A fissure sealant is a thin resin coating flowed into the deep grooves on the biting surface of a back tooth to seal them off before decay can start, and placing one on a healthy tooth involves no drilling and no anaesthetic. It is one of the few dental procedures that is purely preventive: nothing is removed, and nothing needs to have gone wrong first.
If your child's adult back teeth have come through, it is worth asking whether the grooves should be sealed.
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What is a fissure, and why can a toothbrush not clean it?
Run a fingernail across the biting surface of a back tooth and it catches in a set of grooves. Those grooves are fissures — the join lines where the cusps of the tooth fused together as it formed.
On some teeth they are shallow and wide, and a brush cleans them without difficulty. On others they are deep and narrow, sometimes shaped like a flask with a pinched opening and a wider space beneath it.
A single toothbrush bristle is around 0.2 millimetres across. Many fissures are narrower than that at the opening. The bristle passes over the top and never reaches the base, however careful the brushing is.
What can reach the base is what dissolves in saliva: sugars, carbohydrates and the acid the bacteria living down there produce. That is why the biting surfaces of newly erupted back teeth are the most common site of decay in children, and why a child with excellent brushing can still get a cavity there.
The way that decay develops before it is felt is covered in the articles on what happens before a cavity hurts and how childhood decay starts early.
How is a sealant placed?
The whole appointment is short, and the sequence on a healthy tooth is the same each time.
- Clean. The biting surface is cleaned so nothing is trapped under the sealant.
- Isolate and dry. The tooth is kept dry with cotton rolls and suction. This is the step that determines whether the sealant holds, and it is the reason a child who cannot keep their mouth open for a few minutes may need to wait.
- Condition the surface. A mild etching gel is applied for a few seconds and rinsed off, leaving a microscopically rough surface for the resin to grip.
- Flow the resin in. The sealant is a liquid resin that runs into the grooves and fills them.
- Cure it. A blue curing light sets the resin in seconds.
- Check the bite. The clinician checks the teeth meet normally and adjusts if needed.
The child can eat straight afterwards. There is nothing to avoid and nothing wears off.
No drilling and no anaesthetic
This is the part most parents are asking about. A standard sealant placed on a sound tooth does not involve the drill and does not require local anaesthetic. Nothing is cut away and no healthy tooth structure is removed.
That is not the same as saying every child finds it easy. Some children dislike the taste of the etching gel, the dryness, the suction, or simply having someone working in their mouth for several minutes. That is normal, and it is handled with the same show-tell-do approach used at a first visit — the instrument is shown, then explained, then used.
Where a groove already has decay in it, a sealant is no longer the right treatment, and a filling is discussed instead. That conversation happens before anything starts.
Sealants are usually placed at a routine check-up, so nothing separate needs arranging.
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Which teeth, and when?
The six-year molars
The first adult molars arrive at the back at around six, without any baby tooth falling out first, which is why many parents do not notice them. Their grooves are deep, and a six-year-old's brushing rarely reaches that far back reliably. Sealing them soon after they have fully erupted is the most common application.
The twelve-year molars
The second adult molars come through behind the first, at around twelve, and are even harder to reach. The same reasoning applies.
Premolars, and some baby teeth
Premolars are sealed where the grooves are deep enough to warrant it. Baby molars can also be sealed, particularly in a child who has already had decay elsewhere or whose grooves are visibly deep.
Adults
Adults can have sealants too. An adult with deep, stained grooves that have so far stayed healthy is a reasonable candidate, and it is a far smaller intervention than waiting for a filling.
The decision is always made tooth by tooth, after looking at the grooves and at the child's overall decay risk. There is more on the fissure sealants page.
How long do sealants last?
A well-placed sealant can last for years, but it is a material sitting on a chewing surface and it does wear. It can also chip, or lift at an edge if the tooth was not perfectly dry when it was placed.
Sealants are therefore checked at every routine visit. A worn or partly lost sealant is repaired or replaced, which is a short appointment, again without drilling where the tooth underneath is sound.
A sealant that is quietly failing at one edge is the situation worth catching, because a gap under the resin is harder to see and harder to clean than an open groove. That is an argument for keeping recall appointments rather than an argument against sealing.
What a sealant does not do
A sealant protects the biting surface. It does nothing for the surfaces between teeth, where the contact points sit, and those are the second most common place for decay to begin in children.
Cleaning between teeth still matters, and so does what and how often a child drinks and snacks. Nothing about a sealed molar changes that.
Sealants also work alongside fluoride, not instead of it. Fluoride protects the smooth surfaces and helps repair early damage; a sealant physically blocks a groove a brush cannot enter. They address different problems, and neither replaces the other.
General background is available from healthdirect.
What does a fissure sealant cost?
A fissure sealant is $80 per tooth. That applies to adult and baby teeth alike, and it is always priced per tooth, so a child having two molars sealed and a child having four are quoted differently.
That figure assumes no health-fund contribution. A fund may contribute depending on the policy and the level of cover, and a written quotation is provided before any treatment begins. Full pricing is on the fees page.
Sealants may also be included for children eligible for the Child Dental Benefits Schedule, which provides a capped benefit over two calendar years. The schedule is bulk-billed at this practice, meaning Medicare pays the clinic directly and there is no out-of-pocket cost for the services it covers. Eligibility takes a moment to check with the CDBS checker, or you can read the scheme details from the Australian Department of Health.
Quick answers
Does a sealant hurt?
Placing a sealant on a healthy tooth does not involve drilling or an injection, and nothing is removed from the tooth. Some children still find the dryness, the taste or the length of the appointment unpleasant, and that is worked around rather than pushed through.
At what age should sealants be placed?
Most commonly soon after the first adult molars erupt at around six, and again at around twelve for the second molars. The right timing for a particular child depends on when their teeth arrive and how deep the grooves are.
Can a tooth still decay after it has been sealed?
Yes. A sealant covers the biting surface only, and the surfaces between teeth remain exposed. A sealant that has worn or chipped also stops protecting, which is why they are checked at every visit.
Do sealants contain fluoride?
Some sealant materials release a small amount of fluoride and some do not. The protective effect comes mainly from physically sealing the groove, so the choice of material matters less than whether the tooth was dry when it was placed.
Having the grooves checked
Whether a tooth needs sealing is a decision made by looking at it, usually at a routine check-up rather than at a separate appointment. Children's services are listed on the paediatric dentistry hub. Berala Dental is a general dental practice, and children's preventive care is delivered by the oral health therapists.
Ask at the next check-up whether your child's back teeth would benefit from sealing.
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Written and reviewed by Humzah Aly, Oral Health Therapist. This article is general information only and is not a substitute for personalised dental advice. Please see a dental practitioner to discuss what is right for you.
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