Sealants: the most underused tool in prevention

If there were a dental treatment that was painless, required no drilling, took minutes, and reduced caries risk by up to 80%, you would expect every parent to know about it. Yet dental sealants remain one of the most underused preventive tools in modern dentistry.

Quick answer

Pit and fissure sealants are thin resin coatings applied to the chewing surfaces of molars to seal the deep grooves where bacteria accumulate and brushing cannot reach. The Cochrane review reports up to 80% caries reduction in sealed permanent molars compared to unsealed controls over two or more years ^[1]. The ADA clinical practice guideline confirms that sealants are recommended for both preventing and arresting early non-cavitated caries ^[2].

Why grooves are the problem

The deep fissures on the chewing surfaces of permanent molars are narrower than a single toothbrush bristle. Bacteria colonise these grooves immediately after eruption, and no amount of careful brushing can fully clean them. This is why approximately 90% of cavities in children and adolescents occur on these biting surfaces, the anatomy of the tooth creates an environment that favours decay.

What the evidence says

The Cochrane systematic review by Ahovuo-Saloranta and colleagues pooled the randomised controlled trials and found that resin-based sealants applied to permanent molars reduce caries by 11-51% at two years compared to no sealant ^[1]. The American Dental Association's evidence-based clinical practice guideline went further, concluding that sealants are effective for both preventing new caries and arresting existing non-cavitated lesions, meaning that even teeth showing early signs of decay benefit from sealing rather than drilling ^[2].

For primary teeth, a separate Cochrane review by Ramamurthy and colleagues confirmed that sealants are also effective in reducing caries in deciduous molars ^[3].

Sealants vs. fluoride: not a competition

Both work. The Cochrane review on fluoride toothpaste demonstrated clear dose-dependent caries reduction from regular fluoride use ^[4]. The ADA network meta-analysis on nonrestorative treatments for caries confirmed that sealants and fluoride varnish are among the most effective nonrestorative interventions available ^[5].

The question is not which to use, it is whether the child's individual risk warrants one, the other, or both. Evidence-based caries risk assessment models help make that decision ^[6].

How sealants are placed

The procedure takes a few minutes per tooth and requires no anaesthesia:

1. The tooth is cleaned and dried
2. An acid etch is applied briefly to create microscopic texture for bonding
3. The sealant resin is painted into the grooves
4. A curing light hardens the resin in seconds

The child feels nothing. There is no drilling and no injection.

Frequently asked questions

At what age should sealants be placed?

Ideally as soon as the permanent first molars erupt, around age 6, and again when the second molars come through around age 12.

Do sealants last?

With regular check-ups they can last many years. If a sealant chips or wears, it can be repaired or reapplied easily.

Are sealants only for children?

Mostly, but adults with deep unsealed grooves and high caries risk can also benefit.

Can sealants be placed over early decay?

Yes. The ADA guideline supports sealing non-cavitated lesions to arrest their progression ^[2]. This is preferable to drilling and filling.

Are there any risks?

Sealants have an excellent safety profile. The amount of BPA released from resin sealants is negligible and far below any level of concern.

When to see Dr. Khalid

If your child's permanent molars have erupted and have not been sealed, or if you want to discuss a preventive strategy based on your child's individual risk, I am happy to evaluate and recommend the right approach.