February is National Children's Dental Health Month, an opportunity for all of us to reflect on the importance of good oral health in children. This year, the American Dental Association is focusing its attention on sealants, labeling their campaign "Sealants Make Sense."

Dental Caries in Children
Despite the many advances in treating caries in children, it remains a significant challenge. According to the American Academy of Pediatric dentistry in their recent "Child Snapshot 2021," 43% of children aged 2-19 have carious lesions. Prevalence varies, being highest among Hispanic children (52%), followed by Black (44.3%), Asian (42.6%) and White children (39%). Rates also vary by income, with 51.8% of children below the poverty level exhibiting caries. 

Preventing Dental Caries with Sealants
When combined with healthy home habits and regular professional preventive care, sealants can be an important treatment option for children. Data backs up the value of sealants. The CDC notes that sealants can prevent 80% of cavities on back teeth, while school-aged children without sealants are three times more likely to have tooth decay on their first molars than those who get sealants. The ADA, in its chairside guide to the "Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: A Report of the American Dental Association and the American Academy of Pediatric Dentistry," notes that, out of 100 children who do not get a sealant, 50 of them will get caries. Out of 100 children that do have sealants, of those 50 who would have gotten caries, 38 remain caries-free – a 76% reduction.

Despite their proven success, sealants are perhaps the most underutilized dental procedure. A review of Delta Dental's own internal claims data shows that in 2020, 45.2% received a sealant on one first molar and 28.3% received a sealant on a second molar, while 32.8% had sealants on all four first molars and 14.6% on all four second molars.

The Effectiveness and Safety of Sealants
Some dentists might continue to be reluctant to place sealants, perhaps due to concerns that caries-causing bacteria may remain underneath the sealant, leading to disease. However, in its sealant guideline, the ADA recommends the use of sealants in "both sound occlusal surfaces and non-cavitated occlusal carious lesions in children and adolescents" noting that "sealing children's and adolescents' permanent molars reduces costs to the health system by delaying and preventing the need for invasive restorative treatment, particularly when these patients are classified as having an 'elevated caries risk,'" making them a cost-effective treatment that contributes to improved oral health in children.

The guideline also compares sealants to fluoride varnish. While not denigrating the value of varnish, it again underscores the value of sealants relative to fluoride alone for both healthy occlusal surfaces, as well as non-cavitated lesions. The guideline also looked at the safety of sealants, noting that the composition of sealants posed no risk to patients, particularly when compared with the higher risk of developing caries without sealants. Comparisons of the different types of sealant materials, e.g., resin-based, glass ionomer, resin-modified glass ionomer and poly-acid modified, showed no appreciable difference in superiority as of the time of the study. 

Given their safety and long record of reducing caries in children, particularly those at elevated risk, Delta Dental of Virginia strongly supports the placement of sealants on first and second permanent molars in children and adolescents as those teeth erupt, taking into account each patient's individual needs and existing clinical guidelines. We also recommend reviewing the patient's coverage when considering sealants as part of their preventive plan for improved oral and overall health.  

Michael D Weitzner, DMD, MS
Dental Director, Delta Dental of Virginia
Have a suggestion for a future tip? Submit it here.