Q&A With Dr Emma
Hello Dr Emma. My dentist has advised that my 5 year old girl has deep grooves in her teeth and that this may impact on her needing fillings. Have you heard of this before? Also, is it necessary to have fillings in baby teeth as they fall out anyway? She has a healthy low sugar diet by the way. Thank you! Ewa from Yeronga (QLD)
Deep grooves in the biting surfaces of teeth is a common thing. It's not a problem in itself, but deep grooves are hard to clean and easily accumulate plaque. This makes them a high risk area for decay to start, which would then lead to the need for fillings. Even with a good diet, a spot on a tooth which is constantly covered in plaque can start to decay just from the natural sugars found in fruit.
One way of tackling deep grooves is to clean them out, then fill them up using a thin layer of tooth-coloured filling material. This procedure is known as a "fissure sealant". The end result is a much shallower groove which is far easier to clean at home. We have good evidence that fissure sealants work; a review from 2009 shows that in kids, permanent molars with fissure sealants get half as much decay as those without.
Fissure sealants are more commonly done in permanent teeth than baby ones, but there's no reason it can't be done in a baby tooth if the child is capable and willing to sit still. If it's done before the teeth start to decay, there's no need for the injection of local anaesthetic or to drill any tooth away, so it's a very comfortable and non-threatening procedure. Most children who are happy to sit still for a dental examination will be happy to sit still for a fissure sealant.
If baby teeth start to decay, it's really important that they are treated appropriately. If a decaying baby tooth is on the verge of falling out, it's fine to let it be and wobble it out normally. However, some baby teeth aren't replaced by their permanent successors until around age 12, so if they start to decay before they are due to naturally fall out they can quickly become a problem. A decayed baby tooth will eventually become painful and infected, ending in an abscess. That's something nobody wants for their child. There's also additional problems which can be caused by the early extraction of a baby tooth before it's due to fall out naturally. Have a look at my article "Baby teeth are important too" for a bit more light reading on the topic.