If you have children and take them to the dentist, at some point you are going to hear about sealants.  I think sealants are one of the most effective services dentists can provide their young patients to prevent a common type of cavity. 

Pictures are worth a thousand words, so here is a great image that explains why sealants are so effective.  (photo was taken from Dentistry 2000 website)

This photo shows a cross-section of an adult molar tooth.  What it reveals is how adult molars form with deep “grooves” or “crypts” that are more narrow at the depth than one toothbrush bristle.  Because of this fact, biting surfaces cavities are one of the types of cavities that people over the course of history have consistently gotten.  With sealants, these deep grooves are filled with a liquid monomer, and a light is used to cause this material to polymerize and harden.  These are bonded to the tooth and are very effective in sealing out tooth decay of this type.

Parents often ask me if we should seal baby molars as well as the permanent molars.  Without going into great detail this is my response.  Baby molars do not typically have these deep grooves, though some do.  If I see a child getting decay on this surface of baby molars and I need to do a filling on one or more of these baby molars, then yes, sealants would be a good preventative measure in these children.  If the child is low risk for getting decay, meaning they have never had a cavity and have not got factors in their history indicating they will likely get cavities, than sealants on baby teeth are not indicated.

Insurance usually pays for sealants on adult molars because insurance companies have reviewed the research themselves and know paying for a less expensive preventative procedure is financially better for them.  They know if they provide this benefit for their clients they are much less likely to have to pay for more expensive fillings later.  Only a few insurance companies pay for sealants on baby molars.  Medicaid is one of those insurance providers that do and this is the reason.  Low income children have more cavities and they know that in low income populations they are going to save money in the long run for these children by providing as much prevention as possible.

Some dentists will always recommend sealants on all molars, baby molars, etc.  My philosophy is assessing the child’s risk for decay at their first visit to my office by taking a good history, diet evaluation and by the exam itself.  Some children should have every nook and cranny possible sealed because of their high risk for decay; on bicuspids, deep groves on the tongue side of front incisors, and all molars.  Some children only need sealants on permanent molars.  Some families feel “If insurance doesn’t pay, then I’m not doing it.”  Unfortunately not all insurance companies provide the same level of coverage, and no insurance company can replace the evaluation and recommendation by a pediatric dentist for your specific child.  

Hope this helps you decide what is best for your sweet little one!