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Permanent First Molar Sealants Prevent Tooth Decay


  • In school aged American children, does the application of dental sealants to permanent first molars cause a decreased incidence of tooth decay when compared to permanent first molars that are not sealed?

Clinical Bottom Lines

• Six year old children who were routine utilizers of Iowa Medicaid who had at least one molar sealant placed needed significantly fewer restorative treatments compared to those who did not have a sealant placed over a four year period with an odds ratio of 0.48.1
• Sealed molars also required later and less extensive restorations than their nonsealed counterparts over a four year period.1

Summary of Key Evidence

• A four year retrospective study of children enrolled in the Iowa Medicaid program from 1996 - 2000. Inclusion criteria were having a 6th birthday in 1996, continuous enrollment in the Iowa Medicaid program, and routine utilization of services during this period. After application of criteria, the final population studied was 308.1
• Used Medicaid insurance claims to assess the natural history and treatment outcomes of permanent first molars with dental sealants by analyzing the natural history of each first molar of a child separately and building a treatment outcome tree (TOT) for each, then comparing the results. To develop each TOT, all of the services provided to each first molar was identified and placed in chronological order over a four year period. The TOTs were compared based first on whether or not the molar was sealed; TOTs were then further compared for subsequent restorative treatment (including restorations, crowns, endodontic therapy, or extraction).1
• Main results were: 40% of routine utilizers received a sealant during the four year period, sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 vs 29%), sealed molars had significantly fewer extensive restorative treatments (crowns, endodontic therapy, or extraction), the median time to restorative treatment of the sealed molars was greater than that of the nonsealed molars, 4% of sealed maxillary first molars received a one surface restoration (the most common restoration required by children) compared with 18% of nonsealed maxillary first molars. All four first molars had comparatively similar patterns of subsequent care.1
• Limitations identified in this study was that it included only Medicaid-enrolled patients who had the resources and motivation available to make it to at least three dental appointments in a four-year period and that the results supporting the use of sealants can only be applied to a four year period.

Additional Comments

  • A Cochrane systematic review evaluated existing evidence to evaluate the caries prevention of resin based pit and fissure sealants and glass ionomer cements or sealants in children and adolescents. It reviewed studies which were randomized controlled trials of at least 12 months duration in which sealants were used in persons under 20 years old. Results showed that sealants significantly prevented caries of the occlusal surfaces of permanent molars2.


  1. Bhuridej, P, et al. Natural history of treatment outcomes of permanent first molars: A study of sealant effectiveness. Journal of the American Dental Association. Sept 2005; 136:1265-72.
  2. Ahovuo-Saloranta A, et al. Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev 2004(3):CD001830

CAT Author: Haley Sanker, M.D.

CAT Appraisers: Dr. Kerry Mychaliska, M.D

Date appraised: February 11, 2009

Last updated June 11, 2009
Department of Pediatrics and Communicable Diseases
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