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What Is Hidden Caries?


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First off, what is caries?

Caries, or decay, is always bad news for a tooth. Tooth decay is the softening of your tooth enamel and refers to the damage tooth structure caused by acids that are created when plaque bacteria break down sugar in your mouth. If this loss of mineral from the enamel is left untreated, a cavity, or hole in the tooth, can eventually occur. Without treatment, these holes can grow larger over time and may even destroy the whole tooth.

The plaque acids then eat away at the next layer of the tooth (dentin), and this is when you usually start getting pain, as the dentin is close to the nerve of the tooth. Hot and cold food and drink will then aggravate the nerve, which causes pain.


So, what’s the difference between caries and hidden caries?

But hidden caries is possibly worse than having a normal cavity. We can quite easily see a normal cavity, as it has a distinct appearance, and our dental probe will get stuck in the decayed enamel. Below is a picture of a normal cavity and subsequent filling. The first picture shows the decay in situ; there are darker areas in the fissures, and there is a white, sticky residue where the enamel has broken down. The second picture is where we have entered the tooth to remove the decay, and you can see the dark decayed areas are now into the second layer of the tooth, the dentin. The third picture shows how we’ve removed all the decayed material, leaving all the lovely, healthy tooth in place. The final picture shows the filling that we have put back into the tooth. Much better!

Hidden caries, however, is exactly that; hidden. The decay will be near the surface of the tooth but will have caused little or no damage to the enamel surface itself. But sometimes, there may also only be a small indication of a problem on the surface of the tooth, such as a brown mark or the enamel may appear cloudy.

Caries can also be hidden in the way that we can see that there is caries in the tooth, but there may be much more than we initially thought, and the decay may go further into the tooth than we anticipated. It may look like a small filling, but the tooth may end up needing a large filling because of the amount of decay.

The only way we can really find hidden caries is with an x-ray, and this is why we take them routinely every 2 years to check for hidden issues like this. Obviously, we also check bone levels, existing restorations and the general health of your mouth as well with these x-rays.

What do we see when we carry out treatment on a tooth with hidden caries?

Here is a picture of a tooth that has hidden caries. From the surface, all that you can see is a little tiny dark spot. If you look carefully, you can see that the appearance of the white of the tooth surrounding this dark area is ever so slightly cloudier than the rest of the tooth. This can also be an indicator of hidden caries. It shows that there is something happening underneath the enamel, even though the enamel surface is untouched.
So, we decided it best to do some investigation on this tooth This picture is the initial opening of the tooth. We always try to take away as little of the natural tooth as possible to retain tooth integrity, but as you can see with the dark area in this tooth, the decay is a little deeper than we had hoped.
This picture is after we managed to remove all the decay. So, from that tiny, little brown spot on the picture above, the hole in picture 2 shows how much decay was hiding from us! It’s a good job we decided to investigate after all, as if the decay had spread any further, the patient would have been at risk of needing a root canal treatment.
This picture is the result after we have restored the tooth, and you can’t even tell there’s a filling there!

So this is why we encourage patients to visit us every 6 months. We can prevent little problems like this becoming big problems later. If this tooth had been left, then the patient would have been at risk of needing further treatment.

If you would like to know more about our white fillings, please click here.

If you have any questions or would like to make an appointment, please do not hesitate to call us on 0121 550 6958.

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