Dental caries was officially recognized as the most common chronic childhood disease in the 2000 Surgeon General’s report.1 Worryingly, this statistic has not changed, even though we know that rot is largely preventable. As dental hygienists, shouldn’t prevention be our priority?
As a prevention specialist, I believe that dental sealants are one of the most effective tools we have in the battle against tooth decay, not only to protect children’s teeth, but also to protect their ability to learn, grow and thrive.
Why dental sealants matter more than ever
Although fluoride has a proven record of safety and effectiveness, and community water fluoridation remains one of the top 10 public health initiatives of the century,2 Fluoride faces increasing scrutiny and threats of removal. This makes sealants even more critical as a line of defense against childhood tooth decay.
Applied to the cavities and fissures of molars (where nearly 90% of cavities develop), sealants can prevent up to 80% of tooth decay within two years and maintain about 50% effectiveness for up to four years.3 However, despite their proven effectiveness, fewer than half of children and adolescents have sealants on their permanent teeth.3
Overcoming barriers to sealant use
Sealants remain an underutilized tool for caries prevention, in part because of the ongoing controversy over sealing non-cavitated lesions. Skepticism persists, despite studies confirming that bacterial load is reduced and decay can be halted when a sealant is placed over early lesions.4 This skepticism is often associated with microleakage, inadequate isolation and subsequent seal loss, and these challenges are particularly acute in environments where contamination prevention is difficult.
But there are options. In my own experience during medical missions in Guatemala using glass ionomer (GI) sealants, these provided a practical solution and opportunity to treat many more high-risk children than traditional methods would allow. Despite wearing more easily, GI sealants have demonstrated comparable efficacy to resin-based sealants in preventing new caries.5
Cost, convenience and clinical effectiveness
Protecting smiles and supporting success
Children who do not have sealants are almost three times more likely to develop cavities in their first molars,3 which can lead to pain, infection and missing school. In fact, studies show that 34 million school hours are lost each year due to acute dental pain and dental emergencies.7 In line with Maslow’s hierarchy of needs, when a child is in pain, their ability to concentrate and learn is compromised.8
School waterproofing programs: A proven model
School-based dental sealant programs are a powerful way to reach underserved children. These programs have been shown to eliminate barriers such as transportation, cost, and scheduling, save millions of dollars in treatment costs, and prevent more than three million cavities in children from low-income families.9
The impact goes far beyond wear prevention. Sealing programs help children stay in school, empower them to learn without the burden of dental pain, and lay the foundation for a healthier future.
As the debate over fluoride and community water fluoridation heats up, children from low-income households are losing their most affordable defense against tooth decay. This demographic, which is already more likely to experience untreated tooth decay and struggles to access routine care, benefits the most from sealants.10 Sealants and fluoride complement each other, and according to the ADA, caries control is most effective when both are used.11
Some sealants release fluoride, but to remain effective, their protective potential depends on “recharging” through routine fluoride treatments.12 Sustained protection depends on consistent access to both.
Now more than ever, when the opportunity to place seals on vulnerable children arises, whether due to socioeconomic status, geographic location, or systemic barriers, we must respond. Any applied sealant is more than just a barrier to decay. it is a humanitarian effort.
References
- Oral health in America: report of the Surgeon General. Department of Health and Human Services. Accessed August 2025.
- CDC Science Statement on Community Water Fluoridation. Centers for Disease Control and Prevention. 15 May 2024. Accessed August 2025.
- Elements of dental sealants. Centers for Disease Control and Prevention. 15 May 2024. Accessed 30 September 2025.
- Dental sealants. American Dental Association. Updated December 22, 2021. Accessed August 2025.
- Seth S. Glass ionomer cement and resin-based fissure sealants are equally effective in caries prevention. J Am Dent Assoc. 2011, 142(5):551-552.
- Griffin SO, Naavaal S, Scherrer C, Patel M, Chattopadhyay S. Evaluation of school-based dental sealant programs: an updated community guide systematic economic review. Am J Prev Med. 2017? 52 (3): 407-415. doi:10.1016/j.amepre.2016.10.004
- Naavaal S, Kelekar U. School hours lost due to acute/unscheduled dental care. Health Behavior Policy Rev. 2018;5(2):66-73. doi:10.14485/HBPR.5.2.7
- Walsh MM, Darby ML. Dental Hygiene: Theory and Practice. 4th ed Saunders; 2014.
- School seal programs. Centers for Disease Control and Prevention. 15 May 2024. Accessed August 2025.
- Chi DL, Masterson EE, Carle AC, Mancl LA, Coldwell SE. Socioeconomic status, food security, and dental caries in US children: mediation analyzes of data from the National Health and Nutrition Examination Survey, 2007–2008. Am J Public Health. 2014? 104 (5): 860-864. doi:10.2105/AJPH.2013.301699
- Clinical Practice Guidelines for Pit-and-Fissure Sealants 2016. American Dental Association. Accessed August 2025.
- Clinical guidelines on fluoride. American Dental Association. Accessed August 8, 2025.
