Pre-eruptive caries by Dr. Ian McConnachie
Dr. Suham Alexander, Oasis Clinical Editor, interviewed Dr. Ian McConnachie, pediatric dentist at Woodroffe Pediatric Dentistry
Dr. Ian McConnachie is a pediatric dentist practicing in Ottawa as well as on staff at Children’s Hospital of Eastern Ontario. He is currently the consulting editor for the YourOralHealth.ca magazine of the Ontario Dental Association and member of the Editorial Board for Ontario Dentist. Dr. McConnachie is a member of the Expert Panel of Reviewers and Advisors of the Journal of the Canadian Dental Association.
In the summer of 2008, Dr. McConnachie participated as a speaker at a symposium on Designing Dental Programs for High-Risk Children, held as part of the annual meeting of the International Association of Dental Research. Since then, he has published extensively in the dental literature and is a nationally recognized speaker on issues in pediatric dentistry and access to care. He has a lengthy involvement on improving access to care for less advantaged populations and advancing the acceptance and benefit of risk-based care in dentistry. Dr. McConnachie continues to work on committees with numerous Canadian dental organizations and is a Past-President of the Ontario Dental Association.
Listen to the full audio interview (21 mins)
Review two Cases Presented by Dr. McConnachie
Interview Key Messages
Could you please describe for us what pre-eruptive caries are?
The term has been applied to pre-eruptive teeth seen radiographically where there is a radiolucency within the crown of the tooth. Histologically and clinically, it has a very different pattern than the classic caries.
What is the frequency of occult caries?
The literature mentions 2 to 6% of the population experiencing pre-eruptive caries. My personal experience has been much less than that.
Do you think water fluoridation plays a preventive role?
- It begs the question of whether or not the frequency of seeing pre-eruptive caries is related to water fluoridation.
- Two studies in the Netherlands compare two communities: the non-fluoridated community had a higher incidence of pre-eruptive caries.
Are pre-eruptive caries more prevalent in certain populations or areas?
That is a big question mark. There isn’t sufficient information to make any conclusions. However, it is most likely to be seen in the pediatric-adolescent-teenage population and less commonly in the adult population.
What are some of the differential diagnoses for these lesions?
The differential, if anything, is the etiology behind these lesions as opposed to what the clinical entity is. My suspicion is that there are a couple of different clinical entities; we don’t have enough histological information about that yet.
What is the CANARY system?
- CANARY is a diagnostic system for developing decay. It is what I consider the gold standard in devices to be able to assess development of decay and quantify that decay process.
- The pulsating laser diagnostic system both for pit and fissure surfaces and smooth surfaces allows to assess and quantify the demineralization process of decay down to a depth of about 5 mm of penetration so it is an internal analysis tool as opposed to a surface analysis tool.
Is there a call to action for dentists?
- Take a look at the radiographs a little bit more carefully.
- Look more carefully at pre-erupted teeth to assess if any lesions are starting and which need to be monitored.
- Intervene at appropriate intervals.
- Make sure you’re watching carefully if you’ve chosen not to intervene.