What are dental sealants?

Dental sealants are filling materials that the dentist places in the grooves of teeth that are prone to decay.

Dental sealants research

Meta-analysis – Longevity of resin based sealant is much better than any other kind at 5 years Kühnisch 2012

• 5 year survival at 84%

Cochrane review – “Sealants compared with no sealants, on the occlusal surfaces of permanent molars in children and adolescents, are effective at reducing caries up to 48 months. There is less evidence for longer term follow-up
and little for the relative effectiveness of sealing in less high caries risk children. No conclusions could be drawn on the relative effectiveness of different types of sealants.”

Most RCTs are like this one.  Not as useful because of their short term. Short term results are especially troublesome for dental sealants because a sealant hides the grooves and also any potential issues. Therefor, that leaves the dentist guessing as to if the material is leaking and there is active decay below the surface.  I prefer to use sealants primarily to delay the onset and maybe the identification of decay in children prone to decay until the child is old enough to mentally deal with  the dental procedure to restore the tooth with a filling.

 Why I don’t love dental sealant research and dental sealants done in many offices

There is a popular saying on dentaltown about sealants; “dental sealants work great on people that don’t need them”.  The basic idea of taking one of our worst materials, a flowable sealant typically has very high contraction rate, and bonding it to an impossible to fully clean surface due to deep grooves is almost ensuring less than ideal results.  Add to the fact that it is a very technique sensitive procedure and all the studies have been completed under a rubber dam by a dentist with an assistant but in the real world a hygienist is trying to do it with a cotton roll and no assistant. The results will never be the same.

2 studies would give me much more confidence in dental sealants.

#1 Split mouth study.  Sealants left for x years without being allowed to be repaired (since in the real world not all will be).  Then at x years remove all sealant material and take a diagnodent or similar reading.  All decay from both sides must be substantiated with diagnodent.  Tooth should be scanned with intraoral scanner before decay removal and after and software used to determine amount destruction caused by decay.  The area removed would show which method results in ultimately saving more tooth structure.

#2 Split mouth study over the course of 40 years.  Hard to do due to time period needed but possible if can use insurance data information and track back.  Get 10,000 children that had not and same number that had sealants placed 10, 20, and when possible 30 and 40 years ago from real life practices.  Then find as many of these patients as possible and simply calculate the amount of dentistry that has been done on those teeth.

Looking at the research it’s clear dental sealants work though!!

If your goal is to delay, or possibly just hide, through childhood then a dental sealant is the way to go. I do not feel they are good for individuals that are low risk for decay.