FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

DENTAL SEALANTS: KIDS "YES," ADULTS "MAYBE"

Question: My dentist has recommended that I have sealants put on my teeth. I've only had one cavity in my life, but my dentist says some of my rear molars have developed "pits" and cavities may soon develop. I've seen a lot of articles that highly recommend sealants for children, but I haven't seen anything that addresses whether sealants are necessary for adults. The sealants my dentist recommends are not inexpensive. He says it would cost about $600. Is this procedure worthwhile?

Answer: Your question is one that stretches the limits of my expertise, so I've had to do more than my usual amount of research to provide you an answer. I'll begin by talking about those evil "pits" your dentist has found in your teeth.

Healthy teeth have a smooth, hard, protective and wear-resistant outer layer called enamel. It is formed as the tooth grows and can have slight imperfections. Small "pits" on the chewing surfaces of the back teeth, along with small lines called fissures are examples of these imperfections. When these flaws are very shallow, they cause no problem. Larger defects in the protective layer of enamel produce a place for several types of bacteria (Actinomyces, Staphylococcus, Streptococcus and Veillonella, if you want to be on a first-name basis with these little critters) to attack the tooth and cause a cavity. A sealant forms a protective coating over the imperfections that can't be penetrated by these decay-causing bacteria.

Young children and adolescents have much more tooth decay than do adults, so they are a better group to use in a study of a new product that may reduce cavities. A 1991 study published in the Journal of American Dental Association compared individuals that had their teeth treated with sealants when they were children 15 years ago with similar individuals that had no sealant applied to their teeth. It showed that 31.3 percent of the sealant group developed a cavity of the first molar, and in the group that had no sealant applied, 82.8 percent had a cavity in that tooth. This study and many others have shown that sealants reduce the frequency of cavities.

Cavities occur more commonly in children, but adults get them, too. You said you have only had one filling, but your dentist may have noted that your dental "pits" have shown signs of deterioration that could lead to many small cavities. Some dentists prefer to continue watching this type of problem until deterioration becomes great enough to require a filling. A dentist with a more aggressive belief in preventive care would recommend a sealant in this type of situation, since sealants have been shown to reduce the chances of progression to cavities. Sealants are not routinely used for adults because of the low rate at which they develop cavities. However, each individual's situation is different. Your dental health may be improved by the use of a sealant. Talk with your dentist again. You may also want a second opinion, since according to my colleagues in the dental profession the $600 charge is quite high for this type of care.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.