Oral diseases are progressive, cumulative, and become more intricate to treat with advancement. While dental caries is an infectious transmissible disease with children being at the highest risk, primary prevention can reduce this risk. Primary prevention in dentistry is usually considered to be community fluoridated water supplies, professional fluoride treatments, and pit and fissure sealants. While community fluoridated water supplies have been proven to be cost-effective, the cost-effectiveness of pit and fissure sealants has primarily been studied in school-based programs of children from low socio-economic backgrounds. Dental sealant programs are just one way to help increase primary prevention in the oral health disparities of children. The purpose of this paper is to review the literature regarding the cost-effectiveness of pit and fissure sealants as a preventive strategy in preventive dentistry.