Fissure Sealant Consent Form

The treatment of teeth through the use of sealants is a preventative measure intended to facilitate the stopping of tooth decay in the pits of fissures of the chewing surfaces of the teeth.

Sealants are placed with the intent to prevent or delay the need for conventional fillings.

Those risks include possible unsuccessful results and/or failure which are associated with, but not limited to the following;

1. Loosening and/or dislodging; there is the possibility of the sealant loosening or becoming dislodged over a period of time.
   
   This time is indeterminable because of many variables including, but not limited to the following:

   a. The forces of chewing. These forces differ from patient to patient. The forces may be much greater in one patient then in another. Also, the way teeth occlude, (how they come together in chewing), may have an effect on the life of the sealants.

   b. The types of food or other substances that are put in the mouth and chewed. Very sticky foods such as some types of gum; sticky candies such as caramels; some liquorices; very hard substances, etc may cause loosening or dislodgement.

   c. Inadequate oral hygiene such as infrequent or improper brushing of the teeth also may allow leakage around and under the sealant causing it to loosen and allow decay to develop.

2. Sealants are applied to the pits and fissures that are in the chewing surfaces of molar teeth. These pits and fissures are susceptible to decay and can be protected through application of sealants which flow into these ‘nooks and crannies’ and seal those areas. However, sealants do not protect the areas between the teeth, so through brushing and the use of dental floss in these areas is necessary.