Overview
Sealants are either resin-based materials or glass ionomer cements applied to the occlusal (biting) surface of the posterior teeth, covering the pits and fissures that are susceptible to decay. They are primarily intended for use on young, permanent teeth. Sealants can also be used as treatments for non-cavitated carious lesions located in the enamel or in the superficial part of the dentin.
Use and Applications
Pit and fissure sealants are professional, ‘in office’ treatments which require good patient cooperation. For resin-based sealants, the tooth must be thoroughly cleaned and dried prior to application. After etching of the enamel, sealants are applied in a thin layer and cured by visible light before the occlusion is checked. Glass ionomer cements are less sensitive to moisture and require no etching of the enamel.
Effectiveness and Efficacy
Pit and fissure sealants are effective in preventing caries in permanent molars provided that the sealants are regularly controlled and repaired when needed. The preventive fraction is 71% up to five years after placement with a moderate quality of evidence [1]. The prevented fraction is lower in primary molars. Glass ionomer sealants are equally as effective in caries prevention, however require greater maintenance due to an impaired retention rate [2].
Safety
Pit and fissure sealants are available from several brands and are generally recognized as safe. Patients may however be allergic to uncured leaking monomers from the material.
Cost Effectiveness
The use of pit and fissure sealants is the most time consuming professional preventive measure and does not pay off in low-caries populations. Sealants may be cost-effective for individuals who are at high risk of caries [3]. The cost of sealant programs is decreased when performed by dental hygienists.
Recommendations
Pit and fissure sealants are recommended for children who are at a moderate or high risk of developing dental caries, or have early caries lesions in pits and fissures.
Key Further Reading
1. Pit and fissure sealants for preventing dental decay in permanent teeth.
Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev. 2017 Jul 31;7:CD001830.
2. Glass ionomer cements as fissure sealing materials: yes or no?: A systematic review and meta-analysis.
Alirezaei M, Bagherian A, Sarraf Shirazi A. Glass ionomer cements as fissure sealing materials: yes or no?: A systematic review and meta-analysis. J Am Dent Assoc. 2018 Jul;149(7):640-649.e9.
3- Economic evaluation of dental sealants: A systematic literature review.
Akinlotan M, Chen B, Fontanilla TM, Chen A, Fan VY. Economic evaluation of dental sealants: A systematic literature review. Community Dent Oral Epidemiol. 2018 Feb;46(1):38-46.
Guidance Document
ACFF Members can download the full reference document for Pit and Fissure Sealants.