Module 1: Background

1.2 Rationale and Evidence for Programs

Evidence-Based Decision-Making

Dental Sealants Evidence Base

Since 2000, several systematic reviews of dental sealants have been conducted. The following reviews consistently determined that sealants significantly reduce the chances of future dental caries:

A 2001 National Institutes of Health Consensus Development Conference, which involved evidence-based reviews by experts, issued a statement indicating that “pit and fissure sealants have been demonstrated to be effective in the primary prevention of caries and their effectiveness remains strong as long as the sealants are maintained.” The statement also indicates that data support the use of sealants for reversing or arresting the progression of early dental caries.9

A 2007 review by Health Canada, the national public health department of the Canadian government, reports that “the review confirms the efficacy of dental sealants in preventing dental caries in children.”10

A 2008 review by the Cochrane Collaboration, an international not-for-profit and independent organization, concluded that “sealing is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. The effectiveness of sealants is obvious at high caries risk but information on the benefit of sealing related to different caries risks is lacking.”11

In 2008, the American Dental Association’s Council on Scientific Affairs Expert Panel on Dental Sealants concluded that “placement of resin-based sealants on the permanent molars of children and adolescents is effective for caries reduction.”12

Two reviews published in 2008 by the Centers for Disease Control and Prevention reported that sealing non-cavitated caries in permanent teeth is effective in reducing caries progression and that sealants reduced bacteria in carious lesions.13, 14

Although dental sealants have been found to be highly effective, as indicated by the preceding statements, placement of a sealant on a given tooth does not guarantee that the tooth will never decay. Reduction of caries incidence in children after placement of resin-based sealants ranges from 86 percent at 1 year after initial treatment to 78.6 percent at 2 years and to 58.6 percent at 4 years. Sealants are effective in reducing occlusal caries incidence in children’s permanent first molars, with caries reductions of 76.3 percent at 4 years after initial treatment, when sealants were reapplied as needed. Caries reduction was 65 percent at 9 years after initial treatment with no reapplication during the preceding 5 years. There is consistent evidence from private dental insurance and Medicaid databases that placement of sealants on first and second permanent molars in children is associated with reductions in the subsequent provision of restorative services.12