Sealants: The Choices & What to Look For!!

The dental profession is offered a variety of choices when it comes to selecting a pit and fissure sealant. Also the public's perception of the need and benefits of sealants has also come a long way since sealants were first introduced. The public now widely accepts sealants and also expects a good result! However, recent public events, such as questioning sealant composition and hearing about failed sealants that have massive decay beneath them, may be challenging the public's trust.

Pit and fissure sealants are intended to seal surface defects of teeth (particularly in young children), to prevent food accumulation in these areas, and to prevent decay of the tooth. Sealants can and should last for several years. Sealants are not intended to last forever and require regular check ups. The problems with sealants start with undiagnosed decay that is present before a sealant is placed, or when a sealant leaks, and this leads to decay that is not observed, or can not be easily detected.

To help understand these problems and solutions, let's take a look at the choices of sealants today. Several categories exist according to composition and rationale for selection. Almost all sealants used in the US are light-cured. That means they are cured, or made to harden, by visible light (an intense blue light - not an ultraviolet or UV light).

By focusing on the components of the sealant, we can further understand sealant use. Almost all sealants release fluoride to help protect the tooth from decay and to help control bacterial growth around the sealant. (See my previous posting on the benefits of fluoride in dentistry.)

Let's continue with what are considered traditional sealants. These may be either: glass ionomers or a filled resin. The glass ionomers contain water with an acid liquid that reacts with a glass powder. Proponents of this group prefer them because they contain water and therefore are better tolerated in the moist environment of the mouth. Glass ionomers typically for this same reason, containing water, "dissolve" more in the mouth, and are therefore, generally weaker and do not last as long in the mouth, as resin based sealants.

Resin based sealants usually do not contain water and may be more technique sensitive than glass ionomer materials. These sealants require good tooth isolation. Recently, some sealants in this category have been introduced that do contain acid materials and interact better with the tooth. These materials, however, do not replace the need for good tooth isolation and tooth etching to achieve good retention. To differentiate this acid-like resin category, some people use use the term hydrophilic (water loving), to help describe how they are similar to the glass ionomers. The term hydrophilic is, however, a relative term, and care is suggested not to alter good technique in placing them. This means good tooth isolation to avoid saliva contamination and acid etching the tooth before placement. Some of you are very aware of the clinical problems caused by this group! Proper sealant placement also requires a thorough examination of the tooth surface to make sure no hidden decay exists.

More recent advances are clear sealants that allow the dentist or hygienist to see through the sealant. This allows observation of the tooth after the sealant is placed. The very question of what happens beneath a traditional sealant prevents many well intentioned practitioners from placing sealants at all! Today clear, resin-based sealants, now with nano sized filler particles (that do not make them opaque but make them very strong), are available. The use of new laser devices for detecting decay (so that you can also measure any activity beneath the sealant), has also been FDA approved for some of these clear sealants, but not all of them! The question in sealant selection thus becomes: Isn't it more important to see what's happening beneath the sealant, than to actually see the sealant itself?

The last category of sealants, that I would like to describe, are the high fluoride, 5% NaF, containing sealants. These sealants bring us back to one of our primary reasons for placing sealants to begin with: to protect the tooth. This group provides a higher amount of fluoride than traditional resin sealants to protect those individuals who may be at greater risk. Such risk factors may include: difficulty in brushing, patient compliance, health factors, absence of fluoridated water or supplemental fluoride, or lack of access to good dental care. For these patients a 5% NaF sealant should be considered.

With these improvements and public acceptance of sealants, I believe there should also be a greater commitment to following the progress of sealants. W
ith so many sealant choices available I invite the profession and public to become more involved in considering different material options. This involves selecting the best sealant to fit your goals. This should also include becoming more vigilant as to what happens after a sealant is placed. In other words, Keep looking!! The long term success of sealant placement and the health of that tooth depends on good follow-up.

Thanks for reading along, I hope this discussion helps clarify the many choices available in sealants, their intended purposes, and lastly some advice on how to make them work for you. This is a rapidly changing field.

For those interested in sealants, or the components of dental composites, watch for one of my next postings on Bis-Phenol A and Bis-GMA, or send me an e-mail.


Also for further information see my article: "To Seal or Not to Seal - The Clear Solution." Click on image below to read article.


  1. You have a nice conversational style that is easy to follow. Thank you once again!