3.3 Making Decisions About Sealant Placement

There is strong evidence that sealants are effective when used on sound permanent posterior teeth in children and when used on non-cavitated caries lesions. In the latter case, evidence shows that sealants significantly reduce the percentage of non-cavitated lesions that progress to cavitated lesions in children, adolescents, and young adults.2

Based on this evidence, the American Dental Association (ADA) recommends sealing sound pit-and-fissure surfaces as well as non-cavitated pit-and-fissure lesions in children at higher risk for dental caries.3 An expert workgroup sponsored by the Centers for Disease Control and Prevention (CDC) also recommends sealing sound and non-cavitated pit-and-fissure surfaces in children at higher risk for dental caries.4 In other words, any lesion in the pit-and-fissure surfaces that is less severe than a cavitation should be sealed in children at higher risk.

School-based dental sealant programs grapple with the dilemma of how to best deal with cavitated caries lesions in children who may not receive restorative oral health care. Although sealants are not necessarily the treatment of choice for cavitated lesions, in these instances, it is up to the oral health professional authorized to select teeth for sealant placement in the program to decide whether to place sealants.

The following information may help in the decision-making process:

• Sealing over cavitated lesions lowers the number of bacteria in the cavity by at least 100-fold.5
• Small cavitated lesions as well as lesions radiographically into dentin can be sealed without removing all the softened infected tissue and will become arrested or inactive over time while they are sealed.2
• The CDC expert workgroup acknowledged that school-based dental sealant programs treat only children at higher risk for dental caries who are often from families with low incomes and thus may lack access to oral health care. Therefore, the workgroup allowed that—in addition to making an effort to connect children who have cavitated lesions with a source of restorative oral health care—oral health professionals in school-based dental sealant programs who are authorized to select teeth for sealant application might choose to place sealants on small cavitated lesions with no visual signs of dentinal caries.
• Sealants can be removed at any time, and a restoration can be placed. One does not preclude the other.

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