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Dentistry/margin stain fissure sealant

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QUESTION: Hello Dr. Karmen,

I was wondering if you could offer me some advice. A few months ago my dentist sealed my fissures because he said that they were deep and that there was some staining present. He said the sealant would act as a barrier. I asked him if it was possible to get a cavity since I could no longer brush there. He claimed that the only way I could get a cavity is if the sealant started leaking. I was a little hesitant, but I think its too late to take them off. He said he could, but I don't think he could remove them with damaging the enamel on those teeth.

Back to my question, I was looking in the mirror a few days ago at one of the molars he had sealed. There seems to be some staining on the margins of the sealant.I brush everyday at least 2 or 3 times for 2 to 3 minutes. I thought that the sealants were there to make those teeth easier to brush, but it seems that my brush is not able to reach into that spot. Its a very small stain and it seems to be debris accumlating on the margin of the sealant. I'm concerned that the stain will turn into a cavity. Is there anyway to remove this stain or remove the sealants? The sealant itself he used the same composite material used for fillings and he placed it by squeezing it into the fissures with his fingers. Thank you and any help is greatly appreciated!

ANSWER: If there is stain around the edge of the sealants then it means that either it is leaking or that the seal was not good when it was placed. I don't really like that you told me he placed it by pushing it in with his fingers because that can contaminate the material. Usually when this is done it is in a very dry field meaning that there is no moisture or contamination allowed on the teeth during the etching process and sealant process. It is not possible to remove the sealant down inside the fissures ( I think your tooth is still protected down there ) but I think that the edges of these need to be smoothed down and the stain removed. I don't think it's decay yet I think it's just stain but it should be removed and then the edges re etched and sealed properly making sure there is no contamination.  I would prefer it be placed with a dental instrument and not fingers.  


Dr. Karmen

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QUESTION: Dr. Karmen

Thank you for responding so quickly! I'm just worried about the stain accumalating and causing decay in the future. The reason my dentist put on the sealant was to supposedly prevent decay, but I'm regretting even getting them. I haven't had a cavity in about 10 years (I'm 22). He first cleaned the teeth and etched it with an acid. He left the acid there for a few seconds and had the little tube that sucks up spit. He told me not to move my tongue so that it stays dry. He then placed a little bit of composite on his explorer and placed it on the tooth. He then used his finger (he had gloves on) and packed it down. After that he cured it with a curing light for a few seconds and he sent me home.

Would you advise me to take them off completely? I'm just worried that some enamel would be drilled or grinded away if he removes them. I don't want the sealants there anymore. Thank you for your help!

ANSWER: He did everything  correctly and the only part I don't like is pushing it down with his fingers but each dentist has his own way of doing things. The sealants are a good service so don't consider removing them. I am not sure which material he used as there are many different types of the composite but some are very fluid and don't have to be packed in and some are pretty stiff. The trade off is that the fluid ones tend to wear out faster but they also penetrate on their own down into the crevices of the teeth. I don't honestly think you should remove them I just think he needs to do a bit of adjusting on them, etch the edges again and make sure they are sealed.  There are some unfilled resins that work nicely for this.

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QUESTION: Well every dentist I have talked to tell me not to remove it. I'm just worried about microleakage and all the horror stories I have heard about failing sealants and people finding decay under them. Could it be possible to remove these stains with a good polishing? Also, should he remove the stains before etching and reapplying a sealant?

Lastly, as a dentist when a patient come in for their 6 month cleaning or checkup do you do a thorough examination? I feel like my dentist is not checking my teeth like he used to. I have been going to him since I was about 9 or 10 years old. I feel like I need to point out when I see that I need something. For example I just had a cleaning and he said that everything was fine and proceeded to clean my teeth. He didn't notice the staining on the margins of the sealants and he didn't notice that my silver filling seems to be leaking and has a small gap in between the actul tooth and filling. I don't think I should be pointing these things out to him. I was wondering what you thought and if I should look for another dentist.

Thanks Again!

Thanks again!

Answer
Sealants are an excellent preventive tool.  Yes he should remove the stains before resealing the teeth. When I see a patient on recall I always do a complete exam including cancer screenings and periodontal probing.  What horror stores have you heard about failing sealants? In my experience they do very well and last for years and remain solid for a long time. If there is decay under a sealant then it was probably there when it was placed.  I cannot tell you if I would advise getting a new dentist, perhaps you might discuss your concerns with your present one and if you are not satisfied with his answer, then make your own decision.

Dr. Karmen

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Thomas Karmen

Expertise

All general dentistry questions, especially those related to fixed prosthetics. Endodontics, Periodontics, and implants, minor oral surgery I can't answer much about othodontics nor advanced treatment of carcinoma nor deep tissue surgery nor osseous surgery such as jaw reduction or advancement.

Experience

DDS In general practice and consulting with having done some lecturing for local dental societies.

Organizations
ADA and Florida Dental Association and Iowa Dental association

Education/Credentials
DDS degree

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