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3.5 Criteria and Methods for Selecting Teeth to Be Sealed

Explorer Use (Tactile Criteria)

  • Child in dental chairExplorers are not necessary for detecting non-cavitated or cavitated lesions. Evidence suggests that use of an explorer does not improve detection.
  • Forceful use of an explorer on a non-cavitated, subsurface lesion can easily produce a break and cavitate it, thus damaging the tooth. Under existing guidelines and recommendations, this tooth would no longer be a candidate for dental sealant placement.
  • The explorer may be used gently to clean debris or remove plaque; and, once the tooth is sealed, to help assess sealant integrity and retention. An explorer should not be used to assess non-cavitated or cavitated lesions except in those rare occasions where there is doubt about whether cavitation is present. In such instances, the explorer tip can be placed in contact with the tooth surface and moved very gently in the area of interest to see if a discontinuity or break is detected. In fact, if there is any doubt that cavitation is present, it may be best to seal the tooth if a child is determined to be at high risk for caries.

X-rays

  • X-rays should not be taken for the sole purpose of determining whether dental sealants should be placed.7
  • Whether taking X-rays results in more accurate assessment (compared with conducting a visual assessment of occlusal surfaces) has not been determined.
  • Many non-cavitated lesions extend into the dentin; however, this does not mean they are active and therefore in need of operative intervention. Thus, in occlusal surfaces, seeing a lesion in the dentin on an X-ray is not a diagnosis of surface cavitation or an active infection.
  • Since the decision about whether to seal teeth is based on surface cavitation and not on whether a lesion is limited to the enamel or is histologically or radiographically into the dentin, taking X-rays will not alter school-based dental sealant programs’ decisions about whether to seal a tooth.