	Sealants have become quite popular and a number of programs have surfaced to help ensure that school children and other young patients have access to sealants to help protect them from tooth decay.

	Both the ADA and the Centers for Disease Control and Prevention help educate the public on the benefits of sealants and plenty of information on the topic can be found on their respective Web sites (ada.org and cdc.gov/ORALHEALTH). The use of sealants is a staple at most practices that treat children. Adults can benefit from sealants as well.

	But Dr. Gordon Christensen, headlining a panel of six experts in a variety of dental fields, pointed out that studies have shown cases where some serious decay was found after dentists removed sealants. At a CE course titled “Panel-Controversies in Dentistry-2010” at the Chicago Dental Society’s Midwinter Meeting in February, Dr. Christensen said, “Everybody has taken out sealants and found caries under them.”

	While not suggesting their use be stopped, Dr. Christensen warned against “arbitrarily placing them on kids with low caries risks.”
	
	


	When done well, sealants have been shown to last as long as 5 to 10 years. But as in the case with all oral health treatment plans, it is key to have sealants checked on a regular basis. Dental sealants are basically thin plastic coatings applied to the chewing surfaces of the back teeth to protect from decay. These sealants protect the chewing surfaces by keeping germs and food particles out of the grooves. If they are found not to be in place, they can be reapplied to ensure their continued effectiveness.

	Matthew Messina, DDS, Consumer Advisor for the American Dental Association, said sealants have their place in caring for patients who are at risk for caries.

	“The decisions on sealants are really an easy one for the dentist,” the Ohio dentist said. “A sealant is a protective covering for teeth without decay, to help the patient get safely through a cavity prone period-usually adolescence into adulthood. If there is decay present in the tooth, then the decay needs to be removed, at which time the restoration is no longer a sealant. A well-placed sealant protects the deep grooves, pits and fissures in the biting surfaces of the teeth. It remains the clinical decision of the dentist, chairside in examination and consultation with the patient and/or parent, as to whether decay is present and whether a sealant is indicated.”


	Chicago hygienist Kasia Jimenez, BS, RDH, said all the children at the practices where she has worked have gotten sealants as a preventive measure. She also has seen her share of decay under sealants, just as Dr. Christensen conveyed. 

	“Sealants are very common in practices I work at. There are no specific age group we start placing sealants, however we place sealants on permanent teeth,” Jimenez said.  “Every child/teenager/adult is treated as an individual case. There were a couple instances where I sealed primary teeth. That particular patient was congenitally missing permanent molars.

	“Once again, our goal is to maintain those primary teeth as healthy as possible and as long as possible. I did a rotation at Boys and Girls Club where sealants played an important preventive feature. I also applied as a volunteer at Community Health Clinic and Goldie’s Place (shelter for homeless) and I hope to implement patient education on sealants there.”

	Patients with sealants are not expected to return more frequently to have them checked, rather Jimenez says they are evaluated at the patient’s scheduled recare visit. At her practices, sealants get examined with an explorer and with radiographs (if the patient is due for them), and for a virgin tooth Jimenez said they’ll also use KaVo’s DIAGNOdent (kavousa.com) for the examination.

	According to the ADA, children and teenagers are obvious candidates for sealants since the likelihood of developing caries in pits and fissures begins at a young age. But that’s not to say older patients can’t be protected by them.

	“Absolutely! I am a strong believer in prevention,” Jimenez answered when asked if adults should use sealants. “If I see an individual with a caries problem I strongly recommend sealants in this case. If I can prevent further damage in patient’s oral health I will place sealants on adults if necessary. That said, evidence of incipient occlusal caries would qualify for a sealant. Dentinal caries need to be restored and not sealed.”

	She added that when placed properly, patients are satisfied with the longevity of sealants. She has noticed strong results, in particular from Ultradent products (ultradent.com).

	But important steps need to be followed to help the sealants work their best. Jimenez has seen her share of caries under failed sealants. That’s why she stresses the importance of placing them properly.

	“Number one step that is not executed correctly is the isolation of the tooth,” she said. “Rubber dam or Dri-Angles will help in this step. The area has to be dry in order for the sealant to bond properly and ensure the longevity of it.”

	The other critical factor is the cleanliness of the surface. “I always pumice the area and secondly etch the isolated and dried area to increase surface irregularities for maximum sealant retention,” she said. “Once the tooth is prepared it is crucial that it’s dry before placing the sealant.”

	She also recommends you wait several seconds after the sealant is placed to allow the sealant to flow into the pits and fissures.

	Jimenez also has talked to colleagues unaware of the importance of pumicing, so she wants to make sure that step is not skipped. “Usually patients come for their recare visit and at the same visit they receive sealants,” she said. “If you polished teeth with prophy paste you just placed flavoring agents, glycerin and fluoride which may interfere with sealant bonding. It is crucial to pumice teeth that will be sealed on the same visit or polish after sealants are placed.”

	Do far too many dentists open up sealants and find decay? Yes. Does this mean that they’re not a beneficial tool in fighting decay? No.

	When done well and when checked on a regular basis, sealants do just what they’re intended to do-that is they act as a barrier in protecting enamel from plaque and acids.

Articles

   Photo: Getty Images / Mike Kemp  Sealants have become quite popular and a number of programs have surfaced to help ensure that school children and other young patients have access to sealants to help protect them from tooth decay.

Are sealants always the answer?

	“We’re still conducting interviews at this time but we’ll contact you when we’ve made a decision.”

	That could mean a few things: they’re honestly interviewing more candidates, they’re in the process of selecting a hygienist or they are not considering me at all and not telling me yet.  I hate this.  What must I do to get employed?  We’ll be okay with the mortgage for a couple more months but what about all of the other bills?  We can’t delay the car payment again.  I’m so glad we were able to refinance on the house.  Syd’s daycare.  We still have to pay for that.  At least that’s tax deductible.  Temp jobs are nowhere to be found.  I’m getting scared.  I have to find something soon.

 Email unsolicited resume’s to all dental offices in and around Chicago beginning with ‘A’.

	If I were a dentist and I wanted to hire me I would be incredibly lucky to find me because I (the dentist) would be so much like me (the hygienist) and there would be more of us to go around in a practice and we would both love science, music and cooking and the staff would get lots to eat and every work day would be a big, fat, happy potluck.  Everybody wins! 

 List relevant factors for building and maintaining a cohesive dental staff.  What does teamwork truly entail?   
	 
	

	I interviewed with that other office a couple of weeks ago.  The office manager seemed to be impressed with my software knowledge though I wish we spent more time talking about what she’s looking for.  Didn’t she say she was going to call me for a working interview?  Yea, she did… but she hasn’t.  I felt positive and got comfortable vibes from her.  Got to meet the dentist and tour the practice but that’s what happened last time with another office.  Everything appears to be going my way then I get shot down.  Is this what I have to look forward to until the economy starts getting pumped up again?  Can’t teach clinicals-no bachelors.  No extra income to go back to school anyway.  Even if we had a hidden stash of funds it would all go towards Syd’s college fund.  I’m running out of options…

	And that house across the street went into foreclosure.

Should I go back to working corporate dental insurance?  Call every company.  What about a receptionist position?  I’ve never dental assisted before.  Would an office be willing to train me as an assistant?  Perhaps the ADHA downtown needs help.  Don’t close any doors.


	 
	Alright. Enough is enough. This is my Official Day of Stupid! My toddler and I are going to dance like fools to Lady Gaga, I’m going to sing my heart out to No Doubt and Alanis Morissette, I’m going to have a wicked snowball fight with Erik and Syd and I’m not going to think about dental hygiene NOTHIN’!
	 
	

 Begin writing ‘girls with curly hair’ book for Syd.  Try to get a sitter as well.  Maybe Erik and I can see a movie.  Make that cheesecake! 

Eva Watson, RDH is also a writer and lives in Highland Park, IL with her husband and daughter.

		Comment on this and other articles on our Facebook page

		Part Three: Diary of an unemployed hygienist

   Photo: Eva Watson  Day 20  “We’re still conducting interviews at this time but we’ll contact you when we’ve made a decision.”

Part Two: Diary of an unemployed hygienist

	“Did you call that office today?” I called them twice.

	“Did you apply for any new ads?” The few that come out I always apply for.

	“Are you following up with your phone calls?” Always.

	“Do you have any temp gigs coming up?” I only have one next week.

	I always tell him I’m trying. The pressure is building. It’s starting to come between us. Erik has been complaining about stomach discomfort since the beginning of all this. I’m worried about his health. The fact I can’t contribute to our household is tearing me up. I’m responsible for half our bills. We’re a team. His nagging is justified. I’m doing everything I possibly can to, at the very least, get a verbal response from any practice. What else can I do to appease him?

	Day 37 Goal: Keep talking with Erik about everything we feel regarding this situation. Our lines of communication can’t break down. We need each other. Sydney needs us.

	Just finished reading a post on that hygiene Web site. Those opinions on bonuses, fairness and cheap dentists made for an interesting read. The fact that bonuses are still being allocated nowadays is somewhat of a surprising accomplishment to me. I’m pleased there are practices out there that continue to thrive but those hygienists are lucky and fortunate to have the opportunity to work. I’m certain they realize that. I hope they do. I loved when I got those huge bonuses. Who wouldn’t? I remember the big bucks I made as soon as I received my license. That was almost five years ago.

	Man, we were rolling in it. Got the house and put money away. Seemed like I was frequenting Old Navy monthly for Sydney and I was purchasing new lab coats for myself all of the time. I could settle for an unfair, cheap, anti-bonus dentist right about now.

	Day 40 Goal: If an offer comes in and the dentist can’t offer the going rate, take a pay cut. I know what Erik and I can comfortably live on. Don’t be concerned with bonuses or extras. There will be chances to prove myself later. We’re living in a completely different economic country. Everything has changed.

	Whoa, woman. Calm down. Easy…BUT WHY DIDN’T THEY HIRE ME?! I temped in their office for three weeks. They asked me back for three, continual weeks, the staff and I had great laughs, the dentists complimented my work and I performed my job to the utmost of professionalism. Why? What happened? Did someone give me a bad reference? Did I leave calculus? Did I look at someone the wrong way? Am I some kind of freak? What!? I’m going outside to scream! I’ll explain my behavior to the neighbors later!

	Okay, I’m done complaining now. I’m back in control and I can see clearly again. I believe what transpired was this practice had a particular candidate in their sights from the beginning of the selection process but wanted to continue talking with other interviewees and weed out who was not right for their practice. They had to make the best decision for their patients and staff. I believe they liked what I could offer their business but weren’t quite sold. So they asked me to temp for them until, unbeknownst to me, their continued search revealed their ideal hygienist.

	That was quite a rationalization but I’m getting over it. I learned a lot from that experience.

	Day 43 Goal: Temping will not ensure a permanent position. Keep my options open. Don’t put all of my eggs in one basket. Enhance my strengths and correct my weaknesses.

	This is fantastic! Two interviews lined up in the next couple of weeks. What can I give these two offices? Integrity and hard work. I know what I’m capable of and I’m excited to offer them my dental hygiene experience.

	What are my strengths? Great clinical abilities, effective communication and a great business sense.

	What do I want? A progressive dental practice I can grow professionally with while being satisfied personally. My Three Ps! I love it. Thank you Day 50.

	Day 50 Goal: Take solace in my accomplishments. Revel in my improvements and learn from all these experiences since unemployed Day 1. Use ‘My Three Ps’ slogan to keep me motivated and on the right path. If these practices wish to hire another hygienist, push on!

	Hmm…perhaps I should write for a dental hygienist magazine as an outlet. I don’t know. Gee whiz, where would I find the time? All I have is time. Would any hygiene professional be interested in reading about content like this? I do enjoy writing greatly. I’ll consider it. I’ll ask husband and get his take on it as well. I hope I don’t have a Day 60 entry. Wait… is that my phone?

	Eva Watson, RDH is also a writer and lives in Highland Park, IL with her husband and daughter .

   Photo: Eva Watson  Day 37  “Did you call that office today?” I called them twice.  “Did you apply for any new ads?” The few that come out I always apply for.  “Are you following up with your phone calls?” Always.  “Do you have any temp gigs coming up?” I only have one next week.

modernhygienist.com-2010-04-01

Are sealants always the answer?

Part Two: Diary of an unemployed hygienist

Part Three: Diary of an unemployed hygienist