To Seal or Not to Seal

If you have kids and you take them to the dentist, I am sure you have heard about sealants. I don’t know what the statistics are, but I would assume that most dentists recommended dental sealants. In case you are unaware, a dental sealant is a flowable resin generally placed on permanent 6 and 12-year molars. It is placed on the top of the tooth in the grooves of the teeth. Its purpose is to help prevent decay from forming in this area, which happens to be the most common place for dental decay to occur. It does nothing in the prevention of decay between teeth or on any of the other 20 teeth in the mouth – although the molars are generally the first teeth to decay.
Make sense so far? Now for the controversy. In my opinion, sealants have a very limited application. Let me take a step back and give you some information to help you see where I cam coming from.
There are actually many different techniques to place sealants. The way I was taught in school, and the way many if not most sealants are still placed, is that if that little picky thing that everyone hates doesn’t stick in the tooth, the tooth is cleaned and the sealant is placed. The first problem is that the little pick is not very accurate – about 57% according to studies I have seen. The statistic shoots to over 90% accuracy with the aid of laser cavity detection. This is a relatively inexpensive tool that sends a beam of light into the top of the tooth and measures density of tooth structure.
So yes, there are teeth that get sealed that have decay. However, according to studies, sealing over minimal decay is clinically acceptable. These studies say that the sealant can actually stop or prevent the decay from progressing. Would you want that in your mouth?
That is not the main problem though. Once that sealant is placed, the laser detection tool is ineffective. You then have to rely on x-ray detection, which is also not very accurate, unless the decay is moderately large. I cannot tell you how many teeth I have done moderate size fillings on that had clinically acceptable sealants in place.
The main problem is that a sealant is a dental restoration and ALL restorations leak over time. Whether it be a filling or a crown, they all leak and allow bacteria in which may potentially cause decay. So, my position is, why would you place a restoration on a seemingly healthy tooth? A healthy diet, good home care, and regular professional care are the keys to dental decay prevention. So, do sealants prevent decay? They aid in not getting stuff stuck in the grooves of teeth which can cause decay, but they do not guarantee you won’t get decay.
For the few adults out there that still have sealants in place and don’t have decay, you probably wouldn’t have decay even if the sealants hadn’t been there. I would rather have a healthy tooth remain restoration free and be able to be monitored by a laser. If decay is detected early with the laser, the tooth can have a very conservative tooth-colored restoration. This can then be monitored clinically and by x-ray.