Doctor Staci Talks Sealants in a guest blog for Ask the Dentist!
by Staci Whitman, DMD
What are dental sealants?
Dental sealants are thin, plastic coatings that seal over the narrow grooves found on the chewing surfaces of back teeth (molars and premolars).
When placed perfectly on these deep pits, sealants can prevent a significant amount of tooth decay (cavities) by protecting sensitive tooth surfaces from acid that causes cavities.
Sealants are not generally placed on baby teeth but on the tooth enamel of permanent teeth (“adult” teeth).
Dental sealants function much like sealing cracks in a driveway or on the sidewalk. The grooves in the chewing surfaces of back teeth are sealed so that food particles and bacteria will not settle within the fissures, causing cavities.
Application of sealants may be appropriate for some pediatric dental patients to prevent tooth decay in kids. However, they are not a substitute for brushing, flossing, and a healthy diet.
Dental sealants can be placed by your dentist, dental hygienist, or other dental professional. Some states dental boards have laws governing by whom, how, and in what circumstances dental sealants can be placed.
While I will recommend sealants at my office, I do so with very strict criteria, application techniques, and only the cleanest materials. So, are dental sealants worth it for your children’s dental health?
How are sealants applied to teeth?
Sealant placement is a relatively easy process.
- First, the teeth are cleaned of plaque or food particles and then thoroughly examined for tooth decay.
- Each tooth is dried and surrounded by absorbent material so it remains dry throughout the procedure.
- The tooth is cleaned with a mild etchant (acid etch solution) to roughen the tooth surface and encourage bonding of the sealant material.
- The etchant is rinsed and the teeth are dried again.
- Depending on your material of choice, a thin layer of bonding agent may be used prior to the placement of the very viscous sealant material.
- The sealant is painted directly onto the chewing surface of each tooth.
- Finally, a curing light may be used to harden the dental sealant.
The teeth must be nicely isolated so no contaminants, such as saliva, affect the bond. Ozone gas can be applied to ensure bacteria on or around the tooth is reduced or eliminated prior to sealing.
If a small cavity is detected, air abrasion or a dental laser or drill can be used to clean out the infection prior to any material placement.
Can a sealant be placed over existing tooth decay?
Technically, clear sealants can be used over small cavities to prevent major spread of the decay.
However, it’s best to treat any existing decay (or take steps to reverse it, depending on the extent of the decay) before placing a dental sealant.
How long do dental sealants last?
Depending on the techniques used, sealants can last from 3-10 years or more.
Sealants may not last as long for patients who:
- Clench/grind their teeth
- Have acid reflux
- Eat a highly acidic diet
How do I care for my sealants?
Dental sealants are easy to care for and can be brushed and flossed as normal. Use a toothbrush with soft bristles and a toothpaste using a remineralizing agent like hydroxyapatite.
They may stain with diets high in berries, coffee, teas, and red wine. Sealants may “pop” off if you are eating sticky, gummy, chewy foods.
Do dental sealants work?
Do dental sealants prevent cavities? Yes, sealants do work to prevent cavities (tooth decay) if placed perfectly and at the right time.
Most research shows that sealants do reduce cavities, but more long term follow-ups are needed.
In a 2017 Cochrane review, researchers stated that “resin‐based sealants applied to occlusal surfaces of permanent molars reduced caries when compared to no sealant.” However, “trials with long follow‐up times are needed to research the effectiveness of sealing procedures related to different caries prevalence levels.”
The CDC (Centers for Disease Control and Prevention) found in a 2016 study that “Children without sealants had almost three times more cavities in permanent first molars compared with children with sealants.”
The same study stated that dental sealants can prevent 80% of cavities in permanent molars (where 9/10 cavities develop).
This study did not control for dietary patterns, dental hygiene habits, or level of dental care during the same period of time. It only controlled for sex, race/ethnicity, family income, and highest level of education by the head of the household.
Why does this matter? It’s possible that confounding variables — such as diet, dental visits, or dental hygiene habits — may have artificially inflated these numbers.
For example, children who received dental sealants may also have visited the dentist, brushed, and flossed more often. They may be the same children who do not eat sugary or highly acidic foods, which will impact cavity formation.
These statistics should be examined with a hefty grain of salt.
Risks of Dental Sealants
Dental sealants are painless and scientific research has not revealed any adverse effects likely to happen when dental sealants are placed.
However, there are risks if the teeth are not thoroughly examined for dental caries (tooth decay) prior to placement.
Very frequently, I will go to remove or replace a sealant only to find hidden decay underneath. If left undetected, otherwise healthy teeth need extensive fillings and sometimes even nerve therapy or extractions after being covered by a sealant.
A PLoS One study found that even “after adjustment by non-conditional logistic regression for sociodemographic variables, oral health behaviors (toothbrushing, daily use of dental floss and dental appointments) and experience of dental pain, the findings of the present study demonstrate that dental caries is associated with fissure sealant application.”
In plain terms: If sealants are not properly placed, they can actually cause cavities by either creating ledges to catch plaque and food on or by sealing in bacteria and undetected decay to fester and grow underneath the material.
Many parents are concerned about the adverse reactions/effects of dental sealant material.
Most dental sealants contain BPA (bisphenol A) and/or bis-GMA. These are both known endocrine disruptors and should generally be avoided in growing and developing children.
From a 2012 publication: “Researchers found an estrogenic effect with BPA, Bis-DMA, and Bis-GMA because BPA lacks structural specificity as a natural ligand to the estrogen receptor. It generated considerable concern regarding the safety of dental resin materials.”
According to the American Dental Association (ADA), there is “not enough [BPA] to cause you or a loved one any harm” in dental sealants.
The amount of BPA exposure is at its highest during the application and is believed to “level out” within the 24 hours after the procedure. Thus far, there is no known harm of immediate toxicity after placement of sealant material.
However, this has never been tested using blood (serum) BPA or bis-GMA levels, which may present a concern.
To avoid toxic sealant materials (even in very small amounts), ask your dentist what materials they are using for their sealants. Ceramic-based materials, rather than those with BPA, Bis-DMA, or bis-GMA materials, are associated with the smallest level of risk to overall health.
Who should get dental sealants?
Children who benefit most from dental sealants include those:
- With very deep grooves in their molars
- At a high risk for cavities
- Who eat a diet high in processed foods, refined flours and sugars, and sugary drinks
- With special needs that make dental hygiene and/or a healthy diet more challenging
Ideally, sealants should be placed immediately after the eruption of the first molars (around age 6) and second molars (around age 12). Sooner is better to ensure the grooves have not been affected with bacteria or early cavities.
Sealants in Adults
In general, dental sealants are not used on adults, though some sources like the CDC and ADA claim they can help prevent decay. (This has not been tested in clinical trials.)
Dental sealants for adults may not be a good idea because the tooth has been exposed to the oral microbiome for a much longer time. Complex systems of bacteria are more likely to be trapped under the sealant in a deep groove.
To place a dental sealant in an adult tooth, it is important that the grooves be drilled out, treated with ozone, and immediately sealed. This best reduces the risk of growing decay under the sealant material.
Can dental sealants be removed?
Dental sealants can usually be removed in a quick and easy procedure involving either a laser or a dental drill to carefully remove the material used.
This leaves the healthy tooth structure intact, after which it can be resealed if desired.
Removing dental sealants is done to:
- Reseal the tooth with a ceramic sealant (which is considered “cleaner” than traditional sealant)
- Correct chips or cracks in existing dental sealants
- Eliminate poorly placed sealants
- Expose buried decay that can then be restored
Once a sealant is placed, it’s generally not removed unless a dentist spots a problem or the patient (or parent) requests it for other reasons, such as to change the materials being used.
How much do dental sealants cost?
Dental sealants cost $30-60 per tooth before insurance or discount plans.
Sealants placed on adult teeth may be billed as a one surface, posterior resin. This may cost $200-300 before insurance.
Are sealants covered by dental insurance?
Yes, dental insurance almost always covers dental sealants for people under 18.
Some insurance companies will only cover sealants on specific teeth or after a dental exam.
Many states have school-based sealant programs to provide dental sealants for children unlikely to have regular dental visits. These programs are usually provided to kids from low-income families and are funded by the CDC in 20 states and 1 territory.
Are sealants right for my family?
You and your dentist can use the information here to make an informed decision — there is no “right” answer that applies to every person for dental sealants.
If they snack and graze, eat a lot of sticky, processed foods (think crackers, granola bars, pretzels, chips, fruit snacks, etc.), have deep, groovy anatomy on their teeth, or have a history of cavities, then they should probably get sealants.
If your dental hygiene routine is average at best, they should probably get sealants.
If you really trust your dentist and their materials and their techniques, you should consider getting dental sealants.
I generally advise them in higher risk patients, including children with special needs or sensory disorders, simply because homecare and hygiene can be such a challenge.
If you find a dentist who uses diagnostic tools to ensure you are not sealing in decay, uses an antibacterial like ozone to disinfect the surface, and utilizes more non-toxic ceramic materials, sealants can be a wonderful decision for your child.
Recently, I did elect to put sealants on my six-year old daughter’s teeth just as soon as they had erupted enough for me to have proper access to the chewing surfaces. I used all the protocols I mentioned above and feel really good about it.
My reasoning? I cannot and will not always be in control of her hygiene and diet and I want to set her up for success. I hope that I have taught her about proper oral care and dietary choices, but frankly, I want her to avoid experiencing the most common chronic disease in the world…cavities!
Ultimately, of course, it is a parental decision and your advocacy for your child is unparalleled.
Ask questions about the procedure and materials used to your provider and if you do not like the answer, simply decline! Focus instead on cleaning up the diet, improving the hygiene routine, and keeping your oral microbiome in balance and you will thrive.
Not only will your smiles be happier, but your whole-body health will shine!
How to Prevent Cavities without Dental Sealants
Humans survived, thrived, and evolved for millions of years without dental sealants. However, I do feel they can be beneficial if our diets are not ideal or the anatomy of your tooth is exceptionally “groovy.”
If you trust the process your dentist uses, they can be an effective way to prevent decay even with a clean diet.
To prevent cavities:
- Eat real, nutrient-dense, whole foods.
- Practice good oral hygiene, including flossing, tongue scraping, brushing teeth, and oil pulling.
- Try oil pulling, which can also help to dislodge sneaky bacteria in nooks and crevasses.
- Use hydroxyapatite toothpaste to benefit the remineralization and strengthening of our teeth.
- Avoid “grazing” eating patterns and eat at specific times during the day.
- Note and address any mouth breathing, which can cause dry mouth and disrupt the oral microbiome.
- Don’t skip dental check-ups where your dentist can closely monitor any new signs of tooth decay.
Foods that support healthy teeth include those high in:
- Healthy fats
- Minerals like phosphorus, magnesium, and calcium
For more on how to prevent and reverse cavities during childhood (from prenatal development through high school), check out Dr. B’s Guide.