It is not easy to detect hidden dental caries in a routine examination with a mouth mirror and a dental explorer. The appearance of the teeth can be normal looking with no cavities or holes visible. Even when a sharp explorer probes the teeth for cavities, the explore can feel no sticky pits or fissures. Caries, however, are hidden underneath the naturally occurring grooves, pits, and fissures of teeth. Caries can also hide in the areas in contact with the adjacent teeth, rendering them difficult to detect visually and physically.
The hidden dental caries can be existing even before the tooth has erupted. The cases in that caries already existed below the enamel surface before the tooth erupted are called pre-eruptive intra-coronal resorption (PEIR).
The key is early detection and treatment of hidden caries since the outer surface of enamel may appear intact on tactile and visual examination.
There are several ways to detect hidden dental caries. The first thing to do is clean the teeth of plaque, stain, and tartar to improve visual and tactile examinations. The other thing that the dentist can do is to use fibre-optic transillumination light as a diagnostic tool. An intense light is shone into the tooth, and the void below the tooth surface could be visible as a dark area underneath the translucent structures of enamel and dentin. Another technique is using a fluorescence-based caries detection system that projects high-energy blue light onto the tooth surface. Light of this wavelength stimulates bacteria to fluoresce red, whereas healthy enamel fluoresces green. Finally, the gold standard to detect hidden caries is a careful examination of good quality bitewing radiographs of the teeth.
Once the hidden caries are detected, they should be removed and restored as soon as possible to prevent further cavitation of the teeth. The traditional flora of cavity-causing bacteria is found inside caries, namely the Streptococci mutans and Lactobacilli species. If untreated, the cavity will enlarge and advance into the pulp of the teeth, and thus bacterial flora can infect the vital pulpal tissues, then pain and swelling will ensure. Once pain and swelling happen, the only options would be to remove the tooth or perform endodontic treatment. When these events happen, the patients may need bridges, crowns, root canals, implants, and partial dentures.
When the cavities are detected, and the pulps are not involved, treatments should be performed as soon as possible. After the tooth is anesthetized, the tooth to be treated will be isolated with a sheet called a rubber dam (made with nitrile). The decay is carefully removed until all the caries is gone, the cavity was then disinfected, and then a white filling composed of composite resin is used to fill up the void.
If the fissures and pits found on the teeth are deep and prominent but no caries extended into the underlining dentin, they are called the sticky fissures or pits. Simple sealant restorations should restore those situations to prevent extension into the underlying dentin.
Early detection is the key to minimize the chance of infection of the teeth that results in extraction or root canal treatment. The progression of caries can be very rapid, so we encourage patients to visit us every six months. We can prevent minor problems like this from becoming big problems later.
Call Affinity Dental Care at 289-861-5111 to arrange for an appointment to have your oral examination done.