Fissure Sealants for Children in Ukraine

Fissures are the natural grooves on the chewing surface of molars and premolars. In some children they are wide and shallow; in others they are narrow and deep, shaped like a drop or a flask: the entrance is about 0.1 mm wide, while the inner part is wider. A toothbrush bristle is about 0.2 mm in diameter and simply cannot get into such a groove, so plaque stays there even with careful brushing.

That is why a child's first cavity most often appears on the chewing surface. The first permanent molar erupts at 6–7 years, and its enamel goes on maturing for about two more years, taking up minerals from saliva; during this period it dissolves in acid more easily than the enamel of a mature tooth. On top of that, a six-year-old is simply less skilled with a toothbrush than an adult and tends to miss the area behind the last tooth altogether.

The procedure involves filling the grooves with a flowable material and curing it with a lamp. The surface becomes smooth: plaque is washed off it by saliva and removed by the brush, and the entrance to the fissure is sealed off from bacteria and acids. This is not a filling: healthy tissue is not removed, and when a narrow groove is opened, the intervention does not go beyond the enamel.

The indications are specific: the tooth has just erupted; the grooves are deep and closed; the child has already had caries or has a lot of plaque; a diet with frequent snacking; orthodontic appliances; limited ability to brush well. Baby molars with deep grooves are sealed too, usually after the age of three, if the child can cope with the visit. The procedure is not done when there is already a carious cavity in the groove: that is treated first. Nor is a tooth sealed if it has only partly erupted and its surface cannot be kept dry, and sealant is not relied on if caries is developing on the contact surfaces between the teeth, since the material does not reach them. Wide grooves that a brush can reach do not need sealing either.

MediUkraine is a treatment search and coordination service, not a clinic. We select the clinic and the paediatric dentist, arrange the date and support your family throughout, including if you are travelling from abroad. Which teeth to seal, and how, is decided by the dentist after an examination.

The main factor in success is timing. The first permanent molar erupts at 6–7 years and most often becomes the first tooth that needs treatment. The grooves are best sealed as soon as possible after the chewing surface has fully emerged from the gum and can be kept dry: in practice that means the first 6–12 months after eruption. The second permanent molars erupt at 11–13 years and the premolars at around 10–12, and for each tooth the window is counted separately, from its own eruption, not from the child's age.

The reason for the urgency is post-eruptive enamel maturation. The enamel of a newly erupted tooth contains fewer minerals and has a more porous surface; it gains strength from saliva over about two years. During the same period the grooves have not yet been smoothed by chewing, and the child's brushing skills are only just forming. Damage to the chewing surfaces peaks in exactly these two years, so a missed window does not mean "we'll do it later" but "most likely we'll be treating it".

Before sealing, the grooves have to be examined, and this is a stage in its own right. The surface is cleaned, dried with air and inspected in good light, often under magnification: dried enamel with early demineralisation turns chalky white, and a carious cavity under the enamel shows as a greyish shadow. A stained groove is not a diagnosis in itself: a brown line can also appear on dense, arrested enamel. If in doubt, the dentist adds laser fluorescence or orders a bitewing X-ray, which also shows the contact surfaces. The choice of method depends on the outcome of this stage.

The non-invasive method is used when the grooves are open, their bottom is visible and there is no doubt about the state of the enamel. The surface is cleaned with a brush and paste or with an air-abrasion stream, the tooth is isolated from saliva, phosphoric acid gel is applied for 15–30 seconds, rinsed off with water and thoroughly dried: properly prepared enamel looks matt and chalky. The sealant is then placed in the grooves, spread with a probe so that no air bubbles remain, and cured with a lamp for 20–40 seconds. Finally the bite is checked with articulating paper and any excess is ground away.

The invasive method, or fissurotomy, is needed when a groove is narrow and closed, the bottom cannot be seen and the staining raises suspicion. The entrance to the fissure is opened with a fine bur by a fraction of a millimetre, just enough to see the bottom and let the material fill the whole groove without leaving voids. The intervention does not go beyond the enamel, anaesthesia is mostly not needed, and sometimes a topical gel is enough. After that the protocol is the same as the non-invasive one. The difference is fundamental: the material simply will not flow into a closed fissure, and sealant applied over the top only masks what is inside.

If, after opening, a small lesion is found within the enamel or the superficial dentine, the dentist does not call the child back for a separate visit. The affected area is cleaned out within the limits of what was found and closed with composite, and the remaining grooves of the same tooth are covered with sealant in the same session. This is halfway between prevention and a filling, and its price is in between too.

There are two main types of material. Composite sealants based on resins are the standard choice: they hold more firmly than other materials, because after etching the resin flows into the micropores of the enamel. They come clear or opaque; for children an opaque white or coloured one is chosen more often, as it is easier to see at a check-up. Filled composites with a mineral filler are more resistant to wear; unfilled ones are more fluid and flow better into narrow grooves. They share one strict requirement: a completely dry surface. A drop of saliva under the material and the bond is lost, even if everything looks fine from the outside.

Glass ionomer cements work differently. They bond chemically with the tooth tissue, tolerate a little moisture and release fluoride into the adjacent enamel, strengthening it. The trade-off is lower mechanical strength: such material wears faster and is lost from the chewing surface more often. So glass ionomer is chosen mainly where composite cannot be placed: the tooth has partly erupted, the child cannot tolerate long isolation, or the visit takes place under a school programme without full equipment. It is a deliberately temporary solution: once the tooth has fully erupted, the sealant is replaced with composite. An intermediate group consists of resin-modified glass ionomers and compomers, which combine fluoride release with greater strength.

Now for how long sealants last, which is worth knowing before you pay. A composite sealant placed in a dry field remains fully intact in most children during the first year, and after five years it is still whole on roughly half to two thirds of teeth; the rest have lost some material. This is not a sign of poor work: the sealant wears with chewing and is renewed. That is why an examination every six months is part of the method, not a formality: partial loss of material is visible only to the dentist, and an exposed part of the groove under the edge of the sealant is the worst possible state.

Finally, the limits of the method. Sealant covers only the pits and grooves of the chewing surface: it does not protect the contact surfaces between the teeth, the area near the gum or the gum margin, so brushing twice a day, flossing and fluoride toothpaste all still apply. Children at high risk of caries are also prescribed fluoride varnish several times a year, and early demineralisation on smooth surfaces is treated with resin infiltration. Sealing is one tool of a prevention programme, not a substitute for it, and no dentist will promise that a sealed tooth will definitely not decay.

A composite sealant is fully cured with the lamp, so there are no restrictions straight after the visit: the child can eat and drink on leaving the surgery. If glass ionomer cement was used, it is better to stick to soft food for the first few hours, as it reaches its final strength more slowly.

On the first day the child may say the tooth "is in the way" or "feels higher". A difference of a few tenths of a millimetre really can be felt, and it usually disappears within a day or two as the material wears in. If the feeling lasts longer, or the child has started chewing on one side, come back: adjusting the bite takes a few minutes.

There is no pain after the procedure: no tissue below the enamel was prepared and the nerve was not touched. If the tooth does react to cold or sweet things, book an extra check-up: the most likely cause is caries on another surface, unrelated to the sealed grooves.

The first check-up is scheduled after six months. The dentist dries the surface, examines the edge of the sealant under magnification and checks with a probe for any area where the material has come away. Partial loss is corrected by adding material at the same visit; if the sealant has been lost completely, the surface is etched and sealed again.

There is no visible change to judge: the tooth looks the same as before the procedure. There is only one real measure: whether caries has appeared on the chewing surface over the years of follow-up. That is why the programme is designed for years rather than a single visit, and there is no point judging it after a week or a month.

Families travelling from abroad should agree follow-up arrangements in advance. You receive a summary listing the sealed teeth, the material used and the date of the next check-up, and photos of the chewing surfaces can be passed to a dentist where you live, so that follow-up can continue without starting diagnosis from scratch.