DDJ Patient Article · As of March 2026 · Explained Simply
For Which Children and Teeth Is Pit Filling Clinically Truly Worthwhile?
Explained in an easy-to-understand way based on current scientific studies. This article helps you make informed decisions with your dentist.
This article is about a treatment your dentist may recommend or perform.
Quick Summary
The most important findings at a glance:
- Research overall shows a benefit.
- The scientific basis is solid, but not all questions have been definitively answered.
- Pits at risk for caries benefit more from sealing.
- Sealing does not work for the tooth in general, but for the right surface in the correct risk context.
Why Is This Topic Important for You?
You may have heard that there are differing opinions on this topic. This is because science is often more complex than a simple yes or no answer suggests. In this article, we explain what current research actually shows—without technical jargon and without omitting important details.
Pit filling is not a yes/no question, but rather a combination of caries risk, tooth morphology, and recall ability.
Why is this important for you? Because as a patient, you can make better decisions when you understand the background information. This article does not replace a discussion with your dentist, but it gives you the knowledge to ask the right questions.
The most important questions in research revolve around the following areas: high-risk occlusal surfaces, retention and follow-up care, and primary versus permanent molars. In the following sections, we explain what the studies say about each of these areas and what that means for your daily life.
What does "High-risk occlusal surfaces" mean for me as a patient?
A common patient question is how to weigh high-risk occlusal surfaces. The answer is not as simple as one might hope—but research now provides clear indications.
The scientific evidence for sealant placement on caries-prone occlusal surfaces is extensive and consistent. A systematic review by Ahovuo-Saloranta et al. (2017), which included 38 studies with over 7,900 participants, showed a relative caries reduction of about 70 to 80 percent on sealed versus unsealed surfaces after two years. The absolute risk reduction varies greatly depending on the initial risk: For children with high caries risk, the Number Needed to Treat (NNT) is significantly more favorable than for children with low baseline risk.
Wright et al. (2016) confirmed in a scientific review article for the American Dental Association (ADA) that sealing permanent molars significantly lowers the caries incidence on occlusal surfaces. The effects remain detectable even after longer follow-up periods of up to nine years, provided the sealants remain intact. The German S3 Guideline for Sealant Placement (DGZMK/DGKiZ, Kühnisch et al. 2012) recommends sealing caries-prone grooves and pits on permanent molars as an evidence-based measure with a strong recommendation level.
Crucially, the benefit is not distributed evenly across all teeth and children. Beauchamp et al. (2008) and Fontana et al. (2020) emphasize that the greatest effect is seen in children with increased or high caries risk. For low-risk individuals, the added benefit over consistent fluoride use and oral hygiene is marginal, and the indication must be weighed on an individual basis. A blanket sealing of all molars regardless of the risk profile is not supported by scientific evidence.
Methodologically, the scientific evidence relies predominantly on randomized controlled trials and their syntheses. The heterogeneity lies less in the direction of the effect than in the magnitude of the benefit across different risk populations. Some primary studies have short follow-up times or high dropout rates, which limits the long-term precision of the assessment but does not question the basic conclusion.
Methodologically, it should be noted that the included studies vary considerably in study design, follow-up period, and population selection. This heterogeneity limits the comparability of results and explains why pooled effect estimates must be interpreted with caution. Nevertheless, the direction of the effect is consistent across various study types.
For applicability to the German-speaking care context, it is also relevant that a significant portion of the scientific evidence comes from Anglo-American or Scandinavian healthcare systems. Differences in reimbursement structure, treatment culture, and patient access can influence effect sizes without invalidating the core conclusion.
For practice, this means: The indication must be formulated based on the tooth and the risk level. A general recommendation to seal all molars is not supported by guidelines or the body of research. The clinical decision begins with an individual risk assessment—previous caries, pit/fissure depth, dietary habits, and fluoride status.
What is not supported by the scientific evidence: Sealing is no substitute for consistent basic preventive care. Children with low caries risk and good oral hygiene gain little additional benefit. At the same time, a good basic preventive care regimen should not lead to foregoing sealing when caries-prone pits or fissures are present in high-risk children.
The clinical decision should not be based on single studies, but rather on the overall direction of available scientific evidence: Sealing is one of the most strongly supported preventive measures in pediatric dentistry for caries-prone occlusal surfaces.
What does this mean for you? Caries-prone pits and fissures benefit more from sealing.
What does this mean for your next dental visit? The research findings help you better understand your dentist's recommendations and ask targeted questions if anything is unclear.
The science has intensively studied this topic in recent years. For this article, more than six scientific studies were evaluated. It is important to understand: Not every study has the same level of evidence. Large, well-controlled investigations provide more reliable results than small observational studies. The overall picture from these various studies is what we present to you here.
💡 What does this mean for you?
Fissures at risk for caries benefit more from sealant application. Discuss with your dentist at your next visit what this specifically means for your situation.
What does "retention and follow-up" mean for me as a patient?
When it comes to retention and follow-up, the research situation is clearer than many people think. Here you will learn what current studies actually show.
The effectiveness of sealant application is inseparable from the retention of the sealing material. Beauchamp et al. (2008) and an independent scientific review (Ahovuo-Saloranta et al. 2017) consistently show that caries protection lasts only as long as the seal remains intact. Complete loss of retention eliminates the protective effect, and the affected area is again exposed to full caries risk. Retention rates vary between 70 and 95 percent after two years, depending on the material, application technique, and drying process.
Hiiri et al. (2015) and Muller-Bolla et al. (2006) document in their reviews that the retention rate decreases over time, necessitating regular follow-up appointments to detect and repair partial losses early. The clinical implication is clear: a sealant without planned follow-up is an incomplete intervention. Feagin et al. and other long-term data show that sealants repaired during recall visits achieve comparable protection rates in the long term to primary intact sealants.
The choice of material—resin-based sealants versus glass ionomer cement—affects the retention rate. Resin-based materials show higher retention rates in controlled studies than glass ionomer cements (Ahovuo-Saloranta et al. 2017). However, glass ionomer cements have practical advantages in situations with limited drying and can serve as a transitional solution. Wright et al. (2016) emphasize that the scientific evidence for resin-based sealants is overall stronger, without completely ruling out glass ionomer cements in certain clinical situations.
Another methodological aspect concerns technique sensitivity: the quality of drying, contamination control, and layer thickness significantly influence retention. Studies conducted under ideal conditions may overestimate practical retention. The lack of standardization in application technique in the primary studies makes direct comparison of retention data difficult.
Methodologically, it must be noted that the included studies vary considerably in study design, follow-up period, and population selection. This heterogeneity limits the comparability of results and explains why pooled effect estimates must be interpreted with caution. Nevertheless, the direction of the effect is consistent across different types of studies.
For applicability to the German-speaking care context, it is also relevant that a significant portion of the scientific evidence comes from Anglo-American or Scandinavian healthcare systems. Differences in reimbursement structure, treatment culture, and patient access can influence effect sizes without invalidating the core message.
For practice, this means: The professional text must communicate sealing as a process, not as a one-time event. Sealing alone is not enough—it must be integrated into a recall system that detects and repairs partial losses. Practices that seal but do not offer structured follow-up utilize the measure only partially.
What is not concluded from the scientific evidence: A loss of retention does not mean that the original sealant was useless. The phase of retention provided caries protection. However, a loss of retention that is not followed up can create a false sense of security if both the patient and the dentist continue to view the area as protected.
It is important to note that the choice of material should be guided by the clinical situation—resin-based sealants are considered the gold standard with good tooth preparation, while glass ionomer cements can serve as a transitional solution for children with limited cooperation or for primary teeth that are difficult to isolate.
What does this mean for you? With good control, the protective logic remains viable.
What does this mean for your next dental visit? The research findings help you better understand your dentist's recommendations and ask targeted questions if anything is unclear.
How do scientists arrive at these conclusions? They don't just evaluate a single study; they look at many investigations simultaneously. This allows them to determine whether a result was random or if it is consistently confirmed. In this case, the findings are based on 6 scientific papers from different countries and research groups.
💡 What does this mean for you?
With good control, the protective logic remains viable. Discuss with your dentist at your next visit what this specifically means for your situation.
What matters more: Primary or Permanent Molars?
One area that often causes confusion is the difference between primary and permanent molars. However, science has made important advances in recent years.
The strongest scientific evidence for sealant placement is found with permanent molars, especially the first and second molars. One independent systematic review (Ahovuo-Saloranta et al. 2017) primarily focuses on permanent teeth, and both ADA guidelines (Wright et al. 2016) and the German S3 guideline (Kühnisch et al. 2012) focus their strongest recommendations on permanent molars at risk for caries. Caries reduction on the occlusal surfaces of permanent molars is consistently demonstrated over several years.
The data supporting primary molars (baby molars) are significantly thinner. Individual studies, including work by Chadwick et al. (2005) and Muller-Bolla et al. (2006), show a protective effect on baby molars as well, but the number of studies is smaller, follow-up periods are shorter, and the effect sizes are estimated less precisely. Furthermore, the shorter retention time of primary teeth changes the clinical calculus: the cost-benefit assessment shifts when the tooth to be protected is only present for a few years.
Premolars are rarely considered separately in the literature. Some studies suggest that premolars with pronounced fissure relief can also benefit, but the scientific basis is insufficient for a systematic recommendation. Fontana et al. (2020) and the ADA guidelines emphasize that the indication should be guided by caries risk and fissure morphology, not solely by tooth type.
The heterogeneity in the literature mainly concerns whether sealants should be placed on permanent molars even when caries risk is low. Reviews of multiple studies consistently show an effect in high-risk areas, but the absolute risk reduction in low-risk populations is small. Therefore, the stage of tooth development becomes a clinical context factor, not the sole decision criterion.
Methodologically, it must be noted that the included studies vary considerably in study design, follow-up period, and population selection. This heterogeneity limits the comparability of results and explains why pooled effect estimates must be interpreted with caution. Nevertheless, the direction of the effect is consistent across different types of studies.
For applicability to the German dental care context, it is also relevant that a significant portion of the scientific evidence comes from Anglo-American or Scandinavian care systems. Differences in reimbursement structure, treatment culture, and patient access can influence effect sizes without invalidating the core statement.
For practice, this means: The claim requires a developmental context and cannot remain global. Permanent molars at risk for caries are the classically strong indication area. For primary molars, the decision is more individualized and should consider the remaining time window until tooth exfoliation, the caries risk, and the child's ability to cooperate.
What does not follow from scientific evidence: Sealants on primary molars are not evidence-free—they are less evidenced. In high-risk situations, sealing primary molars can also be beneficial, especially if alternative preventive measures are insufficient. However, a general recommendation for primary molar sealants is not justified by the current data.
The clinical decision should not be based on single studies, but rather on the overall direction of available scientific evidence: Permanent molars with caries-prone fissures benefit the most. Applying this to other dental situations requires an individual assessment.
What does this mean for you? Permanent molars with caries-prone fissures are the classically strong area.
What does this mean for your next dental visit? The research findings help you better understand your dentist's recommendations and ask targeted questions if anything is unclear.
What makes these results reliable? In medical research, the rule is: the more independent studies that reach the same conclusion, the more certain the statement is. The type of study and the number of participants also play an important role. Large controlled studies with many participants provide more reliable results than small surveys.
💡 What does this mean for you?
Permanent molars with caries-prone fissures are the classically strong area. Discuss what this specifically means for your situation at your next dental visit.
Frequently Asked Questions
Here we answer the questions patients most often ask about this topic:
❓ What does "High-risk occlusal surfaces" mean for me as a patient?
Caries-prone fissures benefit more from sealants.
❓ What does "Retention and follow-up" mean for me as a patient?
With good control, the protective logic remains viable.
❓ What matters more: Primary or permanent molars?
Permanent molars with caries-prone fissures are the classically strong area.
❓ How certain are the results?
The scientific basis is solid, but not all questions have been definitively answered.
❓ Should I change my behavior based on this information?
Speak with your dentist before making any changes. This article informs you about the state of research, but every situation is individual. Your dentist knows your personal health status best.
❓ Where can I learn more?
The full professional version of this article with all study details can be found on Daily Dental Journal. For personal advice, consult your dentist.
❓ What is the most important message of this article?
Sealants are strongest for caries-prone occlusal surfaces.
❓ Why are there differing opinions on this topic?
Disagreement usually does not arise from the sealing idea itself, but rather from the scope of indication and the quality of aftercare.
🦷 When Should You See a Dentist?
Schedule an appointment with your dentist if:
- You are unsure if a recommended treatment is right for you
- You have symptoms or notice any changes
- You would like to get a second opinion
- You have questions about the topics described in this article
- It has been more than a year since your last dental visit
Important: This article does not replace a dentist's visit. It helps you go into the conversation informed.
What You Can Do Yourself
Here are concrete steps you can take as a patient:
The Most Important Thing in One Sentence
Sealing does not work for the tooth generally, but for the correct surface in the right risk context.
Source Information
This article is based on current scientific evidence and the DDJ editorial guidelines. All statements are supported by studies and presented in a way that is understandable for patients.
The content was prepared by the DDJ editorial team for patients. Medical decisions should always be made in consultation with your dentist.
As of: March 2026 · Language: American English (en-US) · Target Audience: Patients and interested laypeople