Dental Sealants and Fluoride Varnish: Does My Child Need Them?

By Dr. Mohsen Alozaibi, Tiny Teeth Dental Center, Abu Dhabi

"Her teeth look fine, so why does she need anything?" It's a fair question. Sealants and fluoride varnish are not treatments for a problem. They are preventive steps that help keep healthy teeth healthy, and both are usually quick and painless.

What are dental sealants?

The chewing surfaces of back teeth have deep grooves called pits and fissures. They are often narrower than a single toothbrush bristle, so food and bacteria settle there easily, and many cavities in children start in these grooves.

A sealant is a thin protective coating that flows into these grooves and seals them, making the surface smoother and easier to keep clean.

Which teeth are sealed?

• First permanent molars, which usually come through around age 6, behind the last baby teeth.
• Second permanent molars, which usually come through around age 12.
• Sometimes baby molars, for example in children with deep grooves or a higher risk of cavities.
• Occasionally other permanent back teeth with deep grooves.

Sealants work best when they are placed fairly soon after a molar has fully come through, before decay has a chance to start. Your dentist will tell you which teeth would benefit.

What happens during the appointment?

1. The tooth is cleaned and kept dry, often with cotton rolls or a small suction tip. 2. A gentle solution is applied to prepare the surface, then rinsed off. 3. The sealant is painted into the grooves and hardened with a small blue light.

There is usually no drilling and no injection, and each tooth takes only a few minutes. Most children cope well, and your child can usually eat normally straight afterwards.

Do sealants last?

Sealants can last for several years, but they can wear or chip with chewing. They are checked at each routine visit and can be topped up or repaired if needed. Sealants protect the grooves only, so brushing, flossing and fluoride toothpaste are still essential.

What is fluoride varnish?

Fluoride varnish is a sticky, concentrated fluoride coating that is painted onto the teeth with a small brush. It helps strengthen enamel and can help stop very early decay (white spots) from getting worse.

• Quick: it takes about a minute or two.
• Comfortable: no needles, no drilling, and it sets quickly when it touches saliva.
• Safe: only a very small amount is used, and it is suitable for young children.
• From the first tooth: mainstream paediatric guidance supports applying it from when the first tooth appears, often every three to six months depending on your child's risk of cavities.

The teeth may look slightly yellow or feel a bit rough for a few hours. This is normal and goes away with brushing.

After varnish

Follow the instructions you are given. Typically:

• Soft foods and cool or lukewarm drinks for the next few hours, avoiding very hard, crunchy, sticky or hot foods.
• Skip brushing until the evening or the next morning, so the varnish has time to work.

Who benefits most?

All children can benefit, but sealants and varnish are especially helpful for children who:

• Have had cavities before, or have brothers or sisters with cavities.
• Have deep grooves in their back teeth.
• Snack or sip sweet drinks often, or still have night-time milk feeds.
• Find brushing difficult, for example because of braces or special health care needs.

Common questions

• Is it a replacement for brushing? No. They add protection on top of good daily habits.
• Does fluoride varnish replace fluoride toothpaste? No. Keep using a rice-grain smear under age 3 and a pea-sized amount from age 3 to 6.
• Can they be done on a tooth with a cavity? A tooth with active decay usually needs to be assessed and treated first. Your dentist will advise.