Ask The Dentist: Occult caries in children an eerie phenomenon

Dentist Lucy Stock of Gentle Dental Care in Belfast fills us in on how teeth can sometimes grow already rotten on the inside

Occult caries tend to affect young children, so treating them can be a challenge
Occult caries tend to affect young children, so treating them can be a challenge Occult caries tend to affect young children, so treating them can be a challenge

CAN a child’s teeth grow in rotten? Quite frankly, yes – teeth can erupt into the mouth with huge holes in them. They are called “occult” caries.

Even for dentists this is an unusual phenomenon. But, clear as day, you can see teeth that have just erupted into the mouth or are even buried below the gum that have large holes in them on the X-rays. When you look at these teeth in the mouth they look completely normal as all the enamel is still intact. Sometimes the first sign that anything is amiss is when the child complains of toothache.

Occult caries can affect about 2.2 per cent of molar and premolar teeth. There are even examples of eye teeth growing in with this type of defect.

Dental caries refers to a bacterial infection that causes destruction of the teeth. It continues to be the most prevalent infectious disease in the world. But if bacteria cause decay, how can a tooth suffer from “occult” caries in a tooth that is protected by the gum and encased in the jaw bone? This question has not been solved yet; we simply don't know why these teeth are developing like this.

However, when treating these teeth, you don't find traditional decay; it's just a big hole below the enamel, filled with debris. The tooth looks like it is dissolving from the inside out.

Occult caries should not be confused with enamel hypoplasia, brown dented enamel, which is due to the enamel not forming properly.

When the teeth grow with occult caries, it can be equally distressing for the child and the parents. Parents often feel distressed that their child is in pain and feel guilty, as if it’s something they have done or not done to cause this. However, this is nothing to do with how often the teeth are cleaned or anything in the diet – it’s more a developmental issue.

Treatment of these occult teeth can include placing one of the new special regenerative temporary dressings to encourage the tooth to heal itself. If the tooth settles down then later on a filling can be placed to rebuild it.

In other circumstances the tooth may need a root treatment to save it or it may have to be removed to relieve the pain. Bearing in mind that occult caries tends to affect very young children, treating these teeth is a challenge.