Sealants or fluoride varnish for caries prevention?

Fissure sealant

There is evidence from two Cochrane reviews published in 2013 that both fissure sealants (Ahovuo-Saloranta et al) and fluoride varnish (Marinho et al ) prevent caries in occlusal surfaces. So having a understanding the the comparative effectiveness of these two widely used interventions would be helpful.

The aim of this Cochrane review was to evaluate the relative effectiveness of fissure sealants compared with fluoride varnishes, or fissure sealants together with fluoride varnishes compared with fluoride varnishes alone, for preventing dental caries in the occlusal surfaces of permanent teeth of children and adolescents.


Searches were conducted in the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform without restrictions on language or date. Randomised controlled trials with at least 12 months of follow-up comparing fissure sealants, or fissure sealants together with fluoride varnishes, versus fluoride varnishes for preventing caries in the occlusal surfaces of permanent premolar or molar teeth were considered. Study screening, data abstraction and risk of bias assessment was carried out independently by two reviewers with overall quality of evidence being assessed using GRADE methodology. Standard Cochrane approaches were used for data analysis.


  • 8 RCTs involving a total of 1747 children aged 5-10 years of age were included
  • 3 studies compared resin-based fissure sealant versus fluoride varnish. Results from follow up after two years were combined from 2 studies (358 children). Sealants prevented more caries, pooled odds ratio (OR) = 0.69 (95%CI; 0.50 to 0.94)
  • One trial with follow up at 4 and 9 years found that the caries-preventive benefit for sealants was maintained with 26% of sealed teeth and 55.8% of varnished teeth having developed caries at nine years.
  • Evidence for glass-ionomer sealants was of low quality.
  • One split-mouth trial analysing 92 children at two-year follow-up found a significant difference in favour of resin-based fissure sealant together with fluoride varnish compared with fluoride varnish only (OR 0.30, 95% CI 0.17 to 0.55). The evidence was assessed as low quality.
  • 3 studies assessed but did not report any adverse effects


The authors concluded:

Currently, scarce and clinically diverse data are available on the comparison of sealants and fluoride varnish applications; therefore it is not possible to draw clear conclusions about possible differences in effectiveness for preventing or controlling dental caries on occlusal surfaces of permanent molars. The conclusions of this updated review remain the same as those of the last update (in 2010). We found some low-quality evidence suggesting the superiority of resin-based fissure sealants over fluoride varnish applications for preventing occlusal caries in permanent molars, and other low-quality evidence for benefits of resin-based sealant and fluoride varnish over fluoride varnish alone. Regarding glass ionomer sealant versus fluoride varnish comparisons, we assessed the quality of the evidence as very low and could draw no conclusions.


As noted above there are Cochrane reviews that provide evidence for the effectiveness of both the use of fissure sealants and fluoride varnish for caries prevention. Caries prevention programmes at population level have tended to use either one or other approach. Owing to the additional technique sensitivity and workforce consideration for sealant programmes, varnishing programmes are often preferred. As the individual Cochrane reviews suggest greater benefit from sealants over fluoride varnish seeing a direct comparison of the two interventions is helpful. The results of the review tend to support the findings from the individual reviews that the sealants are more effective. However as highlighted by the authors the quality of the available evidence is low so further well conducted high quality studies are needed.


Primary paper

Ahovuo-Saloranta A, Forss H, Hiiri A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD003067. DOI: 10.1002/14651858.CD003067.pub4.

Other references

Cochrane Oral Health Group – Sealants versus fluoride varnish – which is better for preventing decay in children’s teeth?

Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub4.

Dental Elf – 8th Apr 2013 – Review recommends fissure sealants for caries prevention in permanent teeth

Marinho VCC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD002279. DOI: 10.1002/14651858.CD002279.pub2.

Dental Elf – 12th Jul 2013- Updated review confirms substantial reductions in caries from fluoride varnish applications


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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