While we don't doubt that what you state is factual, placing dental sealants is a valuable preventive tool. In defense of this procedure, we would like to explain the following points.

In regard to creating tooth protection, placing a sealant is the first step. The second step (as discussed above on this page) is monitoring its integrity during regular checkups over the following months and years.

The hope is that through regular monitoring the dentist will be able to detect any deficiency [sealant loss (whole or partial), leakage] early on before any decay has started. If instead decay is discovered, then a filling is promptly placed. With regular checkups, having a cavity get so out of hand that a deep cavity has formed that has affected the tooth's nerve could only be considered to be the rare exception.

As a second line of defense, even if periodic evaluation of the sealant's surface didn't reveal problems developing underneath, routine x-ray evaluation (via taking bitewing x-rays) should detect any cavity formation long before it gets out of hand.

[Having sealants doesn't negate the need for periodic x-rays. That's because x-rays are used to detect cavities in additional areas that sealants don't protect (primarily those tooth surfaces that touch adjacent teeth, use the bitewing link above for examples).]

Finally, in regard to the dentist's position, if regular checkups and x-rays weren't involved then they weren't given the opportunity for monitoring that's needed. Beyond that, it's difficult to know how much responsibility they should have taken.

Generally, it seems even with sealant failure of some sort (partial or full loss) the tooth isn't at greater risk for decay than it would have been if one had never been placed. (See studies discussed above regarding both of these points.)

While obviously we don't know the details of your nephew/niece's case, it seems easy to state that what has occurred seems far from the norm. And while a tragedy for the child and tooth, it would be a disservice to others to suggest that this isn't a safe and reliable form of cavity prevention. In the vast majority of cases it is, and it provides a valuable service that can't be duplicated by any other type of dental treatment.

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