These days there are not many certainties in life. But we do know that no matter the circumstances around them, children will always be born, and eventually toddlers will start losing their baby teeth. All children are different, but in general, baby teeth start falling out from the age of 6 or even a bit earlier, and for most kids, all of their baby teeth will have been replaced by adult teeth by about the age of 12. Maybe there is something to the idea of Jewish maturity by about that age?
Toddlers generally have about 20 teeth in their mouth; adults have more. As such, some permanent adult teeth, like those known as 6-year molars (i.e., back teeth), often begin to come in even before any baby teeth start to fall out. This is actually a sign of healthy new growth and should not be feared. At the same time though, since they come in so early, they are most susceptible to decay and long-term problems. This is in part because as other teeth fall out and then develop around them, these molars become the primary chewing teeth, with deep and sometimes narrow grooves known as pits and fissures. These grooves can often collect food crumbs; plaque can form around them; and they are the hardest to reach with a normal toothbrush.
Later, as children’s mouths grow and there is more room, another set of four permanent molars come in. These are not a replacement of any baby teeth, and they come in at around the age 12. Then, at age 18 or so, a further set known as wisdom teeth also develop, but often there is not enough room in the mouth for these, so they get removed.
Since at least the early 1970s, dental researchers have been developing pit and fissure sealants, which are transparent, thin coatings painted onto the molars to protect the grooves and prevent cavities. Not only do sealants reduce the risk of further decay, but they also prevent food scraps from being trapped in the teeth, and they make the teeth easier to clean.
Yet, despite the creation of such innovative sealants and their continued improvement over the last five decades, pit and fissure sealants are significantly underused across the industry, and especially for children. In the case of small children, this is sometimes understandable. Little kids in particular rarely let anyone, including their parents or dentists, look inside their mouths, so it is often hard to determine whether or not they need sealants. And even if they do need them, although the sealants are perfectly safe and approved for children’s use, affixing them is sometimes very difficult, though specialist pediatric dentists are trained to do this.
In 2008, the American Dental Association (ADA) published a series of evidence-based recommendations for sealants, and this was updated in 2016 in collaboration with the American Academy of Pediatric Dentistry (AAPD). In simple terms, all the recommendations concluded that pit and fissure sealants, for both adults and children, are the preferred option for reducing cavities or other long-term issues in all teeth, but particularly for all the molars. Once they are placed, they of course need to be monitored and may need some maintenance, but this is true of any dental addition. Like all things, it is up to each dentist to assess their patient, and to present all the available options to the patient or to their parents.
Ultimately, medicine and dentistry are as much about prevention as they are about cures. In our uncertain world, having all of the options on the table and choosing the best one to protect yourself and your family is something that is still within your control. Pit and fissure sealants are a safe and evidence-based way of preventing future problems for your children. To discuss how sealants might be right for you, contact Riverdale Pediatric Dentistry at 718-725-8997.
