Although the overall caries rate has declined significantly in the past decade, recent studies have shown that caries in occlusal pits and fissures continues to be a significant problem in adolescents and young adults. Radiographic and bacteriologic studies of sealed carious teeth were originally designed to allay the profession's concerns about continued progression of the carious process. These studies have demonstrated that caries is inhibited and may in fact regress under intact sealants. The changes in patterns of caries incidence and the positive results of the sealant studies suggest that alternative approaches to the treatment of incipient or early occlusal caries should be considered. In addition to the radiographic and bacteriological studies of sealed carious teeth, studies on retention over carious pits and fissures, wear, cost effectiveness and changing attitudes of dentists indicate that sealing incipient or early carious lesions is a viable alternative to restoration with amalgam.