What is Pre-Eruptive Intra-Coronal Radiolucency (PEIR)?

This question was submitted by a general dentist: Has anyone seen ‘pre-eruption caries’? I have several cases where radiographically. there appeared to be caries on the occlusal surfaces of unerupted teeth. On eruption, I observed them for a while and after the first one increased in size over time, I went in and restored all of them. All seemed to be carious.

Dr. Anuradha Prakki, Assistant Professor in Restorative Dentistry at the University of Toronto School of Dentistry, provided this quick initial response: 

Researchers identify these cases as pre-eruptive intra-coronal radiolucency (PEIR), as the etiology of pre-eruptive intra-coronal radiolucent lesions is not yet fully understood.  

In definition, PEIR are radiolucent lesions (or defects) located in the coronal dentine, beneath the enamel-dentine junction of unerupted teeth. The prevalence of this type of lesions varies, depending on the type and quality of radiographic exposure as well as the age of the assessed patient. Apparently, 3% of subjects and/or 0.5% teeth may have PEIR.

However, there is consensus that the highest PEIR prevalence is observed in the maxillary and mandibular first permanent molars. Published clinical and histological evidence suggests that these lesions are resorptive in nature.

Based on the little information available on this topic, I would suggest observing the progression of these lesions initially. In case of clear progression teeth should be restored.

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