Most decay in children starts in the grooves on the chewing surface of the molars. Fissure sealants and fluoride application are the two most effective ways to prevent this decay before it starts.
What is a fissure and why does it decay?
The chewing surface of the molars has fine, deep grooves called fissures. These grooves are often narrower than a toothbrush bristle; food debris and bacteria that get inside cannot be brushed out. The enamel of newly erupted teeth is also not yet fully mature, so it is more open to decay.
What is a fissure sealant?
A fissure sealant is a flowable protective filling material that fills these grooves and leaves the surface smooth. The tooth is not drilled and nothing is removed; the grooves are simply sealed.
- The tooth is cleanedThe chewing surface is cleaned with a brush and dried.
- The surface is preparedA gel is applied briefly so the sealant will bond, then washed off and the tooth dried.
- The sealant is appliedThe flowable material spreads into the grooves.
- It is set with lightIt hardens in a few seconds under a blue light. The child can eat and drink straight away.
The procedure takes a few minutes per tooth; it is painless and needs no anaesthetic.
At what age is it done?
- 6–7 years: When the first permanent molars come through
- 11–13 years: When the second permanent molars come through
- In children at high risk of decay it can also be applied to milk molars and premolars.
The best time is soon after the tooth comes through, because a tooth is most likely to decay in its first years.
How long does it last?
Fissure sealants can stay in place for years, but they can wear or partly chip away over time. They are checked at six-monthly visits and renewed if needed. A sealant does not protect between the teeth; flossing and brushing are still essential.
What is fluoride application?
Fluoride combines with the enamel, makes it more resistant to acid and helps repair decay in its earliest stage. Fluoride applied in the clinic comes as a varnish or gel and is more concentrated than in toothpaste.
- The varnish is painted onto the teeth with a small brush; it takes a few minutes.
- After the application it is recommended not to eat hard or hot things for a few hours and not to brush the teeth that day.
- It is repeated two to four times a year depending on the child's risk of decay.
Is fluoride safe?
Fluoride applied by a dentist in the recommended amount and frequency is safe. The point to watch with children is that fluoride toothpaste should not be swallowed. For this reason a smear the size of a grain of rice is used before the age of three and a pea-sized amount between three and six, and brushing is supervised by an adult.
Fissure sealants and fluoride do not replace brushing. When all three are used together, a child's teeth are protected against decay in the best possible way.
For your child's first examination and other preventive treatments, see our pediatric dentistry page.
Frequently asked questions
Can adults have fissure sealants?
They can also be applied to adults who have deep-grooved molars with no decay; but the greatest benefit comes in the years just after the tooth erupts.
Can decay form under a fissure sealant?
Decay does not develop under a sealant that has been applied correctly and is intact. If part of it chips off, that area is left unprotected; this is why it needs checking at appointments.
Will my child be frightened during the procedure?
With no needle and no drilling, most children are comfortable. These treatments are also a good way for a child to get to know the dentist's chair.
This article is for general information and is not a substitute for diagnosis or treatment. If you have a complaint, please see your dentist.