Get any sealant that's available. My 21 year old has never had a cavity. Dental insurance no longer covers the application at this age but still cost effective.
I'm uncertain why a health economist is writing about oral health ... so here it goes from America's Dental Hygienist, 28+ years licensed dental hygienist, speaker, author, vlogger. In effort to recognize the difference between sealants ... let's first begin with parents. Mom or dad must be proactive and establish their child with a pediatric dentist or general dentist by age 1-2. Why? Because there is an bacterial infection that targets kids and it is preventable .... and its treatment is painless! Tooth decay IS an active bacterial infection. I've seen TOO many kids by 3rd grade miss school, endure pain, social embarrassment because they have not been in to see their dental hygienist. Soft teeth is a blanket statement. What happened during tooth development ... let's discover the cause. Trauma, high fever, malnutrition, rare genetic condition. Next, determine the level of risk for tooth decay, home environment for nutrition/oral hygiene home care. Sealants ... when placed properly they will stay. Most, will need replaced due to lack of tooth isolation (kids have a ton of saliva) out of date light to harden material, home care (chewing gum, sticky candy that pulls material off) or they were place before tooth fully erupted. Take your child to hygienist to check status of sealant, check health of enamel, + check health of their mouth. The deal is this, oral health is multifactorial. Tooth decay is preventable.
The future is here=
“The SMaRT Replacement Therapy was designed to be a painless, one-time, five-minute topical treatment applied to the teeth that has the potential to offer lifelong protection against tooth decay,”
“The SMaRT Replacement Therapy was designed to be a painless, one-time, five-minute topical treatment applied to the teeth that has the potential to offer lifelong protection against tooth decay,”
1
Why is an economist writing about dental sealants? Seriously, one should question why someone who is NOT an expert on health, specifically dental health is writing a story based on faulty studies. Children with sealants are more likely to get LOTS of cavities if a sealant were to chip or crack, which happens often. Once the sealant has even a tiny little crevice, bacteria gets trapped inside and multiplies like crazy because your toothbrush can't reach what's under the sealant. I've had sealants and the ONLY cavities I have are on the teeth that had sealants. AVOID. If your child brushes his/her teeth regularly and doesn't chew on sticky or hard candy, s/he should be fine.
I never heard of this treatment. As a child, I had numerous cavities. As an adult, I've also had lots of cavities. My dentists over the years never ever mentioned this possible treatment to me, and now I'm wondering why. I've always paid directly for my treatments; just paid $375 for another session a few weeks ago.
Are sealants effective for adults?
It isn't about the money. It is all about whether your child has "soft" teeth and is susceptible to cavities or not. As a veteran of serious and necessary dental intervention, I wanted my children to avoid this by preventive dental care. My son has teeth like "concrete" as the dentist has said but my daughter was not so fortunate. She had pediatric sealants after an early cavity (no further cavities) and then I also paid for sealants on her adult teeth since they came in when she was on the younger side. So even though she tries to keep her teeth clean, she now got cavities between her teeth at 18. The top sealants worked but they couldn't protect between her teeth efficiently. It is too bad that I couldn't seal each entire tooth. My son has had no sealant and no cavities. I can't wait until oral biomes are identified and can be used to help balance the good and bad bacteria in the mouth hopefully limiting cavities, period.
3
We have been offered sealants by various dentists and have always declined. Like x-rays, sealants are covered by insurance and seem to be pushed as an add on by practices whose bottom line is often pretty slim. Dentistry is not as lucrative a career as it used to be. Our favorite and most experienced pediatric dentist told me pointedly, that he did not favor sealants as he had seem many cases where bacteria trapped under the sealant in a poor application had led to severe decay that was harder to identify. He simply recommended against sealants for that reason and watched molars carefully at regular visits. He also did not push excess use of x-rays at all. Other practices were often persnickety if you chose to forego there "advice" for frequent dental x-rays.
Not incidentally, three kids, one cavity in over 20 years. In our family, we treat tooth brushes as utensils. They pop into the dishwasher after every use, get a light spray of bleach solution, wash and are available to everyone to grab from the kitchen drawer for each use, sanitized and fresh. We also taught the kids to brush thoroughly the back of their tongues where the sulphur bacteria implicated in tooth decay is primarily found. The result has been no cavities barring the one my daughter had 10 years ago. The lower risk of tooth decay allows us to feel confident in being conservative about our use of dental procedures like sealants and x-rays that we feel should be used more judiciously than they often are.
Not incidentally, three kids, one cavity in over 20 years. In our family, we treat tooth brushes as utensils. They pop into the dishwasher after every use, get a light spray of bleach solution, wash and are available to everyone to grab from the kitchen drawer for each use, sanitized and fresh. We also taught the kids to brush thoroughly the back of their tongues where the sulphur bacteria implicated in tooth decay is primarily found. The result has been no cavities barring the one my daughter had 10 years ago. The lower risk of tooth decay allows us to feel confident in being conservative about our use of dental procedures like sealants and x-rays that we feel should be used more judiciously than they often are.
2
Still irritated after all these years that pediatric dentist never even brought this up....malpractice.
Sealants without BPA or BPA derivatives have been available for years.
BPA is widely used in plastics and coatings. In the dental industry it is used in the manufacturing of Bis-GMA, a monomer used in many dental sealants and composites. Since it is used to manufacture Bis-GMA, there is concern that residual Bisphenol A might be present in dental materials made with Bis-GMA.
Embrace Pit & Fissure Sealant made by my family’s company, Pulpdent Corporation, in Watertown, Massachusetts, was introduced fifteen years ago and is formulated without BPA, Bis-GMA, Bis-DMA or any other derivative of BPA. Concerned parents can request Embrace sealant and eliminate any possibility that BPA or its derivatives is in the sealant material.
The sealants my dentist put on my teeth long before public concern over BPA served me very well through my childhood. When my children get permanent teeth, I will have Embrace sealants put on their teeth so that they also enjoy years of protection from caries.
BPA is widely used in plastics and coatings. In the dental industry it is used in the manufacturing of Bis-GMA, a monomer used in many dental sealants and composites. Since it is used to manufacture Bis-GMA, there is concern that residual Bisphenol A might be present in dental materials made with Bis-GMA.
Embrace Pit & Fissure Sealant made by my family’s company, Pulpdent Corporation, in Watertown, Massachusetts, was introduced fifteen years ago and is formulated without BPA, Bis-GMA, Bis-DMA or any other derivative of BPA. Concerned parents can request Embrace sealant and eliminate any possibility that BPA or its derivatives is in the sealant material.
The sealants my dentist put on my teeth long before public concern over BPA served me very well through my childhood. When my children get permanent teeth, I will have Embrace sealants put on their teeth so that they also enjoy years of protection from caries.
1
We have been offered sealants by various dentists and have always declined. Like x-rays, sealants are covered by insurance and seem to be pushed as an add on by practices whose bottom line is often pretty slim. Dentistry is not as lucrative a career as it used to be. Our favorite and most experienced pediatric dentist told me pointedly, that he did not favor sealants as he had seem many cases where bacteria trapped under the sealant in a poor application had led to severe decay that was harder to identify. He simply recommended against sealants for that reason and watched molars carefully at regular visits. He also did not push excess use of x-rays at all. Other practices were often persnickety if you chose to forego there "advice" for frequent dental s-rays.
Not incidentally, three kids, one cavity in over 20 years. In our family, we treat tooth brushes as utensils. They pop into the dishwasher after every use, get a light spray of bleach solution, wash and are available to everyone to grab from the kitchen drawer for each use sanitized and fresh. We also taught the kids to brush thoroughly the back of their tongues where the sulphur bacteria implicated in tooth decay is primarily found. The result has been no cavities barring the one my daughter had 10 years ago. The lower risk of tooth decay allows us to feel confident in being conservative about our use of dental procedures like sealants and x-rays that we feel should be used more judiciously than they often are.
Not incidentally, three kids, one cavity in over 20 years. In our family, we treat tooth brushes as utensils. They pop into the dishwasher after every use, get a light spray of bleach solution, wash and are available to everyone to grab from the kitchen drawer for each use sanitized and fresh. We also taught the kids to brush thoroughly the back of their tongues where the sulphur bacteria implicated in tooth decay is primarily found. The result has been no cavities barring the one my daughter had 10 years ago. The lower risk of tooth decay allows us to feel confident in being conservative about our use of dental procedures like sealants and x-rays that we feel should be used more judiciously than they often are.
3
I had sealants on all of my teeth as a teenager but had never had a cavity up to that point so It probably was needless. My teeth are perfect but I have breast cancer at age 39 and had endometriosis since I was 23. I have to wonder if all this plastic in my mouth has something to do with both diseases?
I think it's irresponsible not to do real research on BPA in these sealants as endocrine diseases and cancers are on the rise.
I think it's irresponsible not to do real research on BPA in these sealants as endocrine diseases and cancers are on the rise.
1
Fact checks
1. The CDC suggests that at 1ppm "it is unlikely that fluoride will have any effect on the bacteria causes tooth decay"
This is backed up by the recent report by the Cochrane review that states there is no evidence to show that adult teeth benefit from drinking fluoridated water.
Fluoride is a known endocrine disrupter and neurotoxin. when we put it in our water we cannot control for dose and we do not monitor for adverse side effects. One 170g tube of toothpaste is enough to kill a one month old baby. Keep out of reach of children and do not swallow.
1. The CDC suggests that at 1ppm "it is unlikely that fluoride will have any effect on the bacteria causes tooth decay"
This is backed up by the recent report by the Cochrane review that states there is no evidence to show that adult teeth benefit from drinking fluoridated water.
Fluoride is a known endocrine disrupter and neurotoxin. when we put it in our water we cannot control for dose and we do not monitor for adverse side effects. One 170g tube of toothpaste is enough to kill a one month old baby. Keep out of reach of children and do not swallow.
2
My children's dentist wanted to do it at age 3 1/2. Doesn't that seem early? Is there any point to doing that now or should we wait til they are older?
1
Only permanent teeth should be sealed, not baby teeth
You can only hope that one day, what comes out of your kid’s mouth will one day be worth all the money you put into it.
3
"To expand application of sealants, some states have initiated sealant programs through schools."
states? what about private insurance companies? if sealants are cost-effective, they should be privately insured, as well as subsidized by state government funds (aka medicaid).
suggested topic for next article: a cross-country analysis on the effectiveness of fluoride in tap water.
states? what about private insurance companies? if sealants are cost-effective, they should be privately insured, as well as subsidized by state government funds (aka medicaid).
suggested topic for next article: a cross-country analysis on the effectiveness of fluoride in tap water.
1
"states? what about private insurance companies? if sealants are cost-effective, they should be privately insured, as well as subsidized by state government funds (aka medicaid)."
They are. However thousands of children go to school every day in pain from cavities or infection in their teeth and mouths because even with 100% coverage for preventive treatment through private insurance or state-funded insurance, their parents still don't bring them to the dentist to receive these benefits.
The vast majority of private insurance programs cover sealants at 100% up to age 18. Medicaid and CHiPs cover sealants. However, we are limited in that we can't hunt them down and force them to come see us (the dentist).
They are. However thousands of children go to school every day in pain from cavities or infection in their teeth and mouths because even with 100% coverage for preventive treatment through private insurance or state-funded insurance, their parents still don't bring them to the dentist to receive these benefits.
The vast majority of private insurance programs cover sealants at 100% up to age 18. Medicaid and CHiPs cover sealants. However, we are limited in that we can't hunt them down and force them to come see us (the dentist).
4
Effectiveness of fluoride: http://www.thecommunityguide.org/oral/fluoridation.html
Just stay away from dental amalgam aka "silver fillings." They contain 50% mercury which off-gasses with heat and abrasion. Exposure is highest during placement, removal and polishing, followed by teeth grinding, chewing, and exposure to heat. The tiny amounts that the ADA and FDA claims are harmless cause great harm to children and adults with common genetic variants who do not methylate - clear metals and toxins - well. Blood mercury levels may be low because it is stored in nerve tissue and organs.
The fact that FDA overruled the concerns of its two expert Dental Products Panels in 2006 and 2010 who called for patient warnings and a phase down or end of its use should be a cause for concern. The fact that FDA was about to issue a patient safety warning in early 2012 but was overruled by HHS based on a GAO cost study should be cause for concern.
The growing number of peer reviewed journal articles in PubMed since 2011 (see James S Woods) finding harm from dental amalgam for certain gene types, associations with a range of chronic diseases, and associations with higher blood levels of mercury in NHANES, should be cause for concern.
ADA is the poster child for how to mount the most effective lobbying and PR campaign in history to defend a pre civil war era product it was founded to promote, and on which its affiliates have held patents over the years. Its own code of ethics prohibits member dentists from raising concerns about health risks from dental amalgam.
The fact that FDA overruled the concerns of its two expert Dental Products Panels in 2006 and 2010 who called for patient warnings and a phase down or end of its use should be a cause for concern. The fact that FDA was about to issue a patient safety warning in early 2012 but was overruled by HHS based on a GAO cost study should be cause for concern.
The growing number of peer reviewed journal articles in PubMed since 2011 (see James S Woods) finding harm from dental amalgam for certain gene types, associations with a range of chronic diseases, and associations with higher blood levels of mercury in NHANES, should be cause for concern.
ADA is the poster child for how to mount the most effective lobbying and PR campaign in history to defend a pre civil war era product it was founded to promote, and on which its affiliates have held patents over the years. Its own code of ethics prohibits member dentists from raising concerns about health risks from dental amalgam.
5
The glass ionomer alternative to resin based sealer works in part because it is a deposit of fluoride directly on the tooth. The glass based sealer is "leaky" and doesn't seal the tooth as well as a resin based one.
So the choices are BPA, fluoride, or roll of the dice.
So the choices are BPA, fluoride, or roll of the dice.
I'm 30 and have never even heard of these before.
Would my children get these? No. Brush your teeth twice a day, eat healthy, reduce sugar.
No need to put extra chemicals in bodies. Also no need to get the X-rays as frequently as recommended.
Would my children get these? No. Brush your teeth twice a day, eat healthy, reduce sugar.
No need to put extra chemicals in bodies. Also no need to get the X-rays as frequently as recommended.
6
Unfortunately, the precautions you mention aren't always enough. I've always been diligent with my dental hygiene and took pride in being cavity-free. When I reached adulthood, my dentist informed me that the way my molars had formed made preventing cavities literally impossible for me to do on my own. A second dentist whom I trust even more agreed.
So, I got some sealant applied to prevent the issues going any further. I'd say your mind is definitely on the right track, just know there are circumstances where these procedures are the best or only way to nip tooth decay in the bud.
So, I got some sealant applied to prevent the issues going any further. I'd say your mind is definitely on the right track, just know there are circumstances where these procedures are the best or only way to nip tooth decay in the bud.
My three adult sons had sealants plus two teeth cleanings a year and have never had a cavity. I think the benefits out way the risk in this case. The dentists are always amazed that some of the sealants are still on their molars.
5
My now 46 year old daughter had sealants applied in elementary school.
She had early onset puberty, fertility issues, obesity (none run in family).
No cavities.
How would researchers track back any association with BPA?
Probably BPA in the baby bottles and dishware then too.
Worries me.
She had early onset puberty, fertility issues, obesity (none run in family).
No cavities.
How would researchers track back any association with BPA?
Probably BPA in the baby bottles and dishware then too.
Worries me.
7
Nowhere is there data shown in these studies on other symptoms besides dental caries as a result of adding 'sealant' in the mouth. Plastic-covered food is known to provoke less-than-healthy bodies. What is this sealant (s) made of?
The studies should have and could have asked about symptoms of ALL kinds in both the sealant and non sealant groups.
Any future studies should include symptomatology in subjects. Of course the studies should be designed by open-minded persons and not anyone standing to gain from people buying more sealant, or by anyone who has become 'sold' on sealants.
From a former long-time trauma psychotherapist who has been trained in scientific method and nutrition.
The studies should have and could have asked about symptoms of ALL kinds in both the sealant and non sealant groups.
Any future studies should include symptomatology in subjects. Of course the studies should be designed by open-minded persons and not anyone standing to gain from people buying more sealant, or by anyone who has become 'sold' on sealants.
From a former long-time trauma psychotherapist who has been trained in scientific method and nutrition.
5
I'm pro brushing, flossing and dental sealants !
My 30 year old son had sealants. Not one cavity !
No major dental expenses, pain or trauma.
My 30 year old son had sealants. Not one cavity !
No major dental expenses, pain or trauma.
3
My parents have plenty of fillings and whatnot, so I was not just genetically blessed. I had sealants; I don't have those issues. When I think about the money and pain I have been saved by that procedure some 35 years ago, I am blown away by what a good investment that was. My friends in Europe were baffled when I explained to them that cavities—for the middle class and upwards who can afford sealants/insurance, of course—are basically a relic of the past.
6
Being such as an effective preventive measure, I wonder why dental insurances do not cover sealants for children? ??
23
Our insurance covers it.
2
Almost all major dental insurance plans cover sealants for children up to age 18. A few cover them for adults. Federally funded Medicaid and CHiPs programs cover sealants.
I know of only one employer based insurance plan in our area that does not cover sealants at least to age 18.
I am a dentist and recommend sealants for most of my child patients. Occasionally I will see a kid with teeth that are so flat that sealants are not needed. If you read the entire op-ed piece, you will have noted that while BPA may be found in the spit for up to 24 hours, it has not been found, even in trace amounts in the blood stream.
It is also worth noting that the bis-phenol containing resin which is used by the milliliter to place a sealant is the exact same material that makes up tooth-colored resin fillings. So if you avoid the sealant in order to avoid exposing your child to BPA, and then they have a cavity that needs to be filled, your choice is pretty much a BPA containing tooth colored filling material or a mercury containing silver filling, only now, it will take 10-20x more than the scant milliliter or so that would have been used to place a sealant. All you've done is post-pone and increase the exposure.
I know of only one employer based insurance plan in our area that does not cover sealants at least to age 18.
I am a dentist and recommend sealants for most of my child patients. Occasionally I will see a kid with teeth that are so flat that sealants are not needed. If you read the entire op-ed piece, you will have noted that while BPA may be found in the spit for up to 24 hours, it has not been found, even in trace amounts in the blood stream.
It is also worth noting that the bis-phenol containing resin which is used by the milliliter to place a sealant is the exact same material that makes up tooth-colored resin fillings. So if you avoid the sealant in order to avoid exposing your child to BPA, and then they have a cavity that needs to be filled, your choice is pretty much a BPA containing tooth colored filling material or a mercury containing silver filling, only now, it will take 10-20x more than the scant milliliter or so that would have been used to place a sealant. All you've done is post-pone and increase the exposure.
2
My employer's dental insurance plan does not cover sealants for "baby teeth". However,it does cover them for permanent teeth.
There are many children younger than 5 years of age that have lots of cavities in their baby teeth. If cavities are really bad for a child's health in so many different ways and to parents as well ( just think of the lost work time to take your child to the dentist for more invasive procedures and your pain and suffering seeing your child suffer through the process!), why an employer's dental insurance plan does not cover sealants for "baby teeth" as well? It just doesn't make any financial and business sense either.
There are many children younger than 5 years of age that have lots of cavities in their baby teeth. If cavities are really bad for a child's health in so many different ways and to parents as well ( just think of the lost work time to take your child to the dentist for more invasive procedures and your pain and suffering seeing your child suffer through the process!), why an employer's dental insurance plan does not cover sealants for "baby teeth" as well? It just doesn't make any financial and business sense either.
I am actually hesitant for another reason: the obsession with removing bacteria from the mouth may end up being harmful and I feel dentistry is not very modern-thinking in this respect. We have learned a lot about the role of bactieria in the gut and now we see that exposure to bacteria via farm animals and thumb sucking is beneficial. The bacteria in our teeth might also turn out to be beneficial and the cracks in the molars a perfect reservoir for them. Sure, there is no clear evidence now, but if i can help my children eat healthier by avoiding sugars and processed food i'm pretty sure they will avoid cavities anyway...
13
There is in fact beneficial bacteria in your mouth, however bacteria 'trapped' in crevices and which thrives there is not necessarily the beneficial type (anaerobic vs aerobic). We have an anti-bacterial chemical in our saliva to maintain control of the bacterial population know as IgA (immunoglobulin A). Bacteria in deep crevices are not as affected by the IgA. Similarly, sealants that leak trap the same bacteria and cause the exact opposite effect that is intended, namely decay. Sealant are and should be evaluated by a dentist on a patient by patient basis, determined on depth of crevices in the teeth, fluoridation, oral hygiene, genetic and environmental factors. One size does not fit all and this article give the impression that medicine works that way - it does not. What these studies don't tell us is what segment of the population was evaluated. There is variable caries risk (high, medium, low) among ethnic groups, socio-economic groups and geographical groups and within those groups there are genetic and oral hygine habits that vary considerably. Thus considering all these variables the question becomes how reliable are the studies before we jump to generalized conclusion. The quicker answer is to see a dentist who has been in your community for some time and has based his years of practice on his reputation. If that dentist also sees other family members and/or you have a long term history with him/her, chance are good you will have the answer that fits your needs.
1
Given the recent disclosures on sugar funded research, and polluter funded climate change denial, and tobacco funded cancer denial, and rampant fraudulent research by pharmaceutical companies, it would be helpful if all articles of thus type disclosed who funded the studies in question. It would be nice if we could trust that all medical research was untainted by profit motive but unfortunately it is pretty clear that those days are over (if they ever really existed in the first place).
35
On BPA concerns: Sealants apply a minute amount of plastic material to the teeth, which last for up to ten years. The amount of BPA or other questionable chemicals leaching into the saliva will be limited by the small amount of plastic present, and the fact that the same source of potential BPA will remain in place for a long time. It's this small risk that should be weighed against sealants' proven benefit against tooth decay.
10
See my comment above on plastics' potential for causing other symptoms of diseases. Until proper longitudinal studies are done no one can know if the sealant applied, say, 35 years ago is what is contributing to the cancer, or diabetes, or obesity or.....whatever....now.
4
Until they develop a sealant that has no possibility of leaching BPA or whatever else, I won't be getting them. It is not definitive to me that they pose no harm... we are only now recognizing the endocrin-disrupting damage that plastics and BPA do to our bodies and the ecosystem...
14
The affordable care act requires pediatric dentistry THEN this comes out.
4
The ACA requires coverage for pediatric dentistry, but subject to the same medical deductible. In my case, $120 for a 2-year-old's 5-minute cleaning with insurance, unless there had already been $7,200 in medical expenses to meet the policy's deductible. Thankfully, there hadn't been.
2
Why are sealants not offered to adults?
6
Great question.
The idea of applying resin to living teeth seems about as bright as making "silver" amalgam fillings which are actually up to 54% mercury. By the way there are no safe minimums of mercury just as there are no safe minimums of BPA.
The idea of applying resin to living teeth seems about as bright as making "silver" amalgam fillings which are actually up to 54% mercury. By the way there are no safe minimums of mercury just as there are no safe minimums of BPA.
3
They are. My dentist recommended sealants to me when I was in my 20s.
1
Sealants are most effective for preventing cavities on newly erupted teeth in children. As an adult, if you haven't yet had a cavity on the chewing surface of a virgin tooth, you are unlikely to get one. Most adults with cavities on chewing (occlusal) surfaces have decay at the margin of an old filling. Sealants cannot be applied to areas that were previously filled.
2
The only cavity I ever got was on a sealed molar where the sealant had broken and the cavity was able to develop under the sealant where it couldn't be brushed. Maybe sealants have changed in the last 20 years but the pediatric dentist said that the sealant needs to be monitored annually and possibly redone. So if you are someone who is not normally prone to cavities due to saliva ph or what have you, maybe it's worth it to think twice about it.
7
Its probably like seat belts. Most of the time they save you, sometimes they kill you.
5
I had my teeth sealed throughout childhood and still, at age 23, have yet to have a cavity. (FYI: I certainly wasn't the best about flossing or brushing throughout adolescence, either) Sealants work and are a very cost effective way to avoid cavities and the pain that comes with dental decay.
13
Before today, I had never even heard of plastic sealants being applied to teeth. But I have to wonder what the 24/7 exposure to a petroleum based product (plastic) in your mouth would do long term.
9
My daughter had dental sealants applied when she was a child. Now that she is almost 23, she has had a total of one small cavity in her mouth. Yes, she had the benefit of regular dental visits but so did I as a child and yet I have several teeth missing in the back of my mouth as a result of cavities, root canals and crowns, and ultimately cracked and broken teeth that had to be removed. Despite having excellent dental insurance coverage all of my life, I have spent thousands of dollars out of pocket and hundreds of hours in dentists' chairs because sealants were not available to me. I didn't hesitate when they were suggested for my daughter and I don't regret it for a moment.
34
Sealants are extremely effective in decay prevention in children, especially those that are decay prone despite good oral hygiene. The positive effects can last into adult hood.
Dentistry is expensive and restoration of tooth decay in a child or an adult can be invasive and traumatic.
People forget that even in 2016, one can still die from an untreated dental infection resulting from untreated tooth decay.
Sealants provide necessary prevention and those parents that refuse this treatment for their children could be setting up their children for future dental caries that could have been prevented. If you are concerned about BPA , ask your dentist to use glass ionomer.
Dentistry is expensive and restoration of tooth decay in a child or an adult can be invasive and traumatic.
People forget that even in 2016, one can still die from an untreated dental infection resulting from untreated tooth decay.
Sealants provide necessary prevention and those parents that refuse this treatment for their children could be setting up their children for future dental caries that could have been prevented. If you are concerned about BPA , ask your dentist to use glass ionomer.
12
$100 per tooth for a filling vs $30-40 per tooth for sealants x 20+ teeth (depending on which ones are sealed) is not exactly an argument for affordability. Also, it depends on genetics: some people have rock-hard cavity-resistant enamel; some don't; and yes, home hygiene and diet are also factors. I resisted sealant application for my kids because it actually involved stripping away some of the natural enamel. So in a way, yes, this still looks like an ADA upsell; though it's reassuring to see the Cochrane reports, it still may make sense to recommend these on a per-person basis and not ubiquitously - which is rather like saying all women need breast implants.
16
They don't seal all twenty teeth, just the rear molars.
4
Cavities and fillings sacrifice natural tooth tissue. Down the road, loss of natural tooth endangers the tooth. As years pass, preserving the tooth requires more and more procedures, costing more and more money. Eventually root canal or an implant may be needed.
That's the story of my mouth. In my fifties, I have a few teeth in my mouth that have cost into the five digits to save.
The cost of the sealant versus the cost of the first cavity is NOT the issue.
Your bizarre last sentence is gasp-worthy.
That's the story of my mouth. In my fifties, I have a few teeth in my mouth that have cost into the five digits to save.
The cost of the sealant versus the cost of the first cavity is NOT the issue.
Your bizarre last sentence is gasp-worthy.
2
We have two children, 17 and 12. Neither one has had sealants applied to their teeth. Neither one has ever had a single cavity.
Neither one of them ever drinks soda.
Funnily enough neither of them is obese either.
Cost effectiveness: through the roof.
Neither one of them ever drinks soda.
Funnily enough neither of them is obese either.
Cost effectiveness: through the roof.
41
you're very lucky
that doesn't mean the treatment is not effective dentally or cost wise
its like saying vaccines are useless because your children didn't come down
with the particular disease
that doesn't mean the treatment is not effective dentally or cost wise
its like saying vaccines are useless because your children didn't come down
with the particular disease
18
I'm a 45-year old adult; never had sealants, never had a cavity--until I had a band from braces removed from a molar. The orthodontist had not fully cemented it, and there was decay behind the band on the side of the molar, something that a sealant would not have protected. No other cavities; just the one more-or-less caused by my dental professional.
3
Your self-congratulations may not be in order.
Let's go anecdote v. anecdote:
My parents never bought soda, juice or or any sugar drink.
They personally supervised my dental hygiene.
"Funnily enough," I was not and am not obese.
And...?
I got childhood cavities galore.
Over the years, I've paid a king's random to save teeth that are more filling than tooth. How I wish today that sealants had been around during my childhood.
Let's go anecdote v. anecdote:
My parents never bought soda, juice or or any sugar drink.
They personally supervised my dental hygiene.
"Funnily enough," I was not and am not obese.
And...?
I got childhood cavities galore.
Over the years, I've paid a king's random to save teeth that are more filling than tooth. How I wish today that sealants had been around during my childhood.
My children flossed and brushed their teeth under my direct supervision until they started high school. Early on, I did the work for them. Between them there was one cavity.
The need to monitor and enforce flossing and brushing is key, sealants or not.
The need to monitor and enforce flossing and brushing is key, sealants or not.
24
Sure. But in lieu of that, it makes perfect sense to invest in proven treatments that reduce the instance of caries and dental disease, because some children don't have a parent who does that for them. The health of the children should be primary to finger-pointing. Sealants work, and they're cheap. #publichealth
10
You were vigilant, and they were lucky to have higher PH saliva and no deep or unfortunately configured pits or fissures. My mom was equally vigilant, and I was less lucky. By high school I had molars full of metal.
1
"To date there is no evidence that sealants lead to patient harm, while there is considerable evidence of benefits."
Framing the risks this way is disingenuous, or at least simplistic. OK, I buy sealants prevent cavities. That's useful info. But most kids who receive routine dental care will not see major health implications from cavities if they are treated. On the other hand, it is possible, based on current understanding of the effects of BPA exposure as a child (though not proven in a dental context specifically, because no good long-term studies have yet been done), that such exposure will have major medical consequence that we won't show up for years. So, e.g., my son's ability to father a child may be significantly affected by exposure to BPA in sealants. Maybe when he's an adult and trying to start a family, he will say he would have preferred the certainty of a few cavities over taking a known possible (if still small and unproven) risk to his future fertility.
Framing the risks this way is disingenuous, or at least simplistic. OK, I buy sealants prevent cavities. That's useful info. But most kids who receive routine dental care will not see major health implications from cavities if they are treated. On the other hand, it is possible, based on current understanding of the effects of BPA exposure as a child (though not proven in a dental context specifically, because no good long-term studies have yet been done), that such exposure will have major medical consequence that we won't show up for years. So, e.g., my son's ability to father a child may be significantly affected by exposure to BPA in sealants. Maybe when he's an adult and trying to start a family, he will say he would have preferred the certainty of a few cavities over taking a known possible (if still small and unproven) risk to his future fertility.
13
Unfortunately, my parents did not have dental insurance when we were children, and I am convinced that if we had received sealants, none of us would be visiting the dentist as extensively as we all do now. Candy and sugary things were prohibited in our household growing up, and we all brushed and flossed regularly. Fortunately, as an adult, I am covered through both my employer's insurance and my husband's employer, as the amount of money I spend on cavities on an annual basis far outweighs any other health expense.
Despite the risk of BPA, I would recommend that anyone questioning putting this in their children's mouths to go ahead and have the treatment done. As an adult dealing with more than routine dental visits, I wish I was able to have afforded that luxury as a child.
Despite the risk of BPA, I would recommend that anyone questioning putting this in their children's mouths to go ahead and have the treatment done. As an adult dealing with more than routine dental visits, I wish I was able to have afforded that luxury as a child.
11
I had sealants applied to all molars around age 10 or so -- over 30 years ago. Of the 25+ cavities small and large I have had filled since then, only one or two have been on or near sealed surfaces. Extremely good cost/benefit ratio.
6
I simply cannot imagine putting anything with BPA permanently inside my children's mouths.
38
Then choose the glass-based alternative.
1
Yes, sealants do seem to be a good idea, although there had been some controversy about using BPA (you know the stuff they outlawed from sippy cups), but I believe they have found better non-toxic materials since then. However, if your child has autoimmune disease or allergies, ask about the materials first.
Wish the Times would be as supportive of the 2015 Cochrane Review on fluoridation that like the 2000 York Review found there was no safety data, poor quality data on minimal cavity reduction in some children, contradictory evidence of any reduction in socioeconomic disparity and no evidence of benefit to adults. “This study does not support the use of fluoride in drinking water.” - Dr. Thomas Zoeller, U Mass scientist commenting on 2015 Cochrane Review
Wish the Times would be as supportive of the 2015 Cochrane Review on fluoridation that like the 2000 York Review found there was no safety data, poor quality data on minimal cavity reduction in some children, contradictory evidence of any reduction in socioeconomic disparity and no evidence of benefit to adults. “This study does not support the use of fluoride in drinking water.” - Dr. Thomas Zoeller, U Mass scientist commenting on 2015 Cochrane Review
7
Zoeller is in a vanishingly tiny minority.
The evidence for fluoride is overwhelming.
The evidence for fluoride is overwhelming.
Sealants have been proven to work effectively. They are usually a simple procedure, however they are a procedure and children have to cooperate to have them applied. They are not particularly effective if the molars are hypoplastic ( not well formed) where they would be desired. Insurance companies frequently cover this procedure but most often they are age defined. The six year molars must be done prior to 10 years and the 12 year molars must be done by 15. This is different for m any policies depending on the insurance companies and the company providing the insurance.
2
I think that anything that helps keep teeth intact is a good idea. Oral health is very important and having healthy teeth and gums is a great start.
Perhaps there could be an article done about braces and their side effects. I had braces as teen but still need to wear an upper retainer to keep my teeth in line. I don't mind it but children and parents should be told that the improvements from braces are not lasting, even if teeth are pulled, without wearing a retainer. There are other side effects that we should know about among them receding gums and accompanying tooth sensitivities.
Perhaps there could be an article done about braces and their side effects. I had braces as teen but still need to wear an upper retainer to keep my teeth in line. I don't mind it but children and parents should be told that the improvements from braces are not lasting, even if teeth are pulled, without wearing a retainer. There are other side effects that we should know about among them receding gums and accompanying tooth sensitivities.
7
Your mileage may vary. I was done with both braces and retainer more than 30 years ago, and my teeth have scarcely shifted at all. And I started with a pretty severely snaggle-toothed mouth.
4
I've been told it has to do with how I swallow and something with my tongue pushing the teeth out. My dentist suggested that I get my tonsils and adenoids removed. Anyone know anything about that?
2
Make sure to replace sealants that have come out. I had a bunch of sealants as a kid and had no cavities for the longest time but then never had the sealants replaced as they eventually came out (nobody mentioned it to me and my parents never followed up with my dentist). Once I hit late adolescence and young adulthood, I had a wave of cavities, and now have fillings in all of my molars. They can come out while eating sticky candy and other similar foods. So stay on top of it! And remember, the price of a cavity also includes getting fillings replaced when they start to deteriorate 20 years later and or getting crowns and root canals when you didn't replace the filling fast enough.
9
Good for the New York Times looking into evidence based dentistry but let's next see if the Times can present any credible evidence for water fluoridation. Based on the prestigious Cochrane Review, the Times concludes that sealants are effective in preventing cavities. However, the Cochrane Review also did a meta analysis of every study ever done on artificial water fluoridation and it did not conclude that fluoridation is an effective public health policy. What it found was a majority of studies were of poor quality and/or biased and done before topical fluoride was readily available.
http://www.newsweek.com/fluoridation-may-not-prevent-cavities-huge-study...
Not only is chemical water fluoridation ineffective but it's unsafe. At this point, the Harvard School of Public Health recognizes only 11 chemicals as known neurotoxins with fluoride being one of them. PhD Professor Philip Grandjean of the Harvard School of Public Health says, "Fluoride seems to fit in with lead, mercury and other poisons that cause chemical brain drain."
At the very least, NY Times readers need to know that many scientists, chemists, toxicologists and many in the medical and dental community oppose artificial fluoridation. An honest appraisal of this archaic public health practice should be your next article on dentistry, Dr. Frakt.
http://www.newsweek.com/fluoridation-may-not-prevent-cavities-huge-study...
Not only is chemical water fluoridation ineffective but it's unsafe. At this point, the Harvard School of Public Health recognizes only 11 chemicals as known neurotoxins with fluoride being one of them. PhD Professor Philip Grandjean of the Harvard School of Public Health says, "Fluoride seems to fit in with lead, mercury and other poisons that cause chemical brain drain."
At the very least, NY Times readers need to know that many scientists, chemists, toxicologists and many in the medical and dental community oppose artificial fluoridation. An honest appraisal of this archaic public health practice should be your next article on dentistry, Dr. Frakt.
20
I asked my dentist about getting sealants for my cavity prone teeth and was told they were not appropriate for adults. Now I'm sad. In the intervening 20 years I have several more teeth that were cavity free then that now have had cavities and even root canals. I wish I'd pushed and insisted on getting the sealants.
7
I'm 43 and had sealants as a child. In my late 30s, my dentist remarked that it was amazing that most of my sealants were still intact (and no cavities on sealed teeth).
5
I'm afraid dentists have morphed from health care professionals to grifters in my book. Sealants may have a role to play in dental health care, but who can trust dentists any more when their focus seems to be unnecessary treatments with high price tags instead of known benefits. The inclusion of BPA in sealants reinforces that impression for me.
47
You have no basis for your charges.
2
You can put using mercury amalgam in the "don't trust dentists" category.
6
I have to intercede on behalf of my dental acquaintances. I hold their virtues so high that that I feel experience in the dental community should be a requirement in replacing Alex Trebec.
In any case, I do feel sad when people loose the beauty of excellent teeth.
The phrase, "Brush Your Teeth", should be modified to include, "Hit every nook and cranny with all the contours and also the gums" !
In any case, I do feel sad when people loose the beauty of excellent teeth.
The phrase, "Brush Your Teeth", should be modified to include, "Hit every nook and cranny with all the contours and also the gums" !
6
The problem with the dental industry is that they are such big upsellers, it is like the boy that cried wolf, ie., if if they have something here that may be good, many people don't believe them.
Before the NY Times jumps on the band wagon with this, give it more time with adults who choose it for their kids and see how it does in a longer run and then recommend it if the stats hold out.
Before the NY Times jumps on the band wagon with this, give it more time with adults who choose it for their kids and see how it does in a longer run and then recommend it if the stats hold out.
10
The stats are already there. You can read the Cochrane review cited here.
5
Thank you for your reply Susana. I believe in longer term stats. It took 20-30 yrs to determine the PSA test was useless and damaging.
Also, I had a good dental plan when I was a young working person and dentists sold me on caps, root canals when I did not need them. Now 20-30 yrs later I am loosing some of those teeth. Root Canals will eventually destroy your tooth if you live long enough.
Also, I had a good dental plan when I was a young working person and dentists sold me on caps, root canals when I did not need them. Now 20-30 yrs later I am loosing some of those teeth. Root Canals will eventually destroy your tooth if you live long enough.
3
So if sealants become the norm in tooth care we can put finally get the fluoride out of municipal drinking water? I'm all for it!
11
I think this may underestimate the "cost" of filling a cavity - let's not forget the lost productivity from time taken off work and the pain which is often the first indicator of a cavity. Factoring these in, sealants seem like a huge bargain.
Perhaps they should qualify as a "preventive service" - someone get on this to stick it to Mylan!
Perhaps they should qualify as a "preventive service" - someone get on this to stick it to Mylan!
5
"But some parents may be concerned that resin-based sealants contain derivatives of bisphenol A, which is thought to play a role in early-onset puberty, infertility and breast and prostate cancer."
*May* be concerned? This is the kind of absurd, we know the substance is harmful but we haven't yet done a 50-year controlled study of the outcome reasoning that leads to exposure to toxic chemicals for years after scientists raise concerns.
But don't worry, toothpaste still has another known harmful substance, triclosan, in it -- maybe the two will cancel one another out, and together, they will scarf up the mercury from amalgam fillings.
*May* be concerned? This is the kind of absurd, we know the substance is harmful but we haven't yet done a 50-year controlled study of the outcome reasoning that leads to exposure to toxic chemicals for years after scientists raise concerns.
But don't worry, toothpaste still has another known harmful substance, triclosan, in it -- maybe the two will cancel one another out, and together, they will scarf up the mercury from amalgam fillings.
37
You can request sealants based on glass ionomer instead.
3
Out of dozens of toothpastes, only Colgate Total is allowed to have triclosan.
3
Triclosan has been banned from all toothpastes except for Cokgate Total.
This article does a journalistic disservice by not addressing Caries Management by Risk Assessment (CAMBRA), a standard of care in today's dentistry. Low Risk kids do not necessarily need sealants, whereas High Risk kids probably do. The article also didn't address the importance of technique in sealant application. Done incorrectly, or not maintained, they can actually lead to increased risk of caries.
39
Basic competence of the dentist is assumed.
This article is timely and I plan to share in western Canada where we are debating fluoride in water as a support to dental health. Poor children are in dental health crisis in some communities. My daughter had sealants in Toronto and had her first small cavity at age 27, not long ago. As a single parent, I made this investment and was proud every year that her teeth were in perfect shape.
8
I had the teeth of all three of my children sealed upon the emergence of each molar. While the sealants lasted, not one got a single cavity. After the ceilings were off, first my oldest and then my second child each got one cavity, then the second. I did some looking around on my own, took them back to the family dentist, and insisted that he seal all molders without fillings. No more cavities in the subsequent five years or so.
Fillings are bad not only because they are expensive, they are bad because they represent The sacrifice of a percentage of natural tooth. The more natural tooth you lose in a given tooth, the more threatened that tooth is long-term.
Note: according to my research, a tooth has a filling, it cannot be successfully sealed. I wish I had kept all of my kids' teeth sealed before learning the hard way what happens when the sealants wear off.
Fillings are bad not only because they are expensive, they are bad because they represent The sacrifice of a percentage of natural tooth. The more natural tooth you lose in a given tooth, the more threatened that tooth is long-term.
Note: according to my research, a tooth has a filling, it cannot be successfully sealed. I wish I had kept all of my kids' teeth sealed before learning the hard way what happens when the sealants wear off.
23
The perspective on BPA offered is unfortunately reveals some bias. No mention is made of the fact that there is considerable scientific controversy about the safety of BPA. Even a few moments of online research reveals this. The FDA has taken a mixed approach to BPA, raising concerns in some applications but not others.
The statement to “date there is no evidence that sealants lead to patient harm” tells us little. What studies have actually been done? What is the quality of those studies? Is it plausible that there a danger might exist? Dental sealants may contain not just BPA but BPA derivatives as well. What do we know of the safety of these substances in dental sealants?
The statement to “date there is no evidence that sealants lead to patient harm” tells us little. What studies have actually been done? What is the quality of those studies? Is it plausible that there a danger might exist? Dental sealants may contain not just BPA but BPA derivatives as well. What do we know of the safety of these substances in dental sealants?
52
For the reasons you raise, and because the two types of seslznts are apparently equally effective in cavity prevention, I would request the non-BPA sealant formulation.
2
Just look at who's funding those research statistics. That should tell you what's the truth. Follow the money, find the truth!
My kids got sealants when they were young and they work great! But one of my adult children has particularly cavity prone teeth and is always going to the dentist even though he does all types of things to avoid getting cavities. No dentist has ever suggested to him to use sealants. As for safety, the risk seems minimal and silver fillings have mercury in them but still have been deemed safe. Do I dare suggest dentists might fear losing out on the money made filling cavities?
10
I had that conversation with my family dentist, who is a good old-school guy and not one of the emerging generation of used car salesman/dentists. I had raised with him resealing the teeth of my three kids -- when they were in their late teens, the sealants had worn off, and they were beginning to get molar cavities. He said it made logical sense to him that if sealants work for kids, they would also work for adults, but he added that he had cover for recommending them for children because of the ADA recommendation of sealants "for all kids." But because (at least at that time) the ADA recommended sealants for adult molders only "for the cavity prone," he did not raise the issue of resealing with patients or parents spontaneously. He said that if the ADA didn't recommend something quite clearly, he tended to hold back for fear of being accused of "up-selling," or aggressively marketing optional services.
34
Sealants are effective in teeth that don't have any fillings in them yet. If your adult child has cavity-prone teeth, and these teeth already have fillings in them, then sealants won't help.
3
My dentist says that the ADA, FDA etc. are afraid to blow the whistle on mercury amalgam fillings because of the potential lawsuits.
2