Do Adults Need Sealants on Teeth?

Do adults need sealants on teeth?  It’s a great question. The purpose of a dental sealant is to protect the grooves on the biting surface of the tooth from trapping plaque and bacteria that can lead to dental decay.  These types of cavities can go undetected for long periods of time as they are asymptomatic and typically don’t show up very well on x-rays.

Sometimes, I tell patients “it’s like putting a truck bed liner on your tooth”.  If I have the feeling that a patient doesn’t know what a truck bed liner is, or I feel like they might think I’m a fool for making that analogy, I don’t mention the truck bed liner.  Thankfully, I live in Sa Antonio Texas, where everyone knows what a truck bed liner is, so we’re good.

So what goes through my mind when I’m proposing to a patient, adult or child, whether or not to get dental sealants?  The answer is caries risk assessment.  If  I decide, based on my clinical judgement of an individual patient, that the risk of caries/dental decay on the biting surface of a tooth is high, then I say go for it.  Let me give you a few generic cases, just so you can see how I’m thinking.

Case 1: 6 year old child that clearly is still struggling with home dental care, eating a diet high in sugar and processed food has all four of their 6 year adult molars are totally in.  The child has had cavities in the past.  High risk patient. GETTING SEALANTS.

Case 2: 17 year old with impeccable oral hygiene, has never had a sealant and has never had a cavity, and the teeth look great.  Low risk patient. MOST LIKELY NOT PROPOSING SEALANTS. 

Case 3: 36 year old patient with deep decay on the biting surface of three of their first molars.  The fourth first molar is the only one that doesn’t have a filling or a cavity.  High risk associated with that tooth. IT’S GETTING A SEALANT.

Did you notice anything about the ages of my cases?  That’s right, age doesn’t have much to do with an individual patient’s risk assessment. It’s a factor, of course, but not always the most important factor. 

So why do patients think sealants are only for children?  Insurance companies, of course!  Insurance companies typically only cover the costs of sealants at 100% for children and adults typically do not have it as a covered benefit and have to pay the full fee.  I read something on an insurance company’s website that said that the with adults the occlusal surfaces of teeth have been worn smooth, thereby reducing the chances for decay.  Occlusal surfaces worn smooth?!  It takes a lot more time than age 19 (when coverage typically stops) to “wear the surfaces smooth”.  How smooth do they want, flat like a cow’s teeth? I don’t see a lot of patients with the biting surfaces of teeth worn smooth. I have patient in their 80’s and 90’s who haven’t “worn their teeth smooth” yet.  Another reason insurance companies say they won’t pay the benefit is because adults have better diet and hygiene practices than children.  Once again, ridiculous, not always true, and completely beside the point.

So, do adults need sealants on teeth? Yes, adults should get sealants on their teeth at the recommendation of a dentist they trust for reasons that are based on sound clinical judgement. The decision should not be because of what some insurance company says.  Insurance coverage or not doesn’t take the risk of getting a cavity away.  On the other side of the same coin, an adult or child should not get sealants on the teeth just because insurance covers it.  There’s no sense in doing dental treatment just for the heck of it because it’s covered.  That’s no way to be treated and it’s no way to practice.  

The best treatment decisions are based on clinical evidence, knowledge or current research, and a mutual understanding between the patient and the dentist.  If a sealant is right treatment choice in a particular situation, it’s the right treatment choice.

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