Beware of large hidden proximal caries

Community
24 Aug 2017

Hidden caries or “occult caries” as some authors used to describe, are considered an unfully disscused issue in our field.
Teeth that appear sound to your eyes, in fact, may exhibit large decay, so you may reassure your patient during regular periodic check-up while hidden caries continue their way towards the pulp.
Etiology of hidden caries is still unclear, some believe to be related to increased use of fluoride which acts in remineralization masking caries progression, but this is still under inquiry.
Some cases they appear as a pre eruptive process (Pre eruptive intracoronal resorption) (PEIR), which look like a radiolucent lesion in the coronal dentin: prevalence varies from 1.55 to 6 %, resembles dental caries as the developing tooth is encrypted and not likely to have been infected with microorganisms. Pathogenesis of PEIR is unclear till now.
For me, etiology is simple in many cases, hidden caries is a fissural caries that leaves enamel and extends downwards invading dentin.
How to dignose hidden caries?
The best diagnostic tool for hidden caries is Bitewing x-ray, other tools include: visual inspection after compressed air, fiberoptic transillumination in dark room.
 

Fig. 1

Our patient came for anterior refilling of 6 anterior teeth. We finished and did full mouth regular check up.

Fig. 2

We noticed decay shadow through enamel on 24 confirmed by transillumination, so we decided to restore it immediately.
26 was endodontically treated with metallic post 3 years ago and stood still.

Fig. 3

Rubber dam in place.

Fig. 4

Drilling through enamel.

Fig. 5

TorVm sectional matrix was used with basic ring in place.

Fig. 6

Distal wall build up.

Fig. 7

After rubber dam removal.

Fig. 8

the right side (same patient) had
hidden caries on 14.

Fig. 9

Rubber dam again.

Fig. 10

Surprisingly we found large hidden decay in neighbouring premolar!

Fig. 11

Restored.

 

Conclusions

Early detection of caries is paramount for oral care, prevention of pain & infection and extensive treatment.

Bibliography