Fluoride and fissure sealants for children

Fluoride and fissure sealants are two simple, painless ways to protect children’s teeth from decay. Fluoride strengthens the enamel on every surface of the tooth, while sealants are thin protective coatings that close the deep grooves of the back teeth, where cavities often start. They work best together with good brushing and a low-sugar diet.

Why children’s teeth need extra protection

Tooth decay (dental caries) is one of the most common health problems in childhood. It starts when bacteria in dental plaque turn sugars into acids that slowly dissolve the enamel, the hard outer layer of the tooth. Children’s enamel is still maturing, and newly erupted teeth are especially vulnerable.

Two areas are most at risk: the smooth surfaces where plaque is left behind, and the narrow grooves (called pits and fissures) on the chewing surfaces of the back teeth. Fluoride mainly protects the first; sealants protect the second. Both work alongside, not instead of, the daily habits described in our practical guide to preventing tooth decay in children.

How fluoride protects the teeth

Fluoride is a natural mineral. When it is present in the mouth in small, regular amounts, it helps enamel repair itself after acid attacks (a process called remineralisation) and makes it more resistant to future attacks. It can even stop very early decay, seen as chalky white spots, before a hole forms.

Children get fluoride in two main ways:

• every day at home, from fluoride toothpaste;
• a few times a year at the dentist, as a concentrated fluoride varnish.

Fluoride toothpaste by age

The amount matters more than the brand. The fluoride levels below are those recommended by the NHS guidance on children’s teeth:

“ppm” means parts per million and is printed on the tube. Brush twice a day, including last thing at night, then ask your child to spit out the excess without rinsing with water, so the fluoride keeps working. Parents should brush for, or supervise, young children until about the age of seven.

Fluoride varnish at the dentist

Fluoride varnish is a concentrated fluoride coating that the dentist paints onto the teeth with a small brush. It takes only a few minutes, needs no injection and no drilling, and is suitable even for very young children. The varnish sets on contact with saliva and releases fluoride over the following hours.

How often it is applied depends on the child’s risk of decay. Many children benefit from an application about twice a year; children at higher risk may need it more often. After the visit, your child should usually eat soft food and avoid brushing for the rest of the day, following the dentist’s instructions. The teeth may look slightly yellowish until the next brushing, which is normal.

What fissure sealants are and which teeth benefit

A fissure sealant is a thin, clear or tooth-coloured plastic coating (usually a resin) that is painted into the grooves on the chewing surface of the back teeth. Once hardened, it closes the grooves so food and bacteria can no longer settle in them. Toothbrush bristles are often too large to clean these grooves properly, which is why decay so often starts there.

Sealants are most often placed on the permanent molars:

• the first permanent molars, which usually come through around the age of 6;
• the second permanent molars, which usually appear around the age of 12.

Sealing soon after these teeth come through gives the most protection. The dentist may also suggest sealing premolars, or deep grooves on baby molars, in children at higher risk. According to the American Dental Association’s MouthHealthy guide to sealants, sealants considerably reduce the risk of decay in molars.

How sealants are placed, step by step

1. Examination: the dentist checks that the tooth is healthy, or that any early changes are small enough to be sealed.
2. Cleaning and drying: the grooves are cleaned and the tooth is kept dry with cotton rolls and gentle suction.
3. Preparation: a mild gel is applied for a few seconds to slightly roughen the surface so the sealant can bond; it is then rinsed off and the tooth is dried again.
4. Application: the liquid sealant is painted into the grooves.
5. Hardening: a blue curing light sets the material in a few seconds.
6. Check: the dentist checks the bite and adjusts it if needed.

Each tooth takes only a few minutes. There is no injection, no drilling and no pain; the main challenge for young children is keeping the mouth open and still for a short while. Your child can eat and drink normally straight afterwards.

How long the protection lasts, and its limits

Sealants usually last several years, but they can wear or chip with chewing. The dentist checks them at every check-up and repairs or replaces them when needed, which is quick and simple. Fluoride, on the other hand, has to be repeated: toothpaste every day and varnish at regular intervals.

A few honest points for parents:

• Neither treatment replaces brushing, a low-sugar diet and regular check-ups.
• Sealants protect the chewing surfaces only, not the spaces between the teeth.
• Swallowing too much fluoride while the teeth are forming, usually by eating toothpaste, can cause faint white marks on the permanent teeth (dental fluorosis). Using the right amount of toothpaste avoids this.
• Side effects are rare. Fluoride tablets or drops should only be given if a dentist recommends them.
• If a tooth already has a cavity, it needs treatment rather than a sealant; our article on whether cavities in baby teeth should be treated explains why.

The cost depends on how many teeth are sealed, whether fluoride varnish is applied at the same visit, the material chosen and whether other treatment is needed. The dentist can explain this after examining your child.

Fluoride and sealants for children in Tripoli at Ajam Dental Clinic

At Ajam Dental Clinic, all dental care for children, from babies to teenagers, is handled by Dr. Soumaya Ajam, who holds a University Diploma in Paediatric Dentistry from Université Saint-Joseph de Beyrouth. Preventive care such as check-ups, fluoride varnish and fissure sealants is part of the children’s dentistry offered at the clinic. If your child has not seen a dentist yet, our guide to your child’s first dental visit explains what to expect.

Patients come to our clinic on Fouad Chehab Boulevard from across Tripoli — Al-Qobbeh, Bab al-Tabbaneh, Jabal Mohsen and Dam wa Farez — as well as from Beddawi, Minieh and the rest of North Lebanon. To book a check-up for your child, contact us by WhatsApp or phone.

This article provides general information for patients. It does not replace an examination by a dentist, who can advise you on your own situation.