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Dentistry/margin stain fissure sealant

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QUESTION: Hello Dr. Peck,

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: Hi Haley and thanks for your question.

In my opinion, fissure sealants are very valuable in preventing tooth decay, especially in deep fissures or in patients with a high caries index/poor or where home care is limited.  Some of the materials used even have the ability to facilitate increased fluoride release to the area where they are placed, increasing their benefit.  It is not unusual for some excess material to be present on the biting surface of the tooth but this will smooth off under normal function, leaving the sealant firmly fixed in the fissure itself.  I really do not see any benefit of having the sealant removed at all, even if some superficial staining of the sealant material is present.  As I Said, this will wear down over time and shouldn't pose any problems for you, but the choice is yours and it is your body.  If you prefer that the sealants are removed, then ask your dentist.  I hope this helps and wish you all the very best further, take care.

Kind regards
Dr Craig Peck

---------- FOLLOW-UP ----------

QUESTION: Hello Dr. Peck,

Thank you for taking time out of your busy schedule and answering my question. I wanted to clarify my situation a little bit more because I don't think I explained it to you clearly.

The sealants that my dentist placed a few months ago was a filled resin. It was not flowable and he had to make adjustments when he put them on so that my bite would not be thrown off.

Now my concern is that there seems to be staining around the margins of the sealants. I can't get them off and I brush 2 or 3 times a day for 2 to 3 minutes. It seems that everytime I eat more and more staining is occuring and I am worried that those stains will turn into cavities.

The reason he sealed off my fissures were because they had some very light brown staining and they were a little deep. He said that since I couldn't brush down into those stains/fissures that they would eventually turn into cavities. I feel like the sealants are not doing what they are supposed to do because there is stain buildup around the margins of the sealant.

I have a feeling that he didn't apply the sealants right and they may have been put on with the wrong material. I would really like to take them off because they seem to be doing more harm than good. I haven't had a cavity in about 10 years and I go to the dentist every six months. I feel like I didn't need the sealants in the first place.

Lastly, if the sealant material is thick and filled is it possible to remove them without harming the tooth enamel? I want to remove the sealants but I am afraid that my dentist might grind off some of the tooth when taking the sealant off. Another dentist suggested that he could maybe pop them off with an explorer.

Thank you again for your help and I really do appreciate the time and effort put into helping others on this site!

Answer
Hi Haley and thanks for the follow up.

AS I said, it is purely up to you what you feel is the best for you - its your body and you remain the boss of all the elements thereof.  One can sometimes pop the sealants off, depending on the material used and the bond strength obtained with the underlying enamel of the tooth.  If this isn't possible, they could be drilled out with a very fine diamond bur with very little, if any, damage to the underlying tooth.  I hope this helps and wish you all the best in resolving this dilemma.

Kind regards
Dr Craig Peck

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Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)

Expertise

I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.

Experience

I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Organizations
Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

Education/Credentials
B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

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