Objective To explore the effect of family-community-school closed-loop oral nursing combined with early aesthetic pit and fissure sealant intervention on dental aesthetic scores in children with high caries risk. Methods A total of 100 children who received pit and fissure sealant treatment at Xiqing District Zhongbei Town Community Health Service Center from October 2021 to June 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 50 children in each group. The control group received conventional oral nursing and conventional pit and fissure sealant intervention, and the observation group received family-community-school closed-loop oral nursing combined with early aesthetic pit and fissure sealant intervention. The dental caries rate, dental aesthetic score, oral hygiene compliance and sealant retention status were compared between the two groups. Results The new incidence of dental caries and the rate of recurrent tooth defect in the observation group were lower than those in the control group (P <0.05). After intervention, the dental aesthetic score, total oral hygiene compliance rate and complete pit and fissure sealant retention rate of the observation group were higher than those of the control group (P <0.05). Conclusion Family-community-school closed-loop oral nursing combined with early aesthetic pit and fissure sealant intervention can effectively reduce the incidence of dental caries and recurrent tooth defect rate in children with high caries risk, improve dental health status and aesthetics, and enhance children’s long-term self-management ability of oral hygiene, which has favorable clinical application value.