There’s no doubt, 8-year-old Blin Rollins has a sweet tooth.
He’d rather drink juice than water and doesn’t turn down sweets, admits his mother, Amy Rollins, 36, of Augusta, Maine.
“He’s a big fan of chocolate, of course,” Rollins said. “And the gooey stuff, Mike and Ikes.”
So when her dentist, Jonathan Shenkin, suggested that dental sealants might keep tooth decay at bay on Blin’s permanent molars, Rollins was intrigued.
“We want to take every kind of preventative action we can to keep his smile beautiful,” she said.
But what Rollins didn’t know is that her child’s mouth is part of an ongoing debate about whether enough children have the liquid plastic caps that protect what Shenkin calls “the most damaged tooth in the mouth.”
Only about 20 percent of children at the poverty level and only 40 percent of children from higher-income homes actually receive recommended sealants, according to studies by the Centers for Disease Control and Prevention.
That puzzles Shenkin, a pediatric dentist and spokesman for the American Dental Association. He says decades of research show that coating the biting surfaces of 6-year-old molars with a resin-based sealant can reduce cavities by up to nearly 80 percent immediately — and up to 60 percent over four years or more.
“It is imperative that once these adult teeth are removed, they are sealed,” he said.
In practice, however, less than 40 percent of dentists actually follow the ADA’s recommendations, according to a 2011 study by researchers at Temple University. The study looked at whether dentists were willing to seal teeth with the beginnings of cavities, but not actual cavities.
“The lack of dentists doing fillings is a very silent and probably the most important care issue we face among children,” Shenkin said. “Parents need to ask for sealants and not take no for an answer.”
But one of the profession’s most respected dentists has been publicly wary of sealants, saying there can be a high failure rate — 50 percent within five years — and arguing they should not be placed if there is evidence of tooth decay.
Gordon J. Christensen, who publishes Clinicians Report, widely regarded as the “Consumer Reports on dental products,” says sealants done right are “an excellent technique” for fighting tooth decay. But, he adds, the success of the sealant depends largely on the skill of the person applying it.
“They need to look for a professional who knows what they’re doing,” he said.
“If they see failure right away, that opens the window for decay.”
Christensen worries about so-called “non-cavitating caries lesions,” early signs of caries that haven’t yet led to cavities. He worries that sealants trap plaque in the tooth, creating an environment that fuels future tooth decay.
CDC researchers say studies have shown that decay doesn’t progress once sealants are added, but Christensen says he’s not convinced.
Dental sealants form when a plastic-like liquid drips onto the biting surface of the tooth, coating the cavities and crevices that normally trap food and encourage bacterial growth.
They are applied to the permanent molars and fixed with UV radiation, ideally between the ages of 5 and 7, when the teeth erupt. The cost can be $30 to $40 for each tooth and is usually covered by most dental insurance policies.
In dental circles, the issue of sealants has been hotly debated for nearly 50 years, and at least since the ADA awarded the product its seal of approval in 1976. While there have been concerns that sealants may expose children in the controversial estrogen-like chemical bisphenol A, or BPA, the benefits in preventing tooth decay in children outweigh the risks, says the American Dental Association.
Studies have consistently shown that sealants protect against tooth decay in high proportions of permanent teeth, sometimes for up to a decade.
“This is a very charged issue,” Christensen admitted.
Between 45 and 55 million fillings are applied each year in the US, with pediatric dentists performing more than twice as many procedures as general dentists or dentists. This according to a report by AFG Researcha company that tracks the use of dental and medical products, in the US Market Snapshot Series Report on Dental Activity.
Support for sealants is shared by oral health experts at the Centers for Disease Control and Prevention, who are particularly in favor of school-based sealant programs aimed at children without regular care.
“We’ve made the argument that they should be used more, particularly in children who are at higher risk of tooth decay,” said Barbara Gooch, a dentist in the CDC’s division of oral health.
For many middle-class parents whose children visit the dentist, the problem is that the topic of sealants may not even come up, Shenkin said.
Some dentists, especially those who treat few children, may be wary of sealants because they can be difficult to place or because they didn’t learn to use them in dental school and aren’t used to providing the treatment, Shenkin said. .
To be clear, not all children need sealants, said Bill Bailey, a dentist with CD, because their teeth aren’t naturally decay-prone or they don’t have great oral hygiene habits. But only a dentist can tell, and Shenkin says parents should at least ask.
But many do, and not just children who are usually at high risk. Recent studies have shown that boys in higher income homes had the highest prevalence of tooth decay.
For those who need sealants, they can mean the difference between a lifetime of healthy teeth and the pain and health risks of chronic tooth decay.
“What people need to know is that 90 percent of tooth decay in an adult is on the biting surface of the back tooth,” Shenkin said.
It advertises the benefits of sealants in part so more parents know to ask about them.
“Dentistry is a demand-driven health service,” he said. “Patient demand really affects what dentists do in their offices.”
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