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Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars


Dr. Tim Wright and Ms. Malavika Tampi spoke with Dr. Chiraz Guessaier about the American Dental Association’s clinical practice guideline titled, “Evidence-based clinical practice guideline for the use of pit-and-fissure sealants”. The guideline was informed by an accompanying systematic review, and both manuscripts were published in the August, 2016 issue of the Journal of the American Dental Association. This project was a collaboration between the American Dental Association and the American Academy of Pediatric Dentistry.

Dr. Tim Wright is Distinguished Professor of Pediatric Dentistry and the Director of Strategic Initiatives, Department of Pediatric Dentistry, at the University of North Carolina Chapel Hill.

Ms. Malavika Tampi is research assistant in the Center for Evidence-Based Dentistry at the American Dental Association.


The updated systematic review and clinical practice guideline highlight new information related to the use of pit-and-fissure sealants, or sealants, on the occlusal surfaces of primary and permanent molars in children and adolescents. The guideline is intended to help clinicians make decisions regarding the prevention of occlusal carious lesions in this population.

The ADA uses the GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) which provides a transparent framework with which the quality of the evidence and strength of the recommendations can be evaluated. This approach aligns with those of other global organizations.

Key Messages

  • Sealants provide a significant reduction in caries incidence compared to the non-use of sealants.
  • Sealants provide a greater reduction in caries incidence compared to fluoride varnishes.
  • Superiority of one type of sealant material over another was unclear due to the very low quality of evidence for comparative studies. The likelihood of lack of retention should be considered when choosing between materials.
  • Sealants reduce the progression of noncavitated occlusal carious lesions.
  • Sealants are underutilized in dentistry and the implementation of this guideline is encouraged to reduce the incidence of caries, and the need for restorative treatments in this population.



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