Position Statement on the Use of Sealants
Dental caries (tooth decay) is a multifactorial, chronic oral disease that affects individuals of all ages globally, with children and older adults being particularly vulnerable1. It is the leading contributor to the global burden of oral disease2. Healthy People 2030 oral health objectives prioritize reducing caries prevalence and increasing sealant use among children and adolescents3. Sealants, used in public health programs as a key quality indicator of preventive care effectiveness, are highly cost effective and can be delivered in both community (e.g., school-based) and clinical settings4. However, although the prevalence of dental sealants has increased, they are still underutilized among individuals at risk for dental caries5.
Posterior teeth are at greater risk for caries due to their complex occlusal anatomy, especially pits and fissures that readily trap biofilm and debris and are harder to clean, making these surfaces more susceptible than smooth surfaces6. Other caries preventive measures such as fluoride in optimally fluoridated areas, are most effective in protecting smooth surfaces; however, sealants provide an additional layer of protection against dental caries7. Pit-and-fissure sealants serve as a physical barrier on the tooth surface, preventing biofilm and food particle accumulation in these areas8. Randomized controlled trials confirm the effectiveness of sealants in preventing dental caries9-12. Observational studies indicate that a large percentage of occlusal surfaces can remain caries-free for up to ten years or more after a single application of a sealant13,14. In addition, sealants are effective to arrest progression of noncavitated caries lesions10,15. Recommendations from systematic reviews strongly support their use as the primary strategy to prevent and arrest noncavitated lesions in the occlusal surfaces of both primary and permanent teeth16,17.
The long-term effectiveness of sealants, particularly resin composite sealants, depends on their retention; therefore, regular visual and tactile assessments should be used to determine if material has been lost. Reapplication or repair should be considered to ensure its long-term effectiveness. Evidence suggests that repaired or renewed sealants have survival rates comparable to newly placed sealants in permanent teeth18.
While sealants are well-established for caries management in children and adolescents, their use in adults (≥18 years) has been less studied. However, emerging clinical evidence suggests that sealants can effectively arrest non-cavitated caries lesions in adults, mirroring outcomes seen in younger individuals and supporting sealant use in adults19.
Initially developed to prevent and arrest caries on occlusal surfaces, sealants are now being recognized for their role in managing approximal caries20. The proportion of caries lesions in proximal surfaces increases with age and contributes significantly to the overall caries incidence, particularly in adolescents and high-risk populations21,22. Like occlusal sealants, proximal sealants create a mechanical barrier that protects against the cariogenic challenges23. Although applying sealants to interproximal lesions requires two appointments to allow for tooth separation, recent studies show that proximal resin composite sealants effectively control the progression of noncavitated lesions24,25 and perform similarly to other noninvasive treatments in arresting these lesions17,26.
Based on the scientific literature, the American Association for Dental, Oral, and Craniofacial Research (AADOCR) strongly supports the use of dental sealants by practitioners in both private and public health settings as a critical component of caries prevention and management. AADOCR also endorses integrating sealants with other caries management strategies as part of a comprehensive approach to oral health care. While the effectiveness of dental sealants in preventing dental caries is well established, AADOCR supports further research on strategies to translate the proven effectiveness of dental sealants into broader real-world implementation, including approaches to improve uptake, optimize delivery models, and foster innovation in sealant materials.
(adopted 2026)
