Indications for fissure sealants and their role in children and adolescents

The concept of sealing caries-prone tooth surfaces seemed inspired and, in the late 1960s, fissure sealing of occlusal surfaces of permanent molars was introduced (Figure 1). Since then, thousands of papers have been published on this subject. They include original studies on the effect of fissure sealing, narrative reviews, guidelines and systematic reviews. Based on all this information, it seems reasonable to assume that there are good answers to relevant questions such as the effect of fissure sealants, what kind of sealant should be preferred, when and for whom, and the costs and benefits. Unfortunately, the answers to these questions are not known with certainty. To seal or not to seal, for whom, when and with what is still debatable. There are lots of hopes and beliefs, sometimes very firm beliefs about fissure sealing. The scientific knowledge is, however, less straightforward and less convincing.

Based mainly on systematic reviews, the aim of this article is to summarize what is known and what is still not known about the effect of fissure sealing with the two most commonly used materials: resin sealants and glass ionomer sealants. The content will be restricted to permanent first and second molars in children and adolescents. It will start with some methodological aspects on study design and their importance for a critical appraisal and interpretation of the outcome of fissure sealing. Then a description of the aims and main conclusions of systematic reviews is given. Available knowledge and evidence will be interpreted and recommendations given to the general practitioner who has to decide if, for whom, when and with what occlusal surfaces of permanent molars could benefit from fissure sealing. Finally, the most important gaps in knowledge will be presented.