SEALANTS offer protection to the most vulnerable chewing surfaces in the mouth. They are not fillings in the true sense, as there is no drilling and therefore no injection of anaesthetic. Notwithstanding, parents need to realize that in addition to sealants, there are available alternatives. Studies have shown that sealants can lower molar decay rates by up to 76.3 percent after four years, provided they are checked and reapplied whenever they are chipped or broken. On the other hand, a study in 2000 compared school-age children who chewed xylitol gum regularly with children treated with professionally applied sealants. After five years, there was no difference between the groups. The protection offered by chewing xylitol gum was equal to that offered by the sealant.

Xylitol is a naturally occurring alcohol found in most plant material, including fruits and vegetable. The product is usually used as chewing gum or mints. There must always be the plan to work to eliminate harmful bacteria from the mouth, with or without sealants. Bacterial cleaning of the mouth is especially important before new molars erupt, no matter whether it is the baby molar of a two-year old, the first permanent molar of a six-year old, or a third molar of a twenty-year old.
Fighting to eliminate harmful germs should be everyone’s priority, but especially in the year before new teeth are expected. The greatest concern is for the children at high risk for cavities because of a dry or acidic mouth. This includes almost all children at some time in their childhood, since the list covers those who have acidic saliva, acid reflux, or an active lifestyle, as well as those who enjoy acidic drinks, citrus fruits, or sugary or starchy foods, or who take medications – especially for those for allergies or asthma.
One day a friend told me about his teenage son’s visit to the dentist. The dentist had found tooth decay in the boy’s new molars. The dentist suggested putting sealants on the teeth to prevent early cavities from growing bigger. He insisted that without sealants, the teeth would end up with big cavities by the time of the boy’s six-month checkup.
My friend and I had talked about the options with the risks and benefits of sealants, as well as the things his son could do to avoid them. He decided to postpone his son’s sealant appointment and instead to use a regimen of fluoride mouth rinsing and mints made with 100 percent xylitol.( I will try to obtain some when I attend the American Dental Association Annual Meeting in Washington, DC, next month). The boy closely followed the daily regimen for six months; then he went for his next dental checkup. Understandably nervous, the father watched while the dentist checked his son’s previously decayed teeth. The dentist looked at his notes and examined the boy’s mouth. He looked closely at the molars where the cavities had been starting six months previously. The dentist checked the teeth with an explorer. He checked them again, searching for cavities. The dentist was puzzled to see that the teeth were strong and firm. The teeth had rebuilt themselves, and the cavities were no longer there.
The dentist called his assistant over, insisting she had forgotten to write in the notes that the sealants had been applied at the previous appointment.
“No sealants were applied,” said the father, explaining how he had cancelled the appointment. He further explained how the teeth must have repaired themselves with the mouth rinses and xylitol the boy had used. The dentist may have been confused, but my friend was convinced, and he continues to make sure that his son protects his teeth every day with this regimen.
Discuss sealants with your dentist, because they are not the only option for dental health. There is no reason why a groove in a molar tooth cannot remain healthy. The most vulnerable time for this groove is as it erupts into the mouth. Creating a healthy environment for a tooth before it erupts into the mouth is of vital importance. Remember that molar grooves take up to a year to fully harden and that it is acidic attacks that destroy the teeth of teenagers and young adults.
A fluoride varnish is another good preventative method and another alternative to sealants if your child appears to be slightly at risk for cavities.
Dr. Bertrand R. Stuart DDS.