Enamel is the material that forms the outer protective layer of our teeth. It is the hardest substance in our bodies. Dentin is the material under our enamel and composes the bulk of the tooth underneath the harder outer enamel layer. Although dentin is softer than enamel, it is the second hardest material in our bodies, even harder than bone.
Enamel, however, is vulnerable to something that can pierce through it if given enough time. Acids produced by bacteria and often present in some foods and drinks will dissolve the enamel. Once an opening occurs in the enamel, bacteria have a higher chance of invading the more porous dentin underneath and injuring the pulp (nerve and blood supply to the tooth).
This is why it is important to place sealants on enamel grooves that have never been restored. Many insurance companies will not pay for sealants on adult teeth. This is not because it is not a worthwhile procedure to do. Just the opposite is true. Sealants reduce the chance that decay will occur in the grooves on the biting surfaces of teeth. A tooth that has never been sealed in a child’s mouth is no different than a tooth that is present in an adult’s mouth. It is in fact the very same tooth with the only difference being that the person it belongs to is now older. In fact, such a tooth has a higher likelihood of decaying in the adult’s mouth than in the child’s mouth due to the additional time bacteria have had to colonize and infect the grooves in the enamel biting surface. This is like having a builder who seals and stains the wood siding on the houses of homeowners under age 30 but does not seal and stain the wood siding of the houses of homeowners over age 30. Is the wood of the older homeowner’s house less likely to rot when it is unprotected? It is made of the same wood as the younger homeowner’s home. The same is true of the enamel grooves on the teeth of people over age 14 as the enamel grooves on the teeth of people under age 14. It’s all the same enamel in need of protection.
Sealants are the best protection we have to protect these grooves from becoming infected with the bacteria that cause decay. At Springs Dental, our dental office in Saratoga Springs New York, I carefully check the grooves on teeth we are about to seal to be sure there is no decay in the enamel grooves. It can be dangerous to place sealants over a decaying groove. The decay can progress in such a situation and possibly reach the pulp undetected until it is too late. To be able to detect decay prior to sealing teeth, it is beneficial to use magnifying eyeglasses called loupes, an intraoral camera or a diagnodent diagnostic laser capable of detecting subsurface decay by measuring the amount of fluorescence the area gives off when the laser light is placed on the tooth.
An unsealed tooth is a vulnerable tooth at much higher risk for decay.
Mark Moskowitz DDS
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