3.5 Criteria and Methods for Selecting Teeth to Be Sealed

Explorer Use (Tactile Criteria)

Explorers are not necessary for detecting non-cavitated or cavitated lesions. Evidence suggests that use of an explorer does not improve detection.
Forceful use of an explorer on a non-cavitated, subsurface lesion can easily produce a break and cavitate it, thus damaging the tooth. Under existing guidelines and recommendations, this tooth would no longer be a candidate for sealant placement.
The explorer may be used gently to clean debris or remove plaque; to confirm and assess cavitation; and, once the tooth is sealed, to help assess sealant integrity and retention. Only in cases in which there is doubt about whether a cavitation is present, the explorer tip can be placed in contact with the tooth surface and moved very gently in the area of interest to see if a discontinuity or break is detected.

X-rays should not be taken for the sole purpose of determining whether sealants should be placed.6
Whether taking x-rays results in more accurate assessment (compared with conducting a visual assessment of occlusal surfaces) has not been determined.
Many non-cavitated lesions extend into the dentin; however, this does not mean that they are active and therefore in need of operative intervention. Thus, in occlusal surfaces, seeing a lesion in the dentin on an x-ray is not a diagnosis of surface cavitation or of an active infection.
Since the decision about whether to seal teeth is based on surface cavitation and not on whether a lesion is limited to the enamel or is histologically or radiographically into the dentin, taking x-rays will not alter school-based dental sealant programs’ decisions about whether to seal a tooth.