Jurnal Bitewing
Jurnal Bitewing
Jurnal Bitewing
ISSN: 1806-7727
[email protected]
Universidade da Região de Joinville
Brasil
de Paiva Bertoli, Fernanda Mara; Marques da Silva, Bruno; Dalledone, Mariana; Losso, Estela Maris
Hidden caries' challenge diagnosis: case report
RSBO Revista Sul-Brasileira de Odontologia, vol. 10, núm. 2, abril-junio, 2013, pp. 188-192
Universidade da Região de Joinville
Joinville, Brasil
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ISSN:
Electronic version: 1984-5685
RSBO. 2013 Apr-Jun;10(2):188-92
Corresponding author:
Estela Maris Losso
Rua Professor Pedro Viriato Parigot de Souza, n. 5.300 – Campo Comprido
CEP 81280-330 – Curitiba – PR – Brasil
E-mail: [email protected]
1
School of Dentistry, Positivo University – Curitiba – PR – Brazil.
Received for publication: December 1, 2012. Accepted for publication: December 20, 2012.
Abstract
Keywords:
dental caries; bitewing Introduction: Hidden caries is a term used to describe occlusal
radiograph; diagnosis. dentine caries that is missed on a visual examination, but is large and
demineralised enough to be detected by another exam for example,
radiographs. Case report: This article reports a case of large dentine
caries, which presented as to be a small pit-and-fissure carious lesion
on the occlusal surface of the right mandibular permanent first molar
in a 10-year-old girl. The treatment included root canal treatment and
the sealing of the cavity with composite resin. Conclusion: Careful
visual examination, with cleaning and drying of teeth, associated to
bitewing radiographs may improve occlusal caries detection. Dentists
should examine bitewing radiographs carefully for proximal caries
and occlusal demineralization. Radiographs are an effective method
of caries diagnosis that can avoid large destruction and allows less
invasive treatment.
clinically undetected occlusal dentine caries (hidden [1, 14, 17]. However, dentists seem to be resistant in
caries) in a group of 8-10 year-old children before and adopting these new caries detection and treatment
after public water supply and dentifrice fluoridation and modalities [18].
the results indicated that fluoride is not responsible
for the increase in hidden occlusal caries [6]. Many
dental practitioners find hidden caries when they start Case report
to intervene operatively into what they suspect is a A 10-year-old girl was referred to pediatric
small carious lesion, revealing instead an extended dentistry clinic at Positivo University with complaint
carious lesion that is well into dentin [4]. of toothache. No relevant medical history was
Dental caries management demands detection reported during t he a na mnesis. A fter toot h
of carious lesions at an early stage. In the last 30 prophylaxis, the clinical examination showed that
years the diagnosis of occlusal caries became more she was at mixed dentition with caries cavities in the
complex and many authors believe that it is possibly teeth #55 and #65. A large pit and demineralization
due to the increase in the use of fluoride [3, 14]. in the occlusal surface was observed in teeth #36
It has been widely reported that the prevalence and #46, although these teeth appeared healthy
of occlusal caries is significantly underestimated (figure 1). Bitewing radiograph revealed rizolysis of
by clinical examination alone [6], and there is no teeth #55 and #65 and a large radiolucent area in
“gold standard” in the caries detection [12]. Besides the coronal dentin of the tooth #36 affecting the
that, complex occlusal fissure morphology, lesion pulp tissue (figures 2 and 3).
extension and nature of the lesion can lead to
misdiagnosis, and frequently dentine lesions are
detected on bitewing radiographs [9]. Nevertheless
this type of examination is not totally effective and
recent studies have been done and other methods,
beyond the traditional (visual inspection aided
by compressed air, tactile examination with a
dental explorer and radiographic examination) in
caries detection have been developed. The most
current methods and devices are: alternating
current impedance spectroscopy technique (ACIST),
computer-aided radiography (CAR), dental digital
radiography (DDR), digital imaging fiber-optic
transillumination (DIFOTI), DIAGNOdent, diagora
image plate system (DIPS), diode laser fluorescence
(DLF), electrical conductance fixed frequency (ECFF),
endoscope filtered fluorescence (EFI), qualitative
light-induced laser fluorescence (QLF), visualix high- Figure 1 – Clinical view of left mandibular permanent
definition imager and intra-oral sensor technology first molar
Figure 2 – Initial bitewing radiograph revealing a carious lesion in the left permanent mandibular first molar and
the rizolysis of the primary maxillary right second molar
Bertoli et al.
190 – Hidden caries’ challenge diagnosis: case report
Figure 3 – Periapical radiography showing the presence of an extensive radiolucent area affecting the coronal pulp
tissue of the left mandibular permanent first molar��
First of all, the patient was anesthetized, and rubber dam isolation was performed. Access to the carious
lesion was made using a diamond bur in a high-speed with water irrigation. Dentine caries removal was completed
by hand and rotary instruments and the pulp tissue was exposed and removed (figure 4). The root canals were
cleaned, dried and filled (figure 5). The coronal cavity was restored with glass ionomer cement (figure 6).
Figure 4 – A) Rubber dam isolation; B) Total caries lesion removed and pulp exposure
Figure 6 – Immediate restoration with glass ionomer cement performed in the left mandibular permanent first molar
5. Diagnosis and Management of Dental Caries primary dentition with and without bitewing
Throughout Life. NIH Consensus Statement Online. radiography. Australian Dental Journal. 2009
2001;18(1):1-24. Mar;54(1):23-30.
6. Hashizume LN, Mathias TC, Cibils DM, Maltz 12. Nyvad B. Diagnosis versus detection of caries.
M. Effect of the widespread use of fluorides on Caries Res. 2004 May-Jun;38(3):192-8.
the occurrence of hidden caries in children. Int J
13. Pereira RF, Gomes RH, Volpato LE. Occult �������
Paediatr Dent. 2012 Feb;20:1-5.
caries lesion: restoration using the occlusal matrix
7. Hopcraft MS, Morgan MV. Comparison of technique. �������������������������������
Rev INPEO de Odontologia. 2008
radiographic and clinical diagnosis of approximal Jul;2(1):1-76.
and occlusal dental caries in young adult
population. Community Dent Oral Epidemiol. 14. Strassler HE, Porter J, Serio CL. �������������
Contemporary
2005 Jun;33(3):212-8. treatment of incipient caries and the rationale for
conservative operative techniques. Dent Clin N Am.
8. Latta MA, Naughton WT. Bonding and curing 2005 Oct;49(4):867-87.
considerations for incipient and hidden caries.
Dent Clin N Am. 2005 Oct;49(4):889-904. 15. Thompson VP, Kaim JM. Nonsurgical treatment
of incipient and hidden caries. Dent Clin N Am.
9. Mestriner SF, Pardini LC, Mestriner WJ. Impact 2005 Oct;49(4):905-21.
of the bitewing radiography exam inclusion on the
prevalence of dental caries in 12-year-old students 16. Yang J, Dutra V. Utility of radiology, laser
in the city of Franca, São Paulo, Brazil. J
������������
Appl Oral fluorescence, and transillumination. Dent Clin N
Sci. 2006 Jun;14(3):167-71. Am. 2005 Oct;49(4):739-52.
10. Mount JH. Defining, classifying, and placing 17. Zanardo A, Rego MA. Occlusal caries diagnosis
incipient caries lesions in perspective. Dent Clin in permanent teeth: an in vitro study. Ciênc
N Am. 2005 Oct;49(4):701-23. Odontol Bras. 2003 Jul-Sep;6(3):50-7.
11. Newman B, Seow WK, Kazoullis S, Ford D, 18. Zandoná AF, Zero DT. Diagnostic tools for early
Holcombe T. Clinical detection of caries in the caries detection. JADA. 2006 Dec;137(12):1675-84.