To Seal or Fill – That is the Question
The anatomy of the teeth is a unique as we are. This could be a product of our genetics (thanks mum dad and the rest of the past clan members), or we could be a spontaneous variation. This means the valleys or fissures in our outer coating (enamel) of the teeth can have a variety of patterns depending of the surrounding tooth structure.
However, it’s the anatomy of the fissure itself that could be a problem. Some fissures are so deep in the enamel that almost go down the next layer tooth, the dentine. Sometimes the fissure is wider underneath than the opening on the biting surface. This makes it impossible to clean, so food and bacteria are lodge in these areas. The heavier the bite on these fissures the more likely the implication of food & bacteria.
This happens any time in life when the bite changes. The sticker the sugar that a person eats, the more fuel for the trapped bacteria, and the greater the chance, and severity, of decay into the dentine.
This is not always seen in xrays as the images will pick up a loss of tooth sturture or density. However, the fact the opening of the decay is small then the tooth material is not lost and therefore may appear normal.
When the decay is removed then a filling can be placed. Unfortuately, they can be diffiult to diagnose. The colour of the surrouding tooth may have a coloured halo due the decay underneath, but this is not always the case. Testing with a probe may reveal a sticky resistance to removing it from the fissure.
However, food getting trapped in a fissure is not a good thing to have, so the fissure should be sealed.
Below the image shows the treatment completed on the premolar as a sealant. The above molar with the decay, is shown also in the image below with a filling placed. The tooth between these teeth will be monitored for changes. The patient will be warn about being careful with their diet to avoid decay.
Unfortunately, we are not all the same, so for one person any sticky sugar can be bad news and continual monitoring is essential. Other factors such as dry mouth or gastric reflux can increase the risk as well.
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