Seal the deal: how dental sealants protect children's teeth

As parents we want the best for our children — their health, their education, their happiness. Dental care quietly affects all three, and a child in pain from a toothache is a child not learning much that day.

Fissure sealants are one of the highest-value preventive treatments in dentistry, and they are worth understanding.

What a fissure sealant is

The biting surfaces of back teeth are not smooth. They carry a pattern of grooves and pits — fissures — and on many teeth those grooves are deeper and narrower than a toothbrush bristle. Food and bacteria fit. The bristle does not.

A sealant is a protective layer, made of white or clear composite resin similar to a white filling, flowed into those grooves and set hard. It removes the hiding place rather than trying to clean it.

Why brushing alone is not enough there

Fluoride in tap water and toothpaste protects smooth surfaces very effectively. It works far less well in a deep fissure, where saliva and fluoride do not readily flow.

That is why the chewing surfaces of molars are the most common site of decay in children and teenagers — including in children whose parents are doing everything right. It is an anatomy problem, not a diligence problem.

It also explains a conversation we have often: a parent who is genuinely supervising brushing twice a day, is told their nine-year-old has a hole in a molar, and assumes they have failed. They have not. The groove was never brushable.

When the teeth arrive

The six-year molars are the ones most often missed, because they arrive behind the baby teeth rather than replacing one. Nothing falls out, so nothing announces them. Many parents first hear about them when we point them out.

Does it hurt?

Generally not. Placement is quick and normally requires no anaesthetic and no drilling, and most children feel nothing beyond the tooth being cleaned and dried.

What actually happens

1. The tooth is cleaned and the grooves checked
2. The surface is prepared — at our clinic often using drill-free air abrasion, which uses a fine stream of particles rather than a rotating bur, so there is no vibration and no drill noise
3. The tooth is isolated and dried. This is the fiddly part, and the part that determines whether the sealant lasts — a sealant placed on a damp tooth fails early
4. A conditioning gel goes on for a few seconds, then is rinsed away. It tastes slightly sour
5. The sealant is painted into the grooves — no pressure, nothing sharp
6. A blue curing light sets it in about twenty seconds. It is bright, not hot
7. The bite is checked and polished, so nothing feels high

About ten minutes per tooth, often less. Your child can eat straight afterwards.

For an anxious child this is frequently a good first treatment-style appointment, precisely because there is nothing to endure. A child who has had a positive experience in the chair is far easier to treat later.

When children need them

Most commonly on the first permanent molars, which arrive around age six behind the baby teeth rather than replacing them — many parents do not realise they have appeared. Then the second permanent molars, usually around twelve.

The useful window is soon after a tooth erupts, before decay has had a chance to start.

Not every child needs every tooth sealed. Your practitioner assesses the depth of the grooves, your child's decay history and their overall risk. Sealants are recommended where there is a reason, not by default.

The case is strongest when

• The grooves are deep and narrow, or stained
• There has already been decay in another tooth, or in the baby molars
• Cleaning is difficult — braces, limited dexterity, additional needs
• Snacking is frequent, or the diet is high in sugar or acid
• The family has a history of decay
• Saliva flow is reduced by medication or a medical condition

It is weaker when

• The grooves are shallow and well coalesced
• The child has never had decay and cleaning is excellent
• The tooth is only partly erupted, with gum still over part of it — usually worth waiting so it can be kept properly dry

They need checking

Sealants are durable but not permanent. They wear with chewing and can chip or partially lift, particularly on a heavily used molar.

We check them at every routine examination and repair or replace them when needed — a partially lifted sealant matters, because a gap under a remaining edge is harder to clean than an unsealed tooth would have been. Keeping six-monthly check-ups is what makes sealants work over the long term.

A reasonable expectation: a well-placed resin sealant commonly lasts several years, with some wear and occasional touch-ups along the way. Losing part of one is not a failure of the treatment; it is why they are checked.

What a sealant does not do

It protects the chewing surface. It does nothing for decay between teeth, which is what daily flossing is for, and it is not a substitute for brushing. A sealed tooth still has four other surfaces.

Nor does it whiten, strengthen the tooth structurally, or stop a tooth that already has decay under the enamel. Which brings us to the question we are asked most.

"Can decay get sealed underneath?"

A fair question, and the honest answer has two parts.

Where there is frank decay — a cavity — a sealant is the wrong treatment and the tooth needs a filling. That is assessed before anything is placed, with X-rays where they are indicated.

Where there is very early demineralisation confined to the enamel, sealing over it is an accepted approach: cut off from food and bacteria, the process stalls. The tooth is monitored rather than forgotten. This is a deliberate clinical decision, discussed with you, not something done to avoid a filling.

What about BPA?

Parents ask, and it deserves a straight answer rather than reassurance.

Some resin sealant materials can release trace amounts of BPA-related compounds in the minutes immediately after placement. Major dental and health bodies have reviewed this and consider the exposure very small — far below everyday exposure from food packaging — and the preventive benefit clearly greater. Rinsing and wiping the tooth immediately after curing, which is routine, reduces it further.

If you would prefer a different material, say so; glass ionomer sealants contain no resin monomers. They release fluoride, which is useful, but do not last as long and are more often chosen for a partly erupted tooth or where staying dry is difficult.

Adults and sealants

Less common, and occasionally appropriate. An adult molar with deep, stained grooves, no decay, and a history of problems elsewhere can be a reasonable candidate. Most adult molars are either already restored or have grooves worn smoother by years of chewing.

Health fund cover for an adult sealant varies, so ask for a quote first.

Aftercare

There is barely any, which is part of the appeal.

• Eat and drink normally straight away
• Brush as usual that night — a sealed tooth is brushed like any other
• Tell us if the bite feels high or the tooth feels odd after a day or two; it is a two-minute adjustment
• Keep flossing. The sealant does nothing between the teeth
• Bring them back for check-ups, which is the whole maintenance plan

Cost

Eligible children aged 0–17 may be covered under the Child Dental Benefits Schedule. Eligibility is determined by Medicare and Centrelink — you should receive a letter if your child qualifies, and we can provide the statement you submit to claim. For private cover we claim on the spot through HICAPS.

Either way, a sealant is among the least expensive things done in a dental surgery, and considerably cheaper than the filling it prevents. Oral health problems get more severe and more expensive the longer they run.

And the comparison is not only about money. A sealant is ten minutes with no injection. A filling in a nine-year-old molar is an injection, a numb lip for two hours, and a tooth that will need that filling replaced periodically for the rest of their life.

Questions we are asked

How long do they last? Commonly several years, with wear and occasional repairs. They are checked at every visit.

Will my child feel it there? For a day at most. If it still feels high after that, bring them in.

Can sealants be put on baby teeth? Sometimes, where a baby molar has deep grooves and the child is at high risk. Usually the focus is the adult molars.

My child already has fillings. Is it too late? No. Sealing the remaining unsealed molars is often exactly the right call, and a history of decay strengthens the case.

Do they stain? They can pick up some surface staining over time, which is cosmetic and not a reason to replace one.

Can I see them? Barely. Clear and tooth-coloured materials are almost invisible — we can point them out in a mirror if you would like.

Is fluoride varnish an alternative? Not an alternative; a companion. Varnish helps smooth surfaces and all-round risk; sealants deal with the grooves. Many children benefit from both.

Who provides this here

Victorian Dental Group is a general dental practice in Malvern East and holds no specialist registration. Sealants are placed by our dentists and oral health therapists. Where a child needs care beyond general practice, we refer to a registered specialist paediatric dentist.

Talk to us

Ask about fissure sealants at your child's next check-up. Full detail on our fissure sealants page, or read about our family and children's dentistry.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · book online

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances. Please see our Disclaimer.