Are Primary (Baby) Tooth Sealants Really Necessary? “Facts Parents Should Know” Revealed by the Latest Review

—From the Director of Tokyo International Dental Clinic, Roppongi

Experience As the Director of Tokyo International Dental Clinic, Roppongi, I have long been involved in preventive treatments for children and determining the indications for sealants. In clinical practice, while sealants are used to prevent early caries starting in the grooves of teeth, I deeply understand the importance of careful judgment based on each child’s individual risk. Through extensive clinical experience, I have come to realize the necessity of a comprehensive preventive strategy rather than relying on a standalone procedure.

Expertise

  • Sealant Types: There are resin-based sealants (high durability but require bonding and strict moisture isolation) and glass ionomer cement (GIC) based sealants (release fluoride and are advantageous for application in moist conditions). Each type has its own advantages and disadvantages.
  • Key Evidence: A systematic review by Cochrane (2022) evaluated the certainty of evidence for sealant effectiveness on primary teeth as “low to very low.” This is primarily due to issues in study design, such as a lack of blinding, variations in observation periods and follow-up rates, and potential biases.
  • Clinical Implications: While the certainty of sealant effectiveness on permanent first molars is considered moderate, it is difficult to draw clear conclusions regarding retention rates and caries-inhibiting effects on primary teeth.

Authority Cochrane systematic reviews are internationally trusted evaluation foundations, known for their impartiality and rigorous methodology. The current conclusion is based on analysis results that adhere to these strict standards. The World Health Organization (WHO) and national pediatric dentistry guidelines also position sealants as an “option for high-risk grooves,” while emphasizing the importance of individual risk assessment and regular follow-ups.

Trustworthiness At our clinic, we don’t simply recommend sealants. We make decisions after comprehensively assessing: (1) caries risk, (2) brushing habits, (3) dietary habits, and (4) parental preferences. If a sealant is to be applied, we make the optimal material choice (resin vs. GIC) based on its properties and always explain the plan for regular retention checks and any necessary repairs.

1) Current Conclusion (Summary) The “clear preventive effect” of sealants on primary teeth has not yet been demonstrated with high certainty (Cochrane 2022: certainty of evidence is low to very low). However, “lack of evidence does not equal no effect”; rather, it indicates a current lack of high-quality follow-up studies.

2) Why the Certainty is Low (Clinical & Research Challenges)

  • It is a procedure that is difficult to blind, making it prone to bias if evaluators know the treatment status during assessment.
  • There is variability in follow-up periods, sample sizes, and exclusion criteria across studies, making it difficult to achieve consistent results.
  • Results can vary depending on how retention rates are reported and how “partial retention” is handled.

3) Practical Differences by Material (Retention Rate Data)

  • Resin-based: Tends to report approximately 70% complete/partial retention at 24 months.
  • GIC-based: Reports indicate retention of about 32% over the same period.
  • → Resin-based sealants tend to last longer, but GIC can be advantageous in situations where strict moisture control is difficult.

4) Side Effects/Risks Major adverse events are rare. The main reported discomforts are procedural discomfort, such as a gag reflex. Care must be taken to avoid psychological burden (treatment trauma) on the child.

5) Clinical Decision Framework (Our Clinic’s Recommended Process)

  • Step 1: Risk assessment (eating habits, oral hygiene, past caries experience, social environment).
  • Step 2: First, thoroughly implement brushing instruction, fluoride management, and dietary improvement.
  • Step 3: Consider sealants only for areas judged to be high-risk and where the treatment benefit is clearly defined.
  • Step 4: Strictly perform material selection, isolation during treatment (e.g., rubber dam), and post-treatment follow-up (retention checks).

Conclusion (Message to Parents) Primary tooth sealants are not a panacea, and current high-quality evidence regarding their effectiveness is insufficient. However, because they may be beneficial depending on individual risk profiles, we strongly recommend making decisions following a comprehensive approach: risk assessment → non-surgical measures → sealant application when necessary → regular maintenance, rather than simply deciding “to do or not to do.” At our clinic, we will work with you to make the best decisions, based on both scientific evidence and extensive clinical experience. If you have any concerns or wish for an individual consultation, please feel free to contact us.

reference
Ramamurthy, P., Rath, A., Sidhu, P., Fernandes, B., Nettem, S., Fee, P. A., … & Walsh, T. (2022). Sealants for preventing dental caries in primary teeth. Cochrane Database of Systematic Reviews, (2).

 

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Tokyo International Dental Clinic Roppongi

Here is the MAP 

  • Address: 5-13-25-2nd Floor, Roppongi, Minato-ku, Tokyo
  • Phone: 03-5544-8544
  • Closest Stations: 
  • Azabu Juban (Toei Oedo Line take exit7）
  • https://youtu.be/iIeG91YEJTA 　The way to the clinic from Ohedo Line Exit7
  • Azabu Juban (Tokyo Metro Namboku Line exit 5a )
  • https://youtu.be/3yniFSfucGg　The way to the clinic from Namboku Line Exit 5a 
  • Roppongi (Hibiya Line exit 3)

We look forward to helping you achieve a healthy, beautiful smile!

Supervised by: Hiroshi Miyashita, Director, Tokyo International Dental, Roppongi

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