Fissure Sealants and Fluoride Varnish for Children: What the NHS Offers (2026 UK Guide)

Last updated: October 2026. Sources: NHS.uk, NHS England, GOV.UK (Office for Health Improvement and Disparities), legislation.gov.uk, the National Institute for Health and Care Excellence (NICE), the National Institute for Health and Care Research (NIHR), Cochrane, NHS inform, Childsmile, GOV.WALES, Public Health Wales, nidirect and NHS trust patient leaflets. All charges, band rules and eligibility verified on 14 October 2026.

TL;DR Fissure sealants and fluoride varnish are quick preventive treatments that help protect children's teeth from decay. NHS dental care is free for children, so families in England pay nothing. Since 1 April 2026, sealants count as Band 2 and varnish as Band 1 for adults who pay, and dental nurses can now apply varnish to children between check-ups.

Tooth decay is still common in children across England. The latest national survey found that 22.4% of 5 year olds "had experience of obvious dentinal decay" [25], and in the financial year ending 2025 there were 33,976 hospital tooth extraction episodes for 0 to 19 year olds with tooth decay as the primary diagnosis [26]. The same report says "Tooth decay continues to remain the most common reason for hospital admissions in children aged between 5 and 9 years." [26]

Two simple treatments offered by NHS dental teams, fissure sealants and fluoride varnish, are designed to help prevent decay before it starts. This guide explains what each one is, which children are offered them and when, what happens at the appointment, what the research shows and how the NHS (National Health Service) rules changed in England on 1 April 2026. It also covers Scotland, Wales and Northern Ireland, safety, aftercare and whether adults can have them. Your child's dentist is always the right person to advise on whether a treatment suits them.

What fissure sealants and fluoride varnish are

Both treatments aim to stop tooth decay before it starts, but they work in different ways. A sealant is a physical barrier over the grooves of the back teeth, while varnish strengthens the enamel itself.

Fissure sealants

The chewing surfaces of back teeth have deep grooves, called pits and fissures, where food and plaque can collect. NHS.uk describes fissure sealing as the treatment "where the chewing surfaces of the back teeth are covered with a special thin plastic coating to keep germs and food particles out of the grooves." [1] An NHS community dental service leaflet describes sealants as "protective coatings that are painted on to the grooves (pits and fissures) on the chewing surface of the back teeth (molars and premolars)." [16]

Sealants go on permanent (adult) back teeth. NHS.uk says fissure sealants "can be done once your child's permanent back teeth have started to come through (usually at the age of about 6 or 7) and again when the rest of their teeth come through between 11 and 14 years." [1] It adds that "The sealant protects teeth from decay and lasts up to 4 years." [1]

Fluoride varnish

Fluoride varnish is a concentrated fluoride coating painted onto the teeth. NHS.uk explains that it "can be applied to both baby teeth and adult teeth" and that "It works by strengthening tooth enamel, making it more resistant to decay." [1] The government's Delivering Better Oral Health toolkit notes that most of the evidence comes from varnish containing 22,600ppm fluoride (2.26% sodium fluoride). [8]

That is far stronger than toothpaste. A Leeds Teaching Hospitals NHS Trust leaflet says "Fluoride varnish contains more than fifteen times as much fluoride as a regular toothpaste." [18] Public Health Wales describes it as "a golden gel that is applied to a dried tooth surface by trained dental professionals." [28]

Sealants and varnish at a glance

Which children are offered sealants and fluoride varnish

The NHS approach in England is to offer fluoride varnish to all children from age 3, and to focus fissure sealants on children whose dentist judges them to be at higher risk of decay.

Fluoride varnish: offered to children from age 3

NHS.uk says: "From the age of 3, children should be offered fluoride varnish application at least twice a year. Younger children may also be offered this treatment if your dentist thinks they need it." [1]

Delivering Better Oral Health (DBOH), the evidence-based prevention toolkit published by the Office for Health Improvement and Disparities (OHID), recommends that dental teams "Apply fluoride varnish (2.26% NaF) to teeth 2 times a year" for all children aged 3 to 6, and "Apply fluoride varnish to teeth 2 times a year" for all children from 7 to 18. [7] For children "giving concern because of dental caries risk", the toolkit recommends varnish "2 or more times a year". [7] It describes fluoride varnish as "one of the best options for increasing the availability of topical fluoride regardless of the levels of fluoride in any water supply." [8]

NHS England's 2026 contract guidance for dental teams sets a higher frequency for children at higher risk, saying "it is recommended that those identified as being at higher risk of dental caries receive fluoride varnish treatments at least 4 times per year." [5] How often your child has varnish therefore depends on the dentist's assessment of their risk.

Some areas also run varnish programmes outside the dental practice. NICE (the National Institute for Health and Care Excellence) advises local authorities in areas where children are at high risk of poor oral health to consider nursery and primary school fluoride varnish programmes that "provide at least 2 applications of fluoride varnish a year." [10]

Fissure sealants: mainly for children at higher risk of decay

In England, sealants are recommended on a risk basis rather than for every child. DBOH states that "it is strongly recommended that resin-based sealants be applied on eruption of permanent teeth, particularly molar teeth, if a child is judged by the clinician to be at higher risk of dental caries." [9]

NHS England summarises the same advice for children aged 7 and over and young people up to 18 "where there is a higher risk of dental caries. This does not apply to all children but for those with a higher risk of dental caries." [5] For children in this higher-risk group, DBOH recommends both sealants on newly erupted permanent teeth and fluoride varnish "2 or more times a year". [7]

If your dentist has not suggested sealants, it may be because they judge your child's risk of decay to be low. It is always reasonable to ask how they have assessed your child's risk and whether sealants would help. Scotland takes a broader approach to sealants, which is covered further down.

What happens at the appointment

Both treatments are carried out in the dental chair, usually at a routine visit, and each takes only a few minutes. Knowing what to expect can help if your child is nervous.

Having a fissure sealant

NHS community dental service leaflets describe a similar sequence of steps:

1. Cleaning. "The tooth will be cleaned, washed and dried". [16]
2. Preparing. The tooth is "prepared with a special solution, and dried." [19]
3. Applying. "the liquid sealant will be applied to the surface of the tooth." [16]
4. Setting. "A blue light will be shone onto the tooth to help the fissure sealant set." [16]

Childsmile, Scotland's national child oral health programme, says "The process is usually quick and easy, taking only a few minutes per tooth." [19] Afterwards, the Bridgewater leaflet notes that "Your child may notice a strange taste for a short time after the fissure sealant has been applied; this is normal and will soon disappear." and that "Your child can eat and drink normally after the treatment." [16]

Sealants need checking over time. Leeds Teaching Hospitals NHS Trust advises: "The sealants should be checked by a dentist at your child's regular dental review appointments to ensure they are still present and intact. Occasionally, they may need to be topped up." [18] DBOH also tells dental teams to "check sealants for wear, integrity and leakage at every visit and re-seal where necessary". [9]

Having fluoride varnish

A Royal Wolverhampton NHS Trust leaflet explains that "the dentist, dental therapist or dental nurse will dry your child's teeth using a cotton wool roll or with a puff of air" and that "The fluoride varnish will then be applied onto your child's teeth using a small brush". [17] The same leaflet describes the process as "simple, quick and painless". [17]

Before the varnish is applied, the leaflet asks parents: "If your child has asthma or any allergies please tell the dental team before treatment takes place". [17] The reason is explained in the safety section below.

Aftercare for fluoride varnish

NHS leaflets agree on most of the aftercare advice:

• Wait before eating or drinking. "Your child should not eat, drink or rinse their mouth for at least 30 minutes. This allows the varnish to set". [17]
• Soft foods for the rest of the day. Childsmile says soft foods "will help the fluoride varnish to stay on the teeth for longer." [27]
• No fluoride drops or tablets for two days. Childsmile advises that "your child should not be given fluoride drops or tablets for two days after the fluoride varnish application." [27]
• Expect a waxy feel and a yellow tint. The varnish "may feel waxy on the teeth and is completely normal" [17], and Public Health Wales notes that "The golden colour can take a few days to fade." [28]

Leaflets differ on brushing that evening. The Royal Wolverhampton leaflet says teeth "should not be brushed until bedtime after the varnish application" [17], while Leeds Teaching Hospitals recommends "Avoid brushing teeth on the evening after application." [18] Follow the instructions your own dental team gives you on the day.

NHS costs and the April 2026 changes in England

For children, the headline is simple: NHS.uk says "NHS dental care for children is free." [1] The April 2026 changes matter mainly for how practices are paid and for adults who pay NHS charges.

Who gets free NHS dental treatment in England

NHS.uk says you can get free NHS dental appointments and treatment if "you're aged under 18, or under 19 and in full-time education", or if "you're pregnant or have had a baby in the last 12 months". [3] Certain benefits also qualify, including "Universal Credit - but only if your income is below a certain amount", and "If you or your partner receive benefits that mean you can get free dental treatment from the NHS, your dependents aged under 20 can also get free dental treatment." [3] A valid HC2 certificate from the NHS Low Income Scheme also gives free treatment. [3] Our full guide to who qualifies for free NHS dental treatment covers every exemption.

Sealants moved to Band 2 and varnish stays in Band 1

Until 31 March 2026, both treatments sat in Band 1. The original 2005 charging rules listed "surface application as primary preventive measures of sealants and topical fluoride preparations" as a Band 1 item. [4] The National Health Service (Primary Dental Services and Dental Charges) (Amendment) Regulations 2026 changed this from 1 April 2026. Their explanatory note says the amendments mean "sealants and conservation treatments of deciduous teeth attract a Band 2 patient charge." [4]

NHS England explains the reason: "To support the use of fissure sealants in children with a history of decay, all fissure sealants will be classified as Band 2 treatment from April 2026 and can be claimed accordingly." [5] Its letter to practices adds that "All fissure sealants will become a Band 2 treatment payable at either 3 or 5 UDAs depending on the number of affected teeth." [6] UDAs (units of dental activity) are how NHS practices in England are paid, so the change gives practices more credit for placing sealants.

Fluoride varnish remains a Band 1 item. NHS.uk lists "putting fluoride on the surface of your teeth" in Band 1 and "sealant to fill small holes or grooves in your teeth" in Band 2. [2]

NHS dental charges in England from 1 April 2026

These charges apply only to people who are not exempt. NHS.uk explains that "If you need a mix of treatments from different bands, you'll pay for the cost of the highest band of treatment you're having." [2] Our NHS dental charges guide explains each band in detail, and our dental check-up cost guide compares NHS and private check-up prices.

New: dental nurses can apply varnish between check-ups

The second April 2026 change creates a new way for children to get varnish. NHS England's guidance says "suitably competent dental nurses will be able to apply fluoride varnish under a prescription (patient specific direction) from the dentist who examined the patient, without a dental examination from 1 April 2026." [5] This applies to "children aged 16 and under". [5]

These nurse-led applications follow a care plan set by the dentist and must be spaced at least 3 months apart. [5] NHS England gives two examples: "for children assessed at lower risk of dental decay and placed on a 12-month recall, fluoride varnish should be applied every 6 months", and "for children identified at higher risk of dental decay and scheduled for a 6-month recall, fluoride varnish should be applied every 3 months." [5]

The guidance says nurses "will be able to" do this, so not every practice will offer it. If your child is at higher risk of decay, ask whether your practice runs nurse-led varnish appointments between check-ups.

Private sealants and varnish

Some families choose private care, often because NHS appointments are hard to find locally. Private practices set their own fees for sealants and varnish, so ask for the price before treatment starts. Remember that NHS care for children is free, so it is worth checking whether a practice can see your child on the NHS before booking privately. NHS.uk notes that "Some dental practices offer both NHS and private appointments. Ask for an NHS appointment." [29]

Scotland, Wales and Northern Ireland

Each UK nation runs its own NHS dental system, so England's band rules and the April 2026 changes do not apply elsewhere. Children's dental care is free on the NHS in all four nations.

Scotland

NHS inform says "Everyone in Scotland is entitled to free NHS dental examinations", and NHS treatment is free for "everyone aged under 26". [21] On varnish, NHS inform advises: "From the age of two, children should be offered fluoride varnish treatment by their dentist at least twice a year. If a child attends a nursery or school that is participating in the Childsmile Fluoride Varnish Programme, they may also receive two additional fluoride varnish applications." [20]

Scotland's guidance on sealants is broader than England's risk-based approach. Childsmile states: "Resin-based fissure sealants should be applied to the permanent molars of all children as early as possible after eruption." [19]

Wales

In Wales, the Welsh Government says you can get free NHS dental treatment if, when treatment starts, you "are aged under 18" or "are aged 18 and in full time education", and free dental examinations if you are "aged under 25" or "aged 60 or over". [23] Wales uses its own charging model based on care packages, with "a maximum total charge of £384 for a course of treatment". [23] Its new patient assessment can include "fissure sealants for enamel caries where clinically appropriate" and "topical fluoride application". [23]

Wales also runs Designed to Smile, which the Welsh Government describes as "a dental health programme for nursery and primary school children up to age 7. This includes daily tooth-brushing and twice yearly fluoride varnish application". [22] Public Health Wales says "Fluoride varnish can be applied by dental teams at your family dental practice and at some nurseries and schools." [28]

Northern Ireland

nidirect says you get free dental treatment in Northern Ireland if you "are under 18 years old" or "are 18 years old and in full-time education", or if you are pregnant or have had a child in the 12 months before treatment starts. [24] Ask your child's dentist which preventive treatments they recommend and how often.

What the research says about sealants and fluoride varnish

Both treatments have been studied for decades, and the evidence shows that each one helps prevent decay. What the research has not settled is which of the two works better.

• Fluoride varnish. A Cochrane review of 22 trials found that varnish reduced decay by 43% in permanent teeth and 37% in baby teeth compared with placebo or no treatment, although "the quality of the evidence was assessed as moderate". [14]
• Fissure sealants. A Cochrane review of 38 trials found "moderate-quality evidence that resin-based sealants reduced caries by between 11% and 51% compared to no sealant, when measured at 24 months." [13]
• Sealants compared with varnish. A 2020 Cochrane review concluded that both help prevent decay in first permanent molars, but "it has not been possible in this review to reach reliable conclusions about which one is better to apply." [15]

The Seal or Varnish trial in Wales

The largest UK head-to-head study, the NIHR-funded Seal or Varnish trial, followed 1,015 children in school mobile dental clinics in deprived areas of South Wales for 3 years. [12] Decay into the dentine of a first permanent molar developed in 17.5% of children who had varnish and 19.6% of children who had sealants, a difference the researchers found was "not statistically significant". [12]

The trial found that "Between 74% and 93% of sealants (upper and lower teeth) were intact at 36 months." [12] Varnish was cheaper to deliver in that programme: "the mean cost to the NHS (including intervention costs) per child was £500 for FS, compared with £432 for FV, a difference of £68.13". [12] These costs relate to that school programme, not to what a family would pay.

The practical message is that sealants and varnish are not either-or choices. DBOH recommends both for children at higher risk of decay [7], and your dentist will suggest what suits your child.

Are fissure sealants and fluoride varnish safe

Both treatments have a good safety record in research studies, but there are a few situations where fluoride varnish is not suitable.

Fluoride varnish safety and who should avoid it

DBOH says fluoride varnish "is well accepted and safe for most patients", with some exceptions. [8] It states that "The use of fluoride varnish is contraindicated in patients with ulcerative gingivitis and stomatitis." [8] It also notes "a very small risk of allergy to one component (colophony) of the most commonly used fluoride varnish" and tells dental teams to check for "allergy to sticking plaster or severe allergy or asthma that has required hospitalisation", where colophony-containing varnish should not be used. [8] DBOH adds that "Other brands of varnish may have different constituents." [8]

That is why the dental team will ask about allergies and asthma before applying varnish. If your child has had a reaction to sticking plasters or has been in hospital with asthma or a severe allergy, tell the dentist.

Some families ask about alcohol in varnish. DBOH notes that some varnishes contain alcohol and that, on the authority of the West Midlands Shari'ah Council, "they are suitable for use by Muslims, provided that they are used in small amounts, well below that which would intoxicate". [8]

Fissure sealant safety

Trials report very few problems with sealants. The Cochrane sealant review found that "Information on adverse effects was limited but none occurred where this was reported." [13] The 2020 Cochrane review notes that five trials "reported that no adverse events resulted from use of sealants or fluoride varnishes over one to nine years." [15] In the Seal or Varnish trial, "No adverse effects were reported." [12]

Can adults have fluoride varnish or fissure sealants

Most of the guidance focuses on children, but adults at higher risk of decay can benefit from varnish too.

DBOH recommends that dental teams "Apply fluoride varnish to teeth 2 times a year (2.26% NaF)" for "adults giving concern because of dental caries risk". [7] It adds that "it is increasingly important to consider its use with adults at higher risk, particularly frail older people, who have maintained their natural teeth." [8] In England, an adult who pays NHS charges and has varnish as part of their care would pay the Band 1 charge of £27.90. [2]

DBOH's sealant recommendations cover children and young people up to 18 [7], and the toolkit has no sealant recommendation for adults. If you think a sealant might help you, ask your dentist. In England, sealants placed on the NHS now fall under the Band 2 charge of £76.60 for adults who pay. [2] [4]

Questions to ask your child's dentist

A short conversation at your child's next check-up can make sure they get the right prevention. Useful questions include:

• Is my child at higher risk of tooth decay? The answer shapes how often they need varnish and whether sealants are recommended. [7]
• How often should my child have fluoride varnish? At least twice a year from age 3 is the NHS baseline, and more often for higher-risk children. [1] [5]
• Would sealants help when the first permanent molars come through? These usually appear at around 6 or 7. [1]
• Do you offer nurse-led varnish visits between check-ups? This option has been available to NHS practices in England since 1 April 2026 for children aged 16 and under. [5]
• When should my child's next check-up be? NHS.uk says the gap between check-ups "could be as short as 3 months or as long as 2 years (or up to 1 year if you're under 18)." [11]

Prevention at home matters just as much. Our guides to how often you and your children should see a dentist and electric versus manual toothbrushes cover the day-to-day side, and our guide to NHS braces for children explains the next dental milestone many families face.

Frequently asked questions

Are fissure sealants free on the NHS for children?

Yes. NHS dental treatment in England is free for anyone under 18, or under 19 and in full-time education, so sealants cost nothing for most children. Since 1 April 2026 sealants count as Band 2 for charging purposes, which only affects people who pay. Children's NHS dental care is also free in Scotland, Wales and Northern Ireland. [3] [4] [21] [23] [24]

How often should children have fluoride varnish?

NHS.uk says children from age 3 should be offered fluoride varnish at least twice a year, and younger children may have it if the dentist thinks they need it. Delivering Better Oral Health recommends two or more applications a year for higher-risk children, and NHS England's 2026 guidance says at least four times a year for them. [1] [5] [7]

Does fluoride varnish hurt?

Fluoride varnish is painted onto dried teeth with a small brush, and an NHS trust leaflet describes the process as "simple, quick and painless". It takes a few minutes. Afterwards, children are usually asked not to eat, drink or rinse for at least 30 minutes and to eat soft foods for the rest of the day. [17] [18] [27]

What is the difference between fissure sealants and fluoride varnish?

A fissure sealant is a thin plastic coating over the grooves of the back teeth that keeps germs and food out. Fluoride varnish is a high-fluoride coating painted onto teeth to strengthen the enamel. In a Welsh NIHR trial, neither was significantly better at preventing decay after 36 months, and varnish cost the NHS less per child. [1] [12]

How long do fissure sealants last?

NHS.uk says a fissure sealant protects teeth from decay and lasts up to 4 years. In the Welsh Seal or Varnish trial, between 74% and 93% of sealants were still intact after 36 months. Dentists check sealants at routine check-ups and top them up when needed, so keep up with your child's regular visits. [1] [12] [18]

At what age should children have fissure sealants?

NHS.uk says sealants can be placed once a child's permanent back teeth start to come through, usually at about 6 or 7, and again when the rest come through between 11 and 14. In England, they are mainly recommended for children aged 7 to 18 whom the dentist judges to be at higher risk of decay. [1] [5] [9]

Can adults have fluoride varnish or fissure sealants on the NHS?

Sometimes. Delivering Better Oral Health recommends fluoride varnish twice a year for adults at higher risk of decay, especially frail older people with their own teeth. Its sealant advice covers children and young people up to 18, so ask your dentist. In England, adults who pay are charged Band 1 for varnish and Band 2 for sealants. [2] [4] [7] [8]

Is fluoride varnish safe for children?

Delivering Better Oral Health says fluoride varnish is well accepted and safe for most patients. It should not be used in children with ulcerative gingivitis or stomatitis, and colophony-containing varnish is avoided in children with a sticking plaster allergy, or a severe allergy or asthma that needed hospital treatment. Always tell the dental team about allergies and asthma. [8] [17]

Finding an NHS dentist for your child

Sealants and varnish are offered as part of regular dental care, so the most important step is getting your child seen. NHS.uk advises taking your child to the dentist "when their first milk teeth appear, or before they are 12 months old", and then "for regular dental check-ups as advised by the dentist." [1] Our parent's guide to your child's first dental visit explains what to expect.

Finding an NHS place is genuinely difficult in many areas. NHS.uk warns that "You may be asked to join a waiting list before you can get a dental appointment." [29] Our guide to finding an NHS dentist accepting new patients sets out practical steps if local practices are full. When you are ready, you can search for a dentist near you on Dentists Closeby and compare NHS and private practices that see children in your area.

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