What a fissure sealant is

Fissure sealants are hard protective coatings applied to cover and protect the deep grooves — fissures — in teeth, and prevent decay.

These fissures are most commonly on the chewing surfaces of the back teeth, the molars and premolars.

The grooves are at high risk of decay because they are deep and narrow, and collect plaque bacteria and food that toothbrush bristles cannot reach. The trapped bacteria produce acids, which cause decay at these prime sites. How does tooth decay develop? sets out that mechanism, and the stages of dental decay traces where it goes if nothing is done.

That is the key idea, and it is worth being blunt about. These grooves are physically narrower than a toothbrush bristle. No amount of brushing cleans them — which is why decay in the fissures happens to careful children as well as careless ones. Which toothbrushes do dentists recommend? is worth reading alongside that, because a better brush does not solve this particular problem.

When the grooves are sealed, the risk of decay is markedly reduced.

The numbers

According to the Australian Dental Association:

A fissure is five times more likely to develop decay than any other tooth surface.

A tooth surface with completely sealed fissures is protected while the seal remains fully intact.

Sealants wear over time. Even after five years, a sealed tooth still has around half the risk of an unsealed one.

That last figure is the honest one and the most useful. Sealants are not permanent — they wear, chip and need review. Half the risk five years later, from a single short appointment, is still a strong return.

It is common to seal only teeth identified as high risk, but your dentist may recommend sealing all premolars and molars as a precaution. Children with chalky teeth — molar-incisor hypomineralisation — are among the clearest cases for sealing everything, because the enamel itself is porous from the day it arrives.

When to have them done

The first permanent molars erupt at around age six.

The best time to apply sealants is immediately after the permanent teeth appear, because that is when they are most susceptible to decay.

Two reasons the timing is so specific:

Newly erupted enamel is not fully mature, and is more vulnerable in its first years in the mouth. The benefits of fluoride covers what helps it mature.

Children do not develop the manual dexterity to brush their own teeth effectively until around age 8 to 10. So the teeth arrive at their most vulnerable exactly when the child is least able to clean them. Protecting your child from dental disease makes the case for a parent doing the brushing until about seven; kids teeth cleaning tips and how to encourage your child to brush cover the practice.

It is also the environment the new molars arrive into that matters. For the same age group, the Australian Dental Association reports that 34 per cent of children aged 5 to 6 years have experienced decay in their primary or baby teeth, and that 27 per cent of children aged 5 to 10 have untreated tooth decay in primary teeth. Those figures are about baby teeth, not the permanent molars a sealant protects — but they describe the mouth the permanent molars erupt into, and the bacteria and diet that produced them do not change on the day the new tooth arrives.

Further permanent teeth continue erupting until age 11 to 14, so sealing is not a single event but something reviewed as teeth appear. The order and appearance of baby teeth sets out that timetable, including which baby teeth are still holding space at that point.

A point parents often miss: the six-year-old molars come through behind the baby teeth, without any tooth falling out, and usually without pain. Many parents do not realise their child has permanent teeth — and those are the teeth this article is about.

Sealants work best combined with regular check-ups, good oral hygiene and a sensible diet. They are an addition to those things, not a substitute. When should a child first visit the dentist?, preventing dental decay, and how does sugar affect your dental health? cover the other three legs.

The World Health Organization puts the reason for that plainly: decay results when plaque on a tooth surface converts free sugars into acids that destroy the tooth over time, and a continued high intake of free sugars, inadequate exposure to fluoride and a lack of plaque removal by toothbrushing with fluoride toothpaste is the combination that leads to it. A sealant addresses the last of those three on one part of one tooth. It does not touch the diet, and it does not protect the surfaces between the teeth — which is why flossing and a hygienist visit still belong in the picture.

What the appointment involves

The treatment is conservative and non-invasive, with no drilling and normally no anaesthetic. No injections and no drilling.

The materials are safe — either a very strong plastic, or a material called glass ionomer. The colour may be white or clear. Glass ionomer is the same family of material described under tooth fillings, and it releases small amounts of fluoride.

The steps:

  1. The tooth is thoroughly cleaned, and the area kept dry.
  2. The tooth is prepared with a weak acid or conditioning agent, so the sealant bonds well.
  3. The sealant is applied in liquid form, flowing into the grooves.
  4. A UV light may be used to set it hard.
  5. The tooth is checked, and smoothed if necessary.

You can eat and drink normally immediately afterwards.

For a child, this is close to the ideal introduction to dental treatment: something is done, it takes a few minutes, and there is no needle and no drill. Individual experience varies, but it asks very little of a child. That matters for more than the day itself — see combating dental anxiety in children and how Smile Solutions helps manage your child's dental anxiety.

The alternative, if a fissure does decay, is more involved: a filling with anaesthetic, or on a badly broken-down molar a crown.

Afterwards

Because sealants sit in high-stress areas — the chewing surfaces — they are subject to wear, and may need reapplying from time to time.

They are checked at routine examinations, which is another reason regular check-ups matter through the years the sealants are doing their work. Decay starting under a worn sealant is not visible to the eye, which is what dental x-rays are for.

That review is the part most easily missed. In the Australian Dental Association's Dental Health Week survey, 29 per cent of children had a check-up in the previous 12 months, 58 per cent every 12 to 24 months, and 9 per cent only when there was a problem. A sealant reviewed every second year is being checked at roughly the interval over which the ADA says its protective effect halves.

Between appointments, the ADA suggests a simple check at home: lift your child's top lip and roll down the bottom lip to look at the teeth, and make an appointment if you see white, brown or black spots on the teeth that do not come off. The ADA is explicit that this does not replace a check-up by a dentist.

Common questions

If we skip the sealants, what actually happens?

For a long time, nothing you can see. That is the whole difficulty — decay in a fissure begins out of sight, in a groove narrower than a bristle, and it does not announce itself.

Where it ends up is measurable. The Australian Dental Association's Children and Young People Oral Health Tracker finds that nearly 11 (10.8) in every 1,000 children aged 5 to 9 are hospitalised for potentially preventable problems due to dental conditions, rising to 14.3 per 1,000 for Indigenous children, and that only 56 per cent of children visit the dentist before age 5. In the ADA's consumer survey of 25,000 people, one third (32 per cent) of parents reported their child's first dental visit was for pain or a problem. At a national level the ADA puts it this way: dental caries "imposes a large cost on the Australian economy. That cost is estimated to be up to $1 billion per year."

The ADA's own explanation of why the timing matters is the sentence worth keeping: problems "if picked up early, can be controlled fairly simply (for example with fluoride applications) before they become established", whereas "leaving it till the teeth hurt or break down means simpler interventions are unlikely to work and more complex treatment may be needed."

So the real decision is not sealant or no sealant. It is whether those grooves are first looked at closely at a check-up, or in pain.

Will the Child Dental Benefits Schedule pay for it?

Often, yes. Fissure sealants are one of the basic services the ADA lists as covered by the CDBS, alongside examinations, x-rays, professional cleans, fillings, root canal treatment and extractions.

Services Australia sets the terms: "We cover up to $1,158 for each eligible child over 2 calendar years for basic dental services under CDBS. The cap amount is indexed yearly on 1 January." Eligibility turns on the child being "0 to 17 years old for at least one day that calendar year", and on you or them getting an eligible payment at least once in that year.

Three things families are caught by:

See Child Dental Benefit Schedule and how the Child Dental Benefits Schedule operates.

We already use fluoride toothpaste and drink tap water. Is a sealant still worth doing?

They are not alternatives to each other, because they work by different means on different parts of the tooth.

Fluoride works chemically, everywhere the saliva reaches. The NHMRC describes it as reducing demineralisation — "this makes teeth more resistant to decay" — and enhancing remineralisation, which "helps the repair of early tooth decay", as well as slowing "the activity of bacteria that cause decay". On whether both water and toothpaste are needed, the NHMRC is direct: "Fluoridated drinking water and toothpaste with fluoride provide important and complementary benefits... Together, the two sources offer more protection than using either one alone."

A sealant works physically, and only in one place. It fills the groove so that plaque and food cannot lodge in it. That is a problem fluoride does not solve, because a fissure is a shape rather than a chemistry.

One related point worth knowing: the NHMRC says fluoride supplements — drops or tablets — "should only be used on the advice of an oral health professional" and "are no longer readily available in Australia". If someone has suggested them, that is a conversation to have with your dentist rather than a purchase to make.

My child is frightened of the dentist. How is that handled?

Not by insisting, and not by springing it on them.

The techniques have names. The American Academy of Pediatric Dentistry describes tell-show-do — the procedure explained in language matched to the child's level, then demonstrated, then carried out — and enhancing control, in which the child is given "a signal (eg, raising a hand) to use if he becomes uncomfortable or needs to briefly interrupt care", with the AAPD adding that "the patient should practice this gesture before treatment is initiated." Distraction — stories, audio, or a short break part-way through a procedure — is the third.

If your child has had a bad visit before, say so when you book. The AAPD names "patients who had a negative or difficult dental visit" as the specific indication for working through the memory of it rather than ignoring it. (AAPD guidance on sedation is written for the United States, and its training and supervision rules do not apply here.)

Combating dental anxiety in children goes into this properly.

What should I ask before agreeing to it?

Five questions that get you a real answer rather than a yes:

  1. Which teeth, and why these ones? The ADA notes it is common to seal only the teeth identified as high risk, but that a dentist may recommend sealing all premolars and molars as a precaution. Either can be the right call; you are entitled to hear which applies to your child and on what grounds.
  2. Which material, and why? Resin or glass ionomer. Glass ionomer releases small amounts of fluoride; the choice is a clinical judgement about the tooth and how dry it can be kept while the material sets.
  3. Is there already decay in that groove? A sealant goes over sound enamel. If decay is established, the treatment is a different one — see why do I need a filling?
  4. When will it be checked, and what happens when it wears? Sealants are not permanent. Ask for the review interval to be stated rather than assumed.
  5. What will it cost, and does the CDBS apply to us? Published fees are in the price guide.

Related reading

Practical details

We have registered specialist paediatric dentists on site; the full team is listed by name.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495. Eligible families may be able to use the Child Dental Benefits Schedule, which covers fissure sealing among the basic services. Services Australia states the scheme covers up to $1,158 for each eligible child over two calendar years, and that the cap amount is indexed yearly on 1 January — check your own eligibility and the current cap with Services Australia before you rely on it. Published fees are in the price guide.

Published 27 August 2018. Figures attributed to the Australian Dental Association are summarised from ADA material; individual risk and suitability vary. Benefit amounts and eligibility for government schemes change; confirm the current position directly. General information only; it does not replace advice from your treating practitioner.

Smile Solutions trades under ABN 28 193 514 103.

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