Summation - Fluoride's Impact on Smooth Surfaces vs Pits & Fissures:

According to the dental community, fluoride's benefits are largely confined to the smooth surfaces of teeth.

The chewing surfaces of teeth ("pits and fissures) are not protected by fluoride - a fact that is now well acknowledged.

What makes this finding particularly significant is the fact that 80 to 90% of cavities in children occur in the pits and fissures.

Because of fluoride's inability to prevent pit & fissure cavities, dentists commonly recommend the use of dental sealants.

According to an editorial in the Journal of the American Dental Association:

"It is estimated that 84% of the caries experience in the 5 to 17 year-old population involves tooth surfaces with pits and fissures. Although fluorides cannot be expected appreciably to reduce our incidence of caries on these surfaces, sealants can."
SOURCE: Journal of the American Dental Association 1984; 108:448.

Excerpts from the Scientific Literature - Fluoride's Impact on Smooth Surfaces vs Pits & Fissures: (back to top)

"[E]namel surfaces with pits and fissures receive minimal caries protection from either systemic or topical fluoride agents."
SOURCE: Pinkham JR. (1999). Pediatric Dentistry: Infancy Through Adolescence. Third Edition. WB Saunders Co, Philadelphia.

"Fluoridation and the use of other fluorides have been successful in decreasing the prevalence of dental caries on the smooth surfaces of teeth. Unfortunately, these efforts have much less effect on dental caries that occur in the pits and fissures of teeth (particularly on the biting surfaces of teeth) where more than 85 percent of dental caries now occur."
SOURCE: White B. (1993). Toward Improving the Oral Health of Americans: an Overview of Oral Health Status, Resources and Care Delivery. Public Health Reports 108: 657-672.

"The type of caries now seen in British Columbia's children of 13 years of age, is mostly the pit and fissure type. Knudsen in 1940, suggested that 70 percent of the caries in children was in pits and fissures. Recent reports indicate that today, 83 percent of all caries in North American children is of this type. Pit and fissure cavities aren't considered to be preventable by fluorides, they are prevented by sealants."
SOURCE: Gray, AS. (1987). Fluoridation: Time for a New Base Line? Journal of the Canadian Dental Association 10: 763-765.

"It is estimated that 84% of the caries experience in the 5 to 17 year-old population involves tooth surfaces with pits and fissures. Although fluorides cannot be expected appreciably to reduce our incidence of caries on these surfaces, sealants can."
SOURCE: Scholle R. (1984). Editorial: Preserving the perfect tooth. Journal of the American Dental Association. 108:448.

"The program focused on four caries-prevention techniques: sealants, a plastic-like coating applied to the chewing surfaces of back teeth and to pits and fissures on the sides of teeth (these surfaces are most prone to decay and ones which fluorides cannot protect adequately)."
SOURCE: Raloff J. (1984). Dental study upsets the accepted wisdom. Science News. 125(1): January 7.

"Let me begin by saying that fluorides are most effective in preventing decay on the smooth surfaces of teeth. However, the chewing surfaces of posterior [teeth] are not smooth. They have crevices and pits and it is our experience that fluorides don't really get access to these pitted areas."
SOURCE: Dr. Harald Loe, Director of the National Institute of Dental Research. Hearings: Subcommittee of the Committee on Appropriations, House of Representatives. March 1984.

Online Information from Dental Health Websites - Fluoride's Impact on Smooth Surfaces vs Pits & Fissures: (back to top)

"Fluoride primarily protects the smooth surfaces of teeth, and sealants protect the pits and fissures (grooves), primarily on the chewing surfaces of the back teeth. Although pit and fissure tooth surfaces only comprise about 15% of all permanent tooth surfaces, they were the site of 83% of tooth decay in U.S. children in 1986-87."
SOURCE: Dental Health Foundation. Selected Findings and Recommendations from the California Oral Health Needs Assessment of Children, 1993-1994. Report at: http://www.dentalhealthfoundation.org/

"Fluoride protects the smooth surfaces, Sealants protect the chewing surfaces."
SOURCE: State of North Carolina Department of Health and Human Services. See: http://www.communityhealth.dhhs.state.nc.us

"Sealants protect the chewing surfaces; Fluoride protects the smooth surfaces"
SOURCE: Colgate Dental Health and Oral Hygiene Resource Center. See: http://www.colgate.com/

"The most important reason for getting sealants is to avoid tooth decay. Fluoride in toothpaste and in drinking water protects the smooth surfaces of teeth but back teeth need extra protection."
SOURCE: National Institute of Dental and Craniofacial Research. Seal Out Tooth Decay. See Report at: http://www.nidcr.nih.gov/nidcr.nih.gov

"Fluoride helps the smooth surfaces of the teeth the most, but is less effective on the chewing surfaces of the back teeth (molars)."
SOURCE: HealthGate Data Corp. Do you need dental sealants? Swedish Medical Center, Seattle Washington. See: http://www.swedish.org/15155.cfm

"Fluoride works best on the smooth surfaces of teeth. The chewing surfaces on the back teeth, however, have tiny grooves where decay often begins. Sealants keep germs out of the grooves by covering them with a safe plastic coating."
SOURCE: Centers for Disease Control and Prevention. Frequently Asked Questions - Dental Sealants. See: http://www.cdc.gov/OralHealth/factsheets/sealants-faq.htm

"Sealants and fluoride work together to prevent dental decay. Sealants prevent decay in the pits and grooves of the chewing surfaces of the molars, while fluoride prevents decay on the smooth surfaces of all teeth."
SOURCE: Santa Cruz Health Services Agency. Dental Sealant Information. Report at: http://www.santacruzhealth.org/dental/Sealants.htm

"Fluoride acts on the smooth surfaces of teeth, while fissure sealants protects the tooth from decay on the pits and grooves on the chewing surfaces."
SOURCE: The Regional Municipality of Niagara, Ontario. Oral Tips. See: http://www.regional.niagara.on.ca/

"Fluorides such as those used in fluoridated water, fluoride toothpaste, and fluoride mouth rinse help prevent decay on the smooth surfaces of teeth. However, fluorides have less effect on the rough, pitted chewing surfaces of the back teeth where food particles and decay-producing bacteria are trapped."
SOURCE: Austin Dental. Sealants. See: http://www.lifetimedental.com/index.php3?id=47

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