Sealants for preventing decay in primary teeth

Priyadarshini Ramamurthy, Avita Rath, Preena Sidhu, Bennete Fernandes, Sowmya Nettem, Patrick A. Fee, Carlos Zaror, Tanya Walsh

Review question

Can putting sealants over the biting surfaces of baby teeth in the back of the mouth prevent tooth decay forming in them?


Tooth decay is one of the most common diseases of childhood that can affect the overall well‐being of the child. The most commonly affected teeth are the back teeth whose biting surfaces are not flat and have grooves (pits and fissures) that can retain food debris and bacteria, leading to formation of cavities (decay). In addition, the opening of these grooves is so small that a toothbrush bristle cannot enter them completely, making them difficult to clean. Sealing the grooves is one of the ways to prevent decay in back teeth. Sealant acts as a protective barrier to food and bacteria, thus preventing their harmful action on tooth surfaces.

Study characteristics

We included nine studies that involved 1120 children (aged 18 months to eight years). The studies used a variety of dental sealants to prevent tooth decay in baby teeth. We assessed most studies as being at high risk of bias overall, because the dental professionals who were measuring the outcomes could see whether a sealant had been placed, and also differentiated between sealant materials.

Key results

Three studies compared sealants with no sealants, and six studies compared different materials or processes to seal the tooth surface. As there were important differences in the design of the studies in terms of the sealant types, the age of the children at the start of the trial and the length of follow‐up, we were unable to pool the data. Only one trial assessed and reported side effects, the nature of which was gag reflex while placing the sealant material.

Quality of evidence

We found low‐quality evidence regarding the effectiveness of sealants in preventing tooth decay on biting surfaces of back baby teeth in children. Hence, we are unable to draw conclusions about the effectiveness of sealants compared to no sealant or a different sealant in preventing development of decay on baby teeth in children. More well‐conducted studies with long follow‐up times are needed.

How up‐to‐date is the evidence?

The review includes studies available from a search of the literature up to 11 February 2021.

Read the full review.

Ramamurthy P, Rath A, Sidhu P, Fernandes B, Nettem S, Fee PA, Zaror C, Walsh T. Sealants for preventing dental caries in primary teeth. Cochrane Database of Systematic Reviews 2022, Issue 2. Art. No.: CD012981. DOI: 10.1002/14651858.CD012981.pub2.