Dental sealants: An underused solution to prevent childhood cavities and protect kids’ health

Dental caries was officially recognized as the most common chronic childhood disease in the Surgeon General’s report in 2000.¹ Alarmingly, this statistic has not changed even though we know decay is largely preventable. As dental hygienists, shouldn’t prevention be our priority?

As a prevention specialist, I believe dental sealants are one of the most effective tools we have in the battle against decay, not only to protect children’s teeth, but to safeguard their ability to learn, grow, and thrive.

Why dental sealants matter more than ever

Although fluoride has a proven track record of safety and effectiveness, and community water fluoridation remains one of the top 10 public health initiatives of the century,² fluoride is increasingly facing scrutiny and threats of removal. This makes sealants even more critical as a line of defense against childhood caries.

Applied to the pits and fissures of molars (where nearly 90% of cavities develop), sealants can prevent up to 80% of decay within two years and maintain roughly 50% effectiveness for up to four years.³ Yet, despite their proven effectiveness, less than half of children and adolescents have sealants on their permanent teeth.³

 Overcoming barriers to sealant use

Sealants remain an underused tool in caries prevention, partly due to ongoing controversy about sealing noncavitated lesions. Skepticism persists, despite studies confirming bacterial load is reduced and decay can be arrested when a sealant is placed over early lesions.⁴ This skepticism is often tied to microleakage, inadequate isolation, and subsequent sealant loss, and these challenges are especially pronounced in settings where preventing contamination 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 have allowed. Despite wearing down more readily, GI sealants have demonstrated comparable effectiveness to resin-based sealants in preventing new caries.⁵

Cost, comfort, and clinical efficiency

Sealants are not only effective, they’re also economical. The cost to place a sealant is significantly lower than a restoration, and the noninvasive procedure is quick and painless.⁶ While four-handed placement has been recommended to increase retention, new advances in HVE and retraction devices have made sealants significantly easier to place. In many settings, hygienists can now single-handedly achieve excellent isolation and moisture control, which enhances both efficiency and retention.

Protecting smiles and supporting success

Children who don’t have sealants are nearly three times more likely to develop cavities in their first molars,³ which can lead to pain, infection, and missed school. In fact, studies show 34 million school hours are lost each year due to acute dental pain and emergency dental care.⁷ In alignment with Maslow’s hierarchy of needs, when a child is in pain, their ability to concentrate and learn is compromised.⁸

School-based sealant 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 among children from low-income families.⁹

The impact goes far beyond preventing decay. The sealant programs help kids stay in school, empower them to learn without the burden of dental pain, and lay the foundation for healthier futures.

As debates over fluoride and community water fluoridation intensify, children from low-income households stand to lose their most accessible defense against dental decay. This demographic, which is already more likely to experience untreated caries and struggles to access routine care, stands to benefit 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 being “recharged” through routine fluoride treatments.¹² Sustained protection depends on consistent access to both.

Now more than ever, when opportunity knocks to place sealants on vulnerable children, whether due to socioeconomic status, geographic location, or systemic barriers, we must answer. Each sealant placed is more than a barrier to decay; it’s a humanitarian effort. 

References

1. Oral health in America: a report of the Surgeon General. Department of Health and Human Services. Accessed August 2025. https://digirepo.nlm.nih.gov/ext/document/101584932X143/PDF/101584932X143.pdf
2. CDC scientific statement on community water fluoridation. Centers for Disease Control and Prevention. May 15, 2024. Accessed August 2025. https://www.cdc.gov/fluoridation/about/statement-on-the-evidence-supporting-the-safety-and-effectiveness-of-community-water-fluoridation.html
3. Dental sealant facts. Centers for Disease Control and Prevention. May 15, 2024. Accessed September 30, 2025. https://www.cdc.gov/oral-health/data-research/facts-stats/fast-facts-dental-sealants.html
4. Dental sealants. American Dental Association. Updated December 22, 2021. Accessed August 2025. https://www.ada.org/resources/ada-library/oral-health-topics/dental-sealants
5. 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.
6. 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
7. Naavaal S, Kelekar U. School hours lost due to acute/unplanned dental care. Health Behav Policy Rev. 2018;5(2):66-73. doi:10.14485/HBPR.5.2.7
8. Walsh MM, Darby ML. Dental Hygiene: Theory and Practice. 4th ed. Saunders; 2014.

9. School sealant programs. Centers for Disease Control and Prevention. May 15, 2024. Accessed August 2025. https://www.cdc.gov/oral-health/php/school-dental-sealant-programs/index.html
10. Chi DL, Masterson EE, Carle AC, Mancl LA, Coldwell SE. Socioeconomic status, food security, and dental caries in US children: mediation analyses 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
11. Pit-and-fissure sealant clinical practice guidelines 2016. American Dental Association. Accessed August 2025. https://www.ada.org/resources/research/science/evidence-based-dental-research/sealants-clinical-practice-guideline
12. Fluoride clinical guidelines. American Dental Association. Accessed August 8, 2025. https://www.ada.org/resources/community-initiatives/fluoride-in-water/fluoride-clinical-guidelines