Pit and Fissure Sealants

Pit and fissure sealants are preventive dental materials used to protect occlusal surfaces of teeth from caries by sealing the grooves and pits that are difficult to clean. According to Mitchell and Gordon (1990), sealants can be classified based on several criteria, including polymerization methods, resin systems, filler content, and color.

Classification of Pit and Fissure Sealants

1. Polymerization Methods

Sealants can be differentiated based on how they harden or polymerize:

• a) Self-Activation (Mixing Two Components)

  • These sealants harden through a chemical reaction that occurs when two components are mixed together. This method does not require any external light source.

• b) Light Activation

  • Sealants that require a light source to initiate the polymerization process can be further categorized into generations:
    • First Generation: Ultraviolet Light
      • Utilizes UV light for curing, which can be less common due to safety concerns.
    • Second Generation: Self-Cure
      • These sealants harden through a chemical reaction without the need for light, similar to self-activating sealants.
    • Third Generation: Visible Light
      • Cured using visible light, which is more user-friendly and safer than UV light.
    • Fourth Generation: Fluoride-Releasing
      • These sealants not only provide a physical barrier but also release fluoride, which can help in remineralizing enamel and providing additional protection against caries.

2. Resin System

The type of resin used in sealants can also classify them:

• BIS-GMA (Bisphenol A Glycidyl Methacrylate)
  • A commonly used resin that provides good mechanical properties and adhesion.
• Urethane Acrylate
  • Offers enhanced flexibility and durability, making it suitable for areas subject to stress.

3. Filled and Unfilled

Sealants can be categorized based on the presence of fillers:

• Filled Sealants

  • Contain added particles that enhance strength and wear resistance. They may provide better wear characteristics but can be more viscous and difficult to apply.

• Unfilled Sealants

  • Typically have a smoother flow and are easier to apply, but may not be as durable as filled sealants.

4. Clear or Tinted

The color of the sealant can also influence its application:

• Clear Sealants

  • Have better flow characteristics, allowing for easier penetration into pits and fissures. They are less visible, which can be a disadvantage in monitoring during follow-up visits.

• Tinted Sealants

  • Easier for both patients and dentists to see, facilitating monitoring and assessment during recalls. However, they may have slightly different flow characteristics compared to clear sealants.

Application Process

• Sealants are applied in a viscous liquid state that enters the micropores of the tooth surface, which have been enlarged through acid conditioning.
• Once applied, the resin hardens due to either a self-hardening catalyst or the application of a light source.
• The extensions of the hardened resin that penetrate and fill the micropores are referred to as "tags," which help in retaining the sealant on the tooth surface.

Degrees of Mental Disability

Mental disabilities are often classified based on the severity of cognitive impairment, which can be assessed using various intelligence scales, such as the Wechsler Intelligence Scale and the Stanford-Binet Scale. Below is a detailed overview of the degrees of mental disability, including IQ ranges and communication abilities.

1. Mild Mental Disability

• IQ Range: 55-69 (Wechsler Scale) or 52-67 (Stanford-Binet Scale)
• Description:
  • Individuals in this category may have some difficulty with academic skills but can often learn basic academic and practical skills.
  • They typically can communicate well enough for most communication needs and may function independently with some support.
  • They may have social skills that allow them to interact with peers and participate in community activities.

2. Moderate Mental Disability

• IQ Range: 40-54 (Wechsler Scale) or 36-51 (Stanford-Binet Scale)
• Description:
  • Individuals with moderate mental disability may have significant challenges in academic learning and require more support in daily living.
  • Communication skills may be limited; they can communicate at a basic level with others but may struggle with more complex language.
  • They often need assistance with personal care and may benefit from structured environments and support.

3. Severe or Profound Mental Disability

• IQ Range: 39 and below (Severe) or 35 and below (Profound)
• Description:
  • Individuals in this category have profound limitations in cognitive functioning and adaptive behavior.
  • Communication may be very limited; some may be mute or communicate only in grunts or very basic sounds.
  • They typically require extensive support for all aspects of daily living, including personal care and communication.

Behavioral Classification Systems in Pediatric Dentistry

Understanding children's behavior in the dental environment is crucial for effective treatment and management. Various classification systems have been developed to categorize these behaviors, which can assist dentists in guiding their approach, systematically recording behaviors, and evaluating research validity.

Importance of Behavioral Classification

• Behavior Guidance: Knowledge of behavioral classification systems helps dentists tailor their behavior guidance strategies to individual children.
• Systematic Recording: These systems provide a structured way to document children's behaviors during dental visits, facilitating better communication and understanding among dental professionals.
• Research Evaluation: Behavioral classifications can aid in assessing the validity of current research and practices in pediatric dentistry.

Wright’s Clinical Classification

Wright’s clinical classification categorizes children into three main groups based on their cooperative abilities:

1. Cooperative:

   • Children in this category exhibit positive behavior and are generally relaxed during dental visits. They may show enthusiasm and can be treated using straightforward behavior-shaping approaches. These children typically follow established guidelines and perform well within the framework provided.

2. Lacking in Cooperative Ability:

   • This group includes children who demonstrate significant difficulties in cooperating during dental procedures. They may require additional support and alternative strategies to facilitate treatment.

3. Potentially Cooperative:

   • Children in this category may show some willingness to cooperate but may also exhibit signs of apprehension or reluctance. They may need encouragement and reassurance to engage positively in the dental environment.

Frankl Behavioral Rating Scale

The Frankl behavioral rating scale is a widely used tool that divides observed behavior into four categories, ranging from definitely positive to definitely negative. The scale is as follows:

• Rating 1: Definitely Negative:

  • Characteristics: Refusal of treatment, forceful crying, fearfulness, or any other overt evidence of extreme negativity.

• Rating 2: Negative:

  • Characteristics: Reluctance to accept treatment, uncooperativeness, and some evidence of a negative attitude (e.g., sullen or withdrawn behavior).

• Rating 3: Positive:

  • Characteristics: Acceptance of treatment with cautious behavior at times; willingness to comply with the dentist, albeit with some reservations. The patient generally follows the dentist’s directions cooperatively.

• Rating 4: Definitely Positive:

  • Characteristics: Good rapport with the dentist, interest in dental procedures, and expressions of enjoyment (e.g., laughter).

Application of the Frankl Scale

• Research Tool: The Frankl method is popular in research settings for assessing children's behavior in dental contexts.
• Shorthand Recording: Dentists can use shorthand notations (e.g., “+” for positive behavior, “-” for negative behavior) to quickly document children's responses during visits.
• Limitations: While the scale is useful, it may not provide sufficient clinical information regarding uncooperative children. For example, simply recording “-” does not convey the nuances of a child's behavior. A more descriptive notation, such as “- tearful,” offers better insight into the clinical problem.

Digit Sucking and Infantile Swallow

Introduction to Digit Sucking

Digit sucking is a common behavior observed in infants and young children. It can be categorized into two main types based on the underlying reasons for the behavior:

1. Nutritive Sucking

   • Definition: This type of sucking occurs during feeding and is essential for nourishment.
   • Timing: Nutritive sucking typically begins in the first few weeks of life.
   • Causes: It is primarily associated with feeding problems, where the infant may suck on fingers or digits as a substitute for breastfeeding or bottle-feeding.

2. Non-Nutritive Sucking

   • Definition: This type of sucking is not related to feeding and serves other psychological or emotional needs.
   • Causes: Non-nutritive sucking can arise from various psychological factors, including:
     • Hunger
     • Satisfying the innate sucking instinct
     • Feelings of insecurity
     • Desire for attention
   • Examples: Common forms of non-nutritive sucking habits include:
     • Thumb or finger sucking
     • Pacifier sucking

Non-Nutritive Sucking Habits (NMS Habits)

• Characteristics: Non-nutritive sucking habits are often comforting for children and can serve as a coping mechanism in stressful situations.
• Implications: While these habits are generally normal in early childhood, prolonged non-nutritive sucking can lead to dental issues, such as malocclusion or changes in the oral cavity.

Infantile Swallow

• Definition: The infantile swallow is a specific pattern of swallowing observed in infants.
• Characteristics:
  • Active contraction of the lip musculature.
  • The tongue tip is positioned forward, making contact with the lower lip.
  • Minimal activity of the posterior tongue and pharyngeal musculature.
• Posture: The tongue-to-lower lip contact is so prevalent in infants that it often becomes their resting posture. This can be observed when gently moving the infant's lip, causing the tongue tip to move in unison, suggesting a strong connection between the two.
• Developmental Changes: The sucking reflex and the infantile swallow typically diminish and disappear within the first year of life as the child matures and develops more complex feeding and swallowing patterns.

Composition of Stainless Steel Crowns

Stainless steel crowns (SSCs) are primarily made from a specific type of stainless steel alloy, which provides the necessary strength, durability, and resistance to corrosion. Here’s a breakdown of the composition of the commonly used stainless steel crowns:

1. Stainless Steel (18-8) Austenitic Alloy:

• Common Brands: Rocky Mountain, Unitek
• Composition:
  • Iron: 67%
  • Chromium: 17%
  • Nickel: 12%
  • Carbon: 0.08 - 0.15%

This composition provides the crowns with excellent mechanical properties and resistance to corrosion, making them suitable for use in pediatric dentistry.

2. Nickel-Based Crowns:

• Examples: Inconel 600, 3M crowns
• Composition:
  • Iron: 10%
  • Chromium: 16%
  • Nickel: 72%
  • Others: 2%

Nickel-based crowns are also used in some cases, offering different properties and benefits, particularly in terms of strength and biocompatibility.

Xylitol and Its Role in Dental Health

Xylitol is a naturally occurring sugar alcohol that is widely recognized for its potential benefits in dental health, particularly in the prevention of dental caries.

Properties of Xylitol

• Low-Calorie Sweetener: Xylitol is a low-calorie sugar substitute that provides sweetness without the high caloric content of traditional sugars.
• Natural Occurrence: It is found in small amounts in various fruits and vegetables and can also be produced from birch wood and corn.

Mechanism of Action

• Inhibition of Streptococcus mutans:
  • Xylitol has been shown to inhibit the growth of Streptococcus mutans, the primary bacterium responsible for dental caries.
  • It disrupts the metabolism of these bacteria, reducing their ability to produce acids that demineralize tooth enamel.

Research and Evidence

• Studies by Makinen:

  • Dr. R. Makinen has conducted extensive research on xylitol, collaborating with various researchers worldwide.
  • In 2000, he published a summary titled “The Rocky Road of Xylitol to its Clinical Application,” which highlighted the challenges and successes in the clinical application of xylitol.

• Caries Activity Reduction:

  • Numerous studies indicate that xylitol chewing gum significantly reduces caries activity in both children and adults.
  • The evidence suggests that regular use of xylitol can lead to a decrease in the incidence of cavities.

• Transmission of S. mutans:

  • Research has shown that xylitol chewing gum can decrease the transmission of S. mutans from mothers to their children, potentially reducing the risk of early childhood caries.

Applications of Xylitol

• Incorporation into Foods and Dentifrices:

  • Xylitol has been tested as an additive in various food products and dental care items, including toothpaste and mouth rinses.
  • Its sweetening properties make it an appealing option for children, promoting compliance with oral health recommendations.

• Popularity as a Caries Prevention Strategy:

  • The use of xylitol chewing gum is gaining traction as an effective caries prevention strategy, particularly among children.
  • Its palatable taste and low-calorie nature make it an attractive alternative to traditional sugary snacks.