Cons of Dental Sealants in Adults
Dental sealants present several disadvantages when used in adults that should be carefully considered before application. While dental sealants can be effective for preventing caries in children and adolescents, their use in adults comes with significant drawbacks including potential BPA exposure, limited effectiveness compared to other preventive measures, and retention issues.
Material Concerns and Chemical Exposure
BPA exposure risk: Dental sealants may contain bisphenol A (BPA), which has been identified as an endocrine-disrupting chemical. Adults have shown higher estimated daily intake (EDI) of BPA than children, with maximum EDI values of 4.86 μg/kg body weight/day 1. This is particularly concerning as BPA is still used in many adult products including dental sealants.
Chemical leaching: Sealant materials can potentially release chemicals into the oral cavity over time, especially when the material begins to degrade, which may contribute to systemic exposure to these compounds.
Limited Effectiveness in Adults
Reduced preventive benefit: Unlike children, adults typically have fully developed teeth with established oral hygiene habits. The preventive benefit of sealants is significantly greater in children and adolescents than in adults who have already developed their permanent dentition 2, 3.
Alternative preventive measures: For adults, other preventive measures such as fluoride application and regular professional cleaning may provide better protection against caries. The CDC recommends that all persons drink water with optimal fluoride concentration and brush teeth twice daily with fluoride toothpaste as the primary preventive approach 1.
Technical and Practical Challenges
Retention issues: Sealants may have poorer retention in adults compared to children due to:
- Greater occlusal forces in adult dentition
- More wear and tear from mastication
- Difficulty in maintaining proper isolation during application in adults with established periodontal issues
Application challenges: Proper isolation is critical for successful sealant application. In adults with:
- Deep gingival pockets
- Gingival recession
- Exposed root surfaces The application process becomes more technically challenging and may result in inadequate sealing.
Cost-Effectiveness Concerns
Limited cost-benefit ratio: The cost-effectiveness of dental sealants in adults is questionable compared to children. Research suggests that sealants are most effective in high-risk populations, but information on the magnitude of benefit in other conditions, such as in adults with lower caries risk, is scarce 2.
Insurance coverage limitations: Many dental insurance plans limit coverage for sealants to children and adolescents, making them an out-of-pocket expense for most adults.
Maintenance Requirements
Need for regular monitoring: Sealants require periodic professional evaluation to ensure they remain intact and functional. Adults would need twice-yearly visits for supportive periodontal therapy and assessment of sealant integrity 1.
Replacement necessity: When sealants fail or are partially lost, they need to be replaced or repaired, adding to the long-term cost and time investment.
Potential Interference with Other Dental Procedures
Diagnostic challenges: Sealants can mask underlying caries if applied over incipient lesions, making radiographic detection of decay more difficult.
Complication of future restorative work: If restorative treatment becomes necessary, the presence of sealant material may complicate the procedure.
Conclusion for Clinical Practice
When considering dental sealants for adult patients, clinicians should weigh these disadvantages against potential benefits. For most adults, a comprehensive preventive approach focusing on regular professional cleaning, proper oral hygiene practices, and fluoride use may be more appropriate and cost-effective than dental sealants. If sealants are considered, they should be targeted to specific high-risk surfaces rather than applied universally.