Background: Dental sealants have been shown to be effective in reducing caries by 80%, however, not all children are at risk of developing caries and therefore it is more efficient to seal the teeth in those children at high caries risk. This was an examination of the relationship between patient and dentist characteristics and the application of sealants. Methods: This study utilized claims and administrative data from a large dental managed care organization in Minnesota. Sealant placement was a covered benefit in the study period. This study was conducted using the data from 6173 children 6 years of age between 1995 and 2006 who had dental encounters with either a general or pediatric dentist and no prior record of receiving a sealant. They all had an assessment of their level of caries risk (low, moderate or high) at age 6. Sealant placement within 6 months of the caries risk exam visit served as the dependent measurement. Results: There were 73 general dentists represented in the study but only 3 pediatric dentists. However, the pediatric dentists had about 20% of the encounters. About 22% of patients were seen by a female dentist and the medium age of the dentist seen was 45. Sixty-two percent of children were deemed at low caries risk and 15% and 23% were at moderate and high risk. Logistic regression analysis predicting 6-month sealant application found higher sealant application rates among children at high or moderate risk (OR 1.89, P<0.0001; OR 1.54, P<0.0001) and female children (OR 1.39, P<0.0001). General dentists were more likely to apply sealants than pediatric dentists (OR 1.94, P<0.0001) even though pediatric dentists were almost twice as likely to rate patients at high risk (38% vs. 20%, P<0.0001). Younger dentists (under age 55) were more likely to apply sealants (OR 1.21, P=0.0483). Conclusions: It is encouraging to see that children at moderate and high risk of developing caries are more likely to be sealed than children at low risk. This is not consistent with earlier studies but may be related to the complete coverage of sealants in the study population. The observation that pediatric dentists see more high risk patients but are less likely to seal may relate to different practice patterns or could be an artifact of the small numbers of pediatric dentists in the study. The reduced sealant rate for older dentists may be related to earlier dental school training not encouraging sealant use.