The paradox of prevention
It is a strange contradiction that we live every day in the clinic. We will spend hours and thousands of dollars rebuilding a tooth that has been damaged by tooth decay. Complex composite work, CAD/CAM crowns, root canals. We have incredible technology to repair the damage. But what about a simple, thin layer of plastic that could have prevented the whole mess? This is often an afterthought. A footnote to the treatment plan. This is the paradox of the dental sealant. We have a mountain of evidence, stretching back decades, showing that this simple process works. A Cochrane review – the gold standard of evidence – found flat-out sealants reduce decay in permanent molars [8]. Someone else confirmed it again a few years later [9]. The science is not disputed.
The mechanism is brutally simple. A sealant is nothing more than a physical barrier. Think of it as caulking the cracks. Molars and premolars have these complex grooves on their chewing surfaces. The technical term is pits and cracks. For toothbrush bristles, they can be impossibly deep canyons where food and bacteria hide. A perfect breeding ground for rot. A sealant simply flows into these grooves and seals them [2]. It physically stops caries microorganisms from setting up shop. No bacteria, no acid. No acid, no cavity. They are some of the most immediate, effective deterrents we have in our arsenal [10]. We even have a whole range of materials to choose from now, from classic resins to glass ionomers, some even with antimicrobial additives cooked right into [3][4]. So the tools are there. The evidence is there. Why the disconnection?
Beyond the Pediatric Chair
Part of the problem is branding. We have pigeon sealants as a pediatric treatment. We conscientiously recommend them when a child’s first permanent molars erupt around the age of six and again for the second molars around twelve [5]. It becomes part of the routine. But the second the patient turns eighteen, the conversation just…stops. As if the grooves in their teeth magically become self-cleaning on their birthday. It doesn’t make sense. An adult with deep, stained fissures is just as – if not more – at risk as a child. But the idea of putting sealants on adults is still viewed as outlandish, a “long-neglected preventive measure,” as one paper put it a decade ago [1]. Not much has changed.
This is where we, as a community, need a reality check. Tooth decay is not a childhood disease. It’s a lifelong battle. Why discard one of our best shields just because the patient is old enough to vote? An unsealed high-risk molar in a 30-year-old is a ticking time bomb. It is a future chewing filling. Then a bigger one. Then maybe a crown. The cost, both financial and biological, escalates at every step. The American Dental Association has long advocated sealants as a cost-effective measure [7]. A sealant costs a fraction of a surface fill. Math isn’t hard. We spend so much time assessing risk – diet, hygiene, fluoride exposure. But we often overlook the simplest physical risk modifier of all: the anatomy of the tooth itself. You can’t brush what you can’t reach.
A change in thinking
So what needs to change? It’s not about finding a new, magical material. The ones we have work fine [3]. It’s about changing the conversation. This is about moving sealants out of the “pediatric services” column and into the “caries management” column, for everyone. The question should not be, “how old is the patient?” It should be, “What does this tooth look like?” Is it deeply grooved? Is it hard to clean? Has he remained cavity-free so far by sheer luck? If so, seal it. It doesn’t matter if the patient is 15 or 50. It’s about managing risk on a surface-by-surface basis.
We must incorporate this thinking into the philosophy of our care routine [10]. It should be as standard as getting wings. During an adult prophylactic, when we see deep, dark spots in a molar gap that somehow hasn’t yet decayed, the first thought shouldn’t be “let’s notice it.” It should be, “let’s seal it.” Let’s take that risk off the table. It’s a simple, non-invasive and powerful statement that we prioritize keeping teeth whole over getting better at drilling them [6]. The ultimate goal is to do less restorative dentistry, not more. And sealants are a direct route to this goal. It’s time to start treating them less like a specialty item and more like the essential tool they are.
References
[1] Gore DR (2010). The use of dental sealants in adults: a long-neglected preventive measure. International Journal of Dental Hygiene, 8(3), 198–203.
[2] Ng, TC, Chu, CH and Yu, OY (2023). A concise review of dental sealants in caries management. Limits in oral health, 41180405.
[3] Piszko, A., Piszko, PJ, Lubojański, A., Grzebieluch, W., Szymonowicz, M., & Dobrzyński, M. (2023). Brief narrative review of commercial dental sealants-Comparison with respect to their composition and possible modifications. Materials (Basel, Switzerland), 16(19), 6453.
[4] Sasa, I., & Donly, KJ (2010). Sealants: a review of materials and use. Journal of the California Dental Association, 38(10), 730–734.
[5] Colombo, S., & Ferrazzano, GF (2018). Dental sealants. Part 2: Who Should Get Dental Sealants and When? European Journal of Pediatric Dentistry, 19(2), 165–166.
[6] Condò, R., Cioffi, A., Riccio, A., Totino, M., Condò, SG, & Cerroni, L. (2014). Sealants in dentistry: a systematic review of the literature. ORAL & Implantology, 6(3), 67–74.
[7] Dental sealants. ADA Council on Access, Prevention, and Interprofessional Relations. ODA Scientific Affairs Council. (1997). Journal of the American Dental Association (1939), 128(4), 485–488.
[8] Ahovuo-Saloranta, A., Forss, H., Walsh, T., Nordblad, A., Mäkelä, M., & Worthington, HV (2017). Hole and fissure sealants to prevent caries in permanent teeth. The Cochrane Database of Systematic Reviews, 7(7), CD001830.
[9] Ahovuo-Saloranta, A., Forss, H., Walsh, T., Nordblad, A., Mäkelä, M., & Worthington, HV (2017). Hole and fissure sealants to prevent caries in permanent teeth. The Cochrane Database of Systematic Reviews, 7(7), CD001830.
[10] Colombo, S., & Paglia, L. (2018). Dental sealants. Part 1: Prevention First. European Journal of Pediatric Dentistry, 19(1), 80–82.
