesion. That right now it was non cavitated incipient lesion. He asked if I wanted to seal them. I wasn't so sure but I trusted him so I let him do it. He cleaned off the fissures (no drilling) and sealed them off with the same composite he uses for fillings. I was confused because I thought that sealants were normally flowing but I figured he knew what he was doing.
I then left the dentist and thought to myself that I made the wrong choice and I shouldn't have sealed off my pits and fissures. I had so many questions and concerns but I didnt want my dentist to think I didn't trust him. I did ask him if could take it off and he said yes but didn't recommend it because I already had some staining.
Here are my questions/concerns:
1) Was it okay for him to seal off that tiny hole? Could I have prevented it from progressing on my own?
2) Was it okay for my dentist to seal off my pits and fissures even though there weren't any cavities just staining? If there were some decay would it arrest it because food and fluids can't get inside the fissures?
3) Is it normal to use the hard composite resin instead of the flowing kind to seal fissures?
4) Would I be more susceptible to decay or get a cavity under the composites since I cannot brush the sealed of portion of my teeth? I am afraid that the brown staining will turn into a cavity since it is sealed off. My dentist said that even if I did have a cavity (which I didn't) it would arrest because of the anaerobic environment. Is that true?
5) My dentist said he could remove the composite on my teeth. Is there a safe way to do this without any danger of removing any part of my actual tooth by mistake?
I called my dentist and asked him about what kind of composite material he may have used. He said that it was a regular composite filling material. I am a little concerned because I was told by another dentist that it should be a fluoride releasing material to prevent decay. This composite material that my dentist used was like a thick paste. He placed a small pea size lump onto my teeth and smoothed it out. I was confused because I thought the composites used for sealing teeth were in syringes and were flowable. That way the sealant can get down into the deep grooves and protect it from debris. I did ask him about that and he said that those kinds come off eventually and that the one he used doesn't wear off.
Also I was reading some research conducted on sealing fissures with staining and it said that the number one problem is the sealant leaking especially if it is high viscosity. The staining then becomes deep decay and it sometimes does the opposite of what it was supposed to do. I am just hoping that this preventative measure doesn't backfire on me and damage perfectly healthy teeth.
So there you go Dr. Dalin, I apologize for the really long email and I know you have actual patients to attend to. I just thought I would try to ask because I am freaking out and I can't seem to get/find a straight answer. Any help is greatly appreciated!
ANSWER: hi victoria
first off, relax...what was done sounds okay. now let's attack your questions: sealants are very good if done well. they can seal off deep grooves and stop decay from forming down in there. the problems occur if they are not done well. they can leak or pop off. normal pit and fissure sealants are thinner than normal composite resin. this is so they can flow and be kept thin (you usually do not have room for a regular composite). if your dentist got regular composite to seal the grooves, it will probably work fine. is your bite okay with these on? you want to hit evenly before and after they are placed. if you seal over a hole, this is a good thing. bacteria will not be able to get in there and cause decay. normally sealants are done as the teeth come in. you do not want to wait for stain or beginnings of decay. why not get it done right away. just brush them daily and all should be fine. can you get decay around or under a sealant? anything is possible. if they are loose or not sealed well, this can happen. when you are in for your regular checkups, things will get examined. and xrays will also be helpful in watching around and under the sealants. can they be removed...the answer here is yes as long as done very carefully. but why take them off. let them do their work for you and prevent any future restorations.
i think i got everything answered here. let me know if you have any other questions. good luck
jeff dalin, dds
---------- FOLLOW-UP ----------
QUESTION: Dr. Dalin,
I appreciate you taking time out of your busy schedule to help me and answer my questions. I also wanted to thank you for answering all my questions and not just part of it. Your answer was both very informative and it reassured me that what my dentist did was okay.
I just had one last question, is it possible to remineralize the stains that were covered by the composite even though they have been covered? I'm not sure if that question makes any sense. Basically I brush with regular Crest cavity protection paste, then rinse with listerine, and lastly rinse with Act Flouride Rinse. I also chew 100% xylitol gum between meals. Will the Flouride in the toothpaste and Act Rinse help remineralize the fissures under the composite? Or does it not matter because the teeth are sealed and are not exposed to the flouride or the antibacterial qualities of the listerine and the xylitol.
Again I apologize for all the questions, but you have been a great help. I am glad that I was able to find this website and find such a knowledgable person. Thanks again and enjoy your weekend.
the sealant will stop anything from getting under it so there will not be any remineralization going on under there. but that is not a problem. the sealant is doing its job by not letting any bacteria get in there so remineralization is not needed. but keep doing what you are doing. the act, etc will be good for all of the rest of the surfaces of the teeth. sealant only works down in the grooves. fluoride works everywhere else. thank you for the kind words. i enjoy being able to help people out. i hope i have put your mind at ease. just make sure your dentist checks everything every checkup (to make sure sealants still solidly in place). good luck
jeff dalin, dds