Hidden Caries: A Case Report of a 17 Years Old Male with Two Afected Mandibular Premolars 320 doi 10.17796/1053-4625-43.5.3 The Journal of Clinical Pediatric Dentistry Volume 43, Number 5/2019 Hidden Caries: A Case Report of a 17 Years Old Male with Two Afected Mandibular Premolars Haifa A Alkhodier */Shahad N Abudawood **/ Kevin J Donly*** Hidden caries is the term used to describe carious lesions that are not visualized clinically on erupted teeth but can be detected radiographically. The exact etiology remains an area of controversy. The purpose of the current case report was to discuss the diagnosis and treatment of two mandibular premolars with hidden caries. After diagnosis was established, both premolars were treated with indirect pulp caps and resin-based composite restorations. A one year follow up appointment revealed both teeth to be free from signs and symptoms of infammation. Keywords: caries, eruption, resorption * Haifa A. Alkhodier, BDS, MS, FRCD(C) is an Associate Consultant in Pediatric Dentistry at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia, an Adjunct Assistant Professor in the Department of Developmental Dentistry, School of Dentistry, at the University of Texas Health Science Center at San Antonio (UTHSCSA), a Pediatric Dentistry Fellow with the Royal College of Dentists of Canada. ** Shahad N. Abudawood, BDS, MS, Former Clinical Assistant Professor in the Department of Developmental Dentistry, School of Dentistry, at the University of Texas Health Science Center at San Antonio. Currently, she works as a Pediatric Dentist at a Private Practice in San Antonio, TX, USA *** Kevin J. Donly, DDS, MS, Professor and the Chair of the Department of Developmental Dentistry , School of Dentistry, at the University of Texas Health Science Center at San Antonio. Send all correspondence to: Haifa Alkhodier Department of Developmental Dentistry- UT Health School of Dentistry 7703 Floyd Curl Drive MC8118. San Antonio, TX 78229-3900 Phone:+966-504456094 E-mail: alkhodier@livemail.uthscsa.edu INTRODUCTION C arious lesions on non-smooth surfaces are usually detected by visualization and tactile sensation using an explorer. Radiographs are used to determine the progression of such lesions into the dentin 1 . The description “hidden caries” was frst used in 1986 for dental caries that is completely diferent from the classical lesions in nature 2 . The term that was used is occult caries. “Hidden/Occult” caries is defned as any occlusal lesion that can’t be visualized on the enamel surface, however can be seen clearly on routine radiographs as radiolucencies in the dentin layer 3,4 . The prevalence of such lesions was found to be from 2.2% to 50% of permanent molars 3 . It’s been reported in premolars 5 and in primary molars as well 6,7 . The exact etiology of ‘hidden caries’ remains a controversy. Some theories have been suggested including defective enamel and its specifc microbiology and the use of fuoride 3,4,8 . Hidden caries is thought to be initiated in one of the following areas: at the fssure’s entrance, near the fssure’s base or on its walls 9 . A study reported that Streptococcus mutans and lactobacilli were found in the lesions. Thus, it’s been suggested that they have the same microbiological profle as classical carious lesions 10 . One of the theories suggested that hidden caries is a consequence of fuo- ride use and “Fluoride bombs” or “fuoride syndrome” were used as terms to describe occult/hidden caries 2 . This theory was based on the belief that fuoride remineralizes early enamel lesions which makes it look intact. However, the disease process progresses in the dentin 11- and appears as radiolu- cency in the dentin during radiographic examination. On the other hand, the association between fuoride exposure and the prevalence of hidden caries in two diferent cities in the Netherlands was investigated. The city with the optimal fuo- ridation system had a 31% lower prevalence of hidden caries 13 Another theory hypothesized that hidden caries is the same as pre-eruptive intra-coronal resorption lesions 3 . This was based on the fact that some studies reported that patients with hidden caries had the same lesions prior to teeth eruption. This was confrmed when old radiographs of the same patients were re-examined 14 . Additionally, when newly erupted intact teeth with caries like lesions in the radiographs were examined histopathologically, resorption was detected in the enamel and dentin which is highly suggestive that hidden caries has been present prior to eruption as pre-eruptive intracoronal radiolucency 7 . Downloaded from http://meridian.allenpress.com/jcpd/article-pdf/43/5/320/2467818/1053-4625-43_5_3.pdf by guest on 14 March 2024