Dental Sealants: Does your child really need them?
Your child may brush twice a day, use fluoride toothpaste and have a relatively healthy diet—and yet their dentist may still recommend dental sealants.
The first question many parents ask is:
“If there is nothing wrong with the tooth, why put something on it?”
The answer lies in the anatomy of the tooth.
The chewing surfaces of molars aren't smooth. They have tiny grooves and pits called pits and fissures. Some of these grooves are so narrow or deep that toothbrush bristles cannot effectively reach the bottom.
And these are precisely the places where plaque and food particles can accumulate.
A dental sealant acts like a protective raincoat over these vulnerable grooves.
This article will help answer the following question;
What exactly is a dental sealant?
A dental sealant is a thin protective material placed over the pits and fissures of a tooth. It flows into the grooves and, once set, creates a physical barrier between the tooth surface and the oral environment.
Think of it like sealing the cracks in a wall before water gets into them.
Sealants don't replace brushing or fluoride. Instead, they address a different problem—the difficult-to-clean anatomy of the chewing surface.
Research shows that sealants can prevent caries and can also help arrest or slow the progression of early, non-cavitated enamel lesions. [1]
Are dental sealants actually effective?
Yes—but their effectiveness depends on the child, the tooth, the caries risk and whether the sealant remains intact.
The Centre of Disease Control (CDC) reports that sealants can prevent up to 80% of cavities on the back teeth for about two years, with protection continuing thereafter. [2] That doesn't mean that an individual child has an “80% guarantee.” It is a population-level estimate, and the benefit varies according to caries risk and other factors.
Which children benefit most?
This is where I think parents need to understand an important concept:
Sealants are not simply an age-based treatment. They are a risk-based treatment.
A dentist may recommend sealants when a child has:
Deep or narrow pits and fissures
Previous cavities
High sugar exposure
Difficulty maintaining effective oral hygiene
Newly erupted permanent molars
Early non-cavitated lesions
A history suggesting increased caries susceptibility
The AAPD recommends individualized caries-risk assessment and incorporates sealants alongside fluoride, diet counselling, oral hygiene and other preventive measures.[3]
When should my child's teeth be sealed?
The most important time is often soon after the permanent molars erupt.
The first permanent molars usually erupt around 6 years of age, and the second permanent molars around 12 years—although eruption timing varies from child to child.
But there is an important practical consideration:
The tooth needs to be sufficiently erupted and dry enough for the dentist to place the sealant properly.
What happens during a sealant appointment?
The procedure is usually quick and does not require drilling away healthy tooth structure. Steps involved in the procedure are;
What if there is already a little cavity?
This is one of the most important things for parents to understand.
Not every dark groove is a cavity that needs a filling.
A tooth may have:
Stained fissures
Deep anatomical grooves
An early/non-cavitated enamel lesion i.e. the tooth structure is not broken.
An actual cavitated lesion extending into dentine (second layer of the tooth) i.e. there is a break in the continuity of the tooth
These are not the same thing.
Evidence supports sealing non-cavitated lesions in appropriate situations because the sealant can prevent or slow further progression.[4] However, a tooth with a cavitated lesion, particularly one involving dentine, may require restorative treatment rather than simply being sealed.
How long do dental sealants last?
There isn't one fixed expiry date.
Some sealants remain intact for many years. Others partially or completely wear away earlier.
But here's the important part:
A sealant does not have to remain perfectly visible forever to have been worthwhile.
Your child's dentist should check the sealants during routine examinations.
If part of a sealant is lost, it may be possible to repair or replace it.
Once the sealant is placed, is the tooth protected forever?
Not quite.
A sealant is a preventive intervention that needs to be checked, just like any other dental treatment. Additionally, a sealant only protects the chewing surfaces of the tooth, for other surfaces there are fluoride based preventive strategies which you can discuss with your dentist.
Are dental sealants safe?
Dental sealants have been used for decades and are considered an established preventive treatment.
The available clinical evidence supports their use for caries prevention, and studies included in the Cochrane review reported no adverse events attributable to sealants in the trials that specifically reported them.
Parents sometimes come across concerns about ingredients such as BPA.
This is an area where it's useful to distinguish exposure from clinical harm. Some resin materials can involve BPA-related compounds during manufacture or setting, but the presence of a chemical in a material does not automatically mean that clinical exposure causes harm. If a parent has specific concerns, discussing the material being used with their dentist is entirely reasonable.
Are sealants only meant for permanent teeth in children?
The CDC notes that sealants can be placed on primary and permanent teeth and that people can even benefit from them into adulthood.
However, the evidence base is much stronger in children and adolescents.
So an adult with:
deep fissures,
previous cavities,
a newly erupted tooth,
or elevated caries risk
may absolutely be considered for a sealant.
Age alone shouldn't be the deciding factor.
The condition of the tooth and the person's caries risk matter more.
The bottom line for parents
Dental sealants are a minimally invasive preventive treatment designed to protect the most vulnerable anatomy of the tooth.
For a child with deep fissures or increased caries risk—particularly around the eruption of permanent molars—it can be an important opportunity to prevent a filling.
But sealants aren't magic.
They don't replace:
twice-daily brushing with fluoride toothpaste
sensible control of sugary drinks and snacks
regular dental examinations
fluoride when indicated
individualized caries-risk assessment
And perhaps the most important message for parents is this:
Prevention sometimes it means doing less treatment later.
References;
Ng TC, Chu CH, Yu OY. A concise review of dental sealants in caries management. Front Oral Health. 2023 Apr 17;4:1180405. https://pubmed.ncbi.nlm.nih.gov/37138858/
CDC. About dental sealants. Oral Health. https://www.cdc.gov/oral-health/prevention/about-dental-sealants.html
AAPD. Caries-risk Assessment and Management for Infants, Children and Adoloscents.https://www.aapd.org/media/Policies_Guidelines/BP_CariesRiskAssessment.pdf
Wright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, Donly K, Hewlett ER, Quinonez RB, Chaffin J, Crespin M, Iafolla T, Siegal MD, Tampi MP, Graham L, Estrich C, Carrasco-Labra A. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: A report of the American Dental Association and the American Academy of Pediatric Dentistry. J Am Dent Assoc. 2016 Aug;147(8):672-682. https://jada.ada.org/article/S0002-8177(16)30473-1/fulltext
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