This case was submitted by Dr. Matt Gilchrist
An 11 year-old presented to my office in December 2013 for a routine recall examination. The right bitewing revealed what appeared to be gross decay on the 1-4 occlusal. Upon further review of the bitewing from last year, it was noted that this exact same lesion had been present since the tooth first erupted into the child’s mouth (sorry, no picture, as we were not digital at that time). The tooth has been symptomatic, and a PA was taken which was within normal limits. Clinically there was no evidence of gross decay, no shadow / halo, not even a detectable pit.
I decided today that it would be best to investigate this a bit further, so I thought that I would prepare through the enamel to see what was happening. It turned out that there was gross decay undermining the buccal cusp, which then lead to a pulp exposure (roughly 1mm in diameter). The pulp appeared to be in good health, therefore I made the decision to do a direct pulp cap with Dycal, followed by a RMGIC base, and finally a resin restoration. The tooth is still immature, and I feel that it might have the ability to heal from this procedure. I have informed the child’s parents that a future root canal is most likely.
I am wondering how a caries could be this extensive on a tooth that has only been present in the mouth for a short time. As mentioned above, it has looked like this since last year when the tooth first erupted and the child was 10 years old.
Would this be your treatment of choice? Would you have initiated a pulpectomy?