Children’s dentistry · Prevention
Fissure sealants for children: what the evidence shows
Fissure sealants are one of the few preventive procedures with clear numbers behind them. This article sets those numbers out with their scope and states plainly what sealants do not achieve.
The short answer
Fissure sealants are a thin coating that seals the grooves on the biting surface of molars. According to the ADA and AAPD guideline they reduce caries by 76% at 2–3 years (OR 0.24, 95% CI 0.19–0.30, moderate quality evidence, strong recommendation), by 79% at 4–7 years and by 85% beyond seven years.
Key points
- Sealants reduce caries by 76% at 2–3 years (OR 0.24, 95% CI 0.19–0.30, moderate quality evidence, strong recommendation) in the ADA and AAPD guideline, by 79% at 4–7 years and by 85% beyond seven years.
- A Cochrane review of resin sealants versus no sealant in first permanent molars in children aged 5 to 10 reported OR 0.12 (95% CI 0.07–0.19) at two years, across six trials at low risk of bias covering 1,066 children, moderate-quality evidence.
- Sealants cover only the grooves of the biting surface and do not protect the contact surfaces between the teeth.
- Sealants are checked at every review appointment because they can wear or be partially lost, in which case they are topped up.
- The clinic does not publish a price for sealants; scope and cost are confirmed in writing after an examination.
What a fissure sealant is
The biting surface of a molar is not smooth. It has grooves and pits that in some children are so narrow that toothbrush filaments physically cannot enter them. That is where decay most often starts in childhood.
A sealant is a thin material applied to the cleaned surface that seals the grooves, leaving a smooth surface that a brush can clean. It is a mechanical barrier rather than a medicine, and it is not a substitute for brushing.
The procedure usually requires no drilling and in most cases no anaesthetic. It takes a few minutes per tooth, and the child needs to keep the mouth open and the surface dry, which is the main practical difficulty in very young children.
Which teeth, and when
Sealants are most often placed on the first permanent molars, which erupt around age six, and later on the second permanent molars. Premolars are sometimes included where their grooves are deep and caries risk is high.
The timing is soon after eruption, once the surface is accessible and can be kept dry, and before a lesion has appeared. If the tooth has not erupted far enough to be isolated, we wait rather than work in unsuitable conditions.
The decision is based on risk rather than on a rule applied to every child. Diet, cleaning quality, previous findings, the depth of the grooves and the ability to attend for review are all considered. Our approach with children is described on the children’s dentist page.
What the evidence shows
The guideline of the American Dental Association and the American Academy of Pediatric Dentistry reports a caries reduction of 76% at two to three years (OR 0.24, 95% CI 0.19–0.30, moderate quality evidence, strong recommendation), 79% at four to seven years and 85% beyond seven years.
A Cochrane systematic review compared resin sealants with no sealant in first permanent molars in children aged 5 to 10 and reported OR 0.12 (95% CI 0.07–0.19) at two years, across six trials at low risk of bias covering 1,066 children, with moderate-quality evidence.
These numbers are not a promise for an individual child. They describe groups of children followed for defined periods, and they depend on placement technique, on follow-up and on the risk in the particular case. That is why a sealant is checked at every review appointment.
What sealants do not achieve
A sealant covers the grooves of the biting surface. It does not protect the contact surfaces between teeth, and in teenagers that is a common site for decay, particularly where floss is not used. Second, a sealant does not replace brushing, because the sealed surface still collects plaque.
The material wears with chewing and can be lost in part or entirely, sometimes without anyone noticing. Its integrity is therefore checked at every review appointment and topped up where needed. A sealant that nobody checks is not reliable.
Third, a sealant is not placed mechanically on every surface. Where a lesion is already present, it is assessed and treated as a lesion rather than covered so that it disappears from view.
An honest word about preventive evidence
Not everything routine rests on equally strong evidence. For adults without severe periodontitis who attend regularly, a Cochrane review of 2 trials covering 1,711 participants found that routine scale and polish makes little or no difference to gingivitis, probing depths or oral health-related quality of life over 2 to 3 years, with high-certainty evidence, producing only a small reduction in calculus of unclear clinical importance.
A further Cochrane review of recall intervals covering 1,736 participants likewise found high-certainty evidence of little or no difference between risk-based and fixed six-month intervals over four years.
The other half of that picture matters just as much: in patients who do have periodontitis, subgingival instrumentation is efficacious and reduces pocket depths. Prevention is therefore not identical for everyone; it follows the risk. Professional cleaning is described on the dental hygiene page.
How the appointment runs
The surface is first assessed to decide whether it is suitable for sealing. The tooth is then cleaned, isolated from saliva and dried, the surface is prepared, and the material is applied and cured. The bite is checked so that the sealant does not interfere with chewing.
With children who find it hard to keep the mouth open or who are apprehensive, we start with one tooth and continue at the next appointment rather than finishing everything at once. We use the tell-show-do approach and no child is held down.
Expectations set beforehand matter too. If a child arrives believing that something will simply be placed on the teeth without discomfort, and an anaesthetic then becomes necessary because of a lesion, trust is lost. So we examine first and plan afterwards.
Price and insurance cover
We do not publish a price for sealants. The scope depends on the number of teeth, on the condition of the surfaces and on whether other treatment is needed, so the cost is confirmed in writing after an examination. An examination with diagnosis is €25. The full list is on the prices page.
The clinic holds a contract with the Bulgarian National Health Insurance Fund. What is covered for people under 18 depends on the child’s insurance status and on the terms of the current contract. We check the status and confirm the scope before treatment.
We do not state specific amounts or covered procedures in advance by telephone, because they depend on status and on the findings. Please bring the child’s health insurance details to the first appointment.
The Club awaits you
At the examination we assess the grooves, the caries risk and whether the timing is right. Call +359 896 121 314.
What the evidence shows
76%
caries reduction with fissure sealants at 2–3 years
Joint American Dental Association / American Academy of Pediatric Dentistry clinical practice guideline (odds ratio 0.24, 95% CI 0.19–0.30; moderate quality, strong recommendation); 79% at 4–7 years. Cochrane confirms the effect in first permanent molars in children aged 5–10.
Sources
Ahovuo-Saloranta A, et al. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev 2017;7:CD001830. (opens in a new window) · Wright JT, et al. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants. J Am Dent Assoc 2016;147(8):672–682. (opens in a new window)
Frequently asked questions
Frequently asked questions
Most often soon after the first permanent molars erupt, around age six, and later on the second permanent molars. The decision is based on caries risk, on the depth of the grooves and on whether the surface can be isolated and kept dry. If the tooth has not erupted far enough, we wait rather than work in unsuitable conditions.
The procedure usually requires no drilling and in most cases no anaesthetic. The main requirement is that the child keeps the mouth open and the surface stays dry for a few minutes. If that is difficult, we treat one tooth per appointment. If a lesion is already present, the plan changes and this is discussed with you beforehand.
The material wears with chewing and can be partly lost, sometimes without the child noticing. Its integrity is therefore checked at every review appointment and topped up where needed. How long it lasts depends on placement technique, on the bite and on eating habits rather than on a single figure that applies to everyone.
Yes. A sealant covers only the grooves of the biting surface and does not protect the contact surfaces between teeth, which is a common site for decay in teenagers. Daily brushing and cleaning between the teeth remain the basis, and the sealant is an addition to them rather than a replacement.
We do not publish a price, because the scope depends on the number of teeth and on the condition of the surfaces. The cost is confirmed in writing after an examination. An examination with diagnosis is €25. For an insured child under 18 we also check what the health insurance contract covers.
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