The prevalence of clinically undetected occlusal dentine caries in Scottish adolescents

Abstract

During the third examination of a 3-year anti-caries dentifrice study, bitewing radiographs were read to detect occlusal, as well as approximal caries lesions in 2623 subjects aged 14-15 years. These analyses showed that 1.4% of 2107 upper molars and 7.2% of 2288 lower molars (P less than 0.001), previously scored as clinically 'sound', were carious at a radiographic Grade '3' score (dentinal involvement), and 0.2% had radiographic pulpal lesions. However, for teeth which had been deemed as having a 'suspicion' of caries clinically, but which a 0.6 mm blunted probe would not enter, 29.1% of lower molars had definite radiographic evidence of dentinal caries as compared to only 7.6% of upper molars (P less than 0.001), and a further 0.5% exhibited pulpal extension. In addition, 23.9% of lower premolars also showed dentinal involvement in this group. Overall, 12.1% of lower molars and 3.1% of upper molars showed definite radiographic evidence of occlusal caries in the absence of a firm clinical indication. Thus, the use of bitewing radiographs would appear to be a most helpful adjunct to clinical caries diagnosis, not only of approximal lesions, but also for the detection of early occlusal caries, in these days of generally available topical fluoride.

An investigation into the use of bitewing radiography in children in Greater Glasgow

“…5 It was concluded that, even with a trained clinical examiner and optimum conditions, hidden caries was a major problem when no radiographs were exposed. While there is some risk to patients and staff when using ionising radiation, this risk can be reduced through proper training, use of appropriate films and radiographic equipment, and continued professional development to ensure radiation protocols are up-to-date and being implemented efficiently.…”

Enamel cracks. The role of enamel lamellae in caries initiation

“…12 Clinically undetected occlusal caries has been reported by a number of authors. 13,14 With the decrease in caries incidence in some geographical areas, occlusal caries beneath pits and fissures now forms a higher proportion of the total caries experience so that 'hidden caries' beneath intact surfaces has come into prominence, attracting the names fluoride syndrome and fluoride bomb. 15- 18 Weerheijm et al found in a group of 6-18 year olds that 15 per cent of the first and second molars judged clinically sound exhibited bite-wing radiolucencies and that these hidden lesions occurred in children with low DMF scores."…”

Diagnosis and management of unusual dental abscesses in children

“…59 The terms 'hidden caries' or 'occult caries' refer to the fact that such lesions are thought to have originated as carious lesions, and have eluded discovery during clinical examination. [60][61][62][63] On the other hand, the terms 'fluoride bombs' or 'fluoride syndrome' suggest that fluoride is an aetiological factor 64,65 (Fig 7a). This theory states that fluoride has encouraged remineralization and the slowing of caries process in the surface enamel, masking the cavitation which progresses in dentine.…”