Wednesday, July 12, 2006

Tooth Internal Resorption

Sometimes the pulp of a tooth gets irritated either by a trauma or a deep cavity and undergoes internal resorption. The cells of the pulp get all "riled" up and the pulp begins to resorb the tooth structure from the inside out. This is sort of like a little pacman eating away any tooth structure in front of it. It's the same process that happens when a new permanent tooth moves up under a baby tooth. Osteoclastic activity slowly begins to dissolve the root of the baby tooth till it's about gone. That's when the baby tooth gets loose. Well, you really don't want that to happen to a tooth from the inside out; especially a permanent tooth. It is rare, but I have seen this most often with baby teeth that have had a history of a large cavity. Most teeth do very well after a restoration, but a few can get internal resorption. It can happen with teeth that have sustained a trauma as well. In a baby tooth, it may not need treatment or it may even need to be removed depending on a lot of factors. It doesn't uaually cause any discomfort. If it's a permanent tooth, it may need a root canal to stop the process as shown here in an x-ray I found on the internet.

34 comments:

Jason said...

Hi Dr Dean,

My 8 month old baby had a trauma on his half erupted (actually more like 10% erupted) tooth yesterday.

There was some blood and he cried for a couple of minutes and show no further irritation. But his gums became bruised and slightly swollen after a couple of hours.

Would this accidently likely cause serious complications like Internal Resorption, Abscess, or hopefully just slight discolouration?

Pls advise, thanks a lot!

Dr. Dean Brandon said...

Probably no big deal, but get it looked at to make sure.

Liz said...

Hi Dr Dean

I have had two molars removed due to internal resorption, now a front tooth has been found to be too severly resorbed to be treated and will also have to be removed. What can I do if anything to protect my remaining teeth?
Thanks

Dr. Dean Brandon said...

Hmm that does not sound good does it. I would ask your dentist to observe things closely and perhaps things can be delt with sooner rather than later, so that things do not get out of hand.

danie24 said...

Hi Dr. Brandon,

My 2 year old daughter fell about 3-4 weeks ago and her central incisor was knocked inwards toward her palate. I moved the tooth back into place immediately after the accident, and she has been on a soft, monitered diet ever since as it is still slightly mobile. After about 2 weeks it started to discolor and is becoming more brown each day (much to my dismay). Her dentist x-rayed the tooth a week ago and it seems to be ok so far. No signs of infection or resorption. We will be following up with him again in 2 months for another x-ray. At what point would you feel it was ok to have the tooth treated for the discoloration? Is there a time frame that you recommend waiting before touching the tooth? Obviously I would wait until the tooth has totally stablized, but assuming all remains well, what would you recommend? What treatment usually yields the most aesthetic outcome? Are there any possible negative side effects of treating the tooth?

Also, in the event that an abcess should develop or some resorption begins, I have heard that baby root canals post-trauma are often unsuccessful. I would really hate to have the tooth extracted given her young age...what would you recommend?

Dr. Dean Brandon said...

You may want to read my post on:

My Child's Tooth is Turning Dark!

Dee Daniels said...

Dr Dean,

My 4 year old son fell on a step and had trauma to his two front top teeth. I took him in to his dentist and had a X-ray done that indicated that one was broken all the way across under the gum and the other was really loose. The one that is loose but not broken has started to turn beige. It has been a week since the incident and we went in today for a follow-up and was informed that both teeth would need to be extracted and was given the option to have pediatric partials put in.
I would like to know what your thoughts are regarding extraction versus having the teeth come out naturally.

Bombed out mom!

Dr. Dean Brandon said...

Upper front baby teeth usually fall out naturally around 7 to 8 years of age. So, that is why we often recommend treating these teeth. You may need to read my posts on "decay in two year olds teeth" and "fake baby teeth-pedo partial", etc.

Tina said...

Hi Dr. Dean,
My sons tooth fell out this morning and in its place was a red protruding thing. I don't know what it is and don't know if it is harmful. My son is upset and I don't know how to comfort him because I don't know what it is. If you could give me the correct termonlogy that would be helpful. Thankyou, Tina

Dr. Dean Brandon said...

Tina, that sounds pretty common to me--I see something like that when baby teeth fall out--usually just the remaining pulp and gum tissue. If it's that it usually resolves in a few days.

chris said...

Dear Dr. Dean, My 13 year old recently had a regular dental check-up. One of the xrays showed tooth resorption on a lower mandibular molar. There is no external decay on this tooth. In fact, she has never had a cavity and does not have gum disease. We were referred to an endodontist. She has had braces for the past 18 months and just got them off 2 months ago. What causes tooth resorption? Can it happen in her other teeth? How can it be prevented? How can it be treated? Any information you can provide would be helpful. - Thanks - chris

Dr. Dean Brandon said...

There is Internal resorption (as per this post), and then there is External resorption that can be caused by any number of things including trauma or caries. It can even be caused by orthodontic treatment (it is a side effect that sometimes occurs from moving teeth. It does not mean the orthodontist did anything incorrectly, it's just the way the body responds in some patients)--Sometimes this needs to be treated, sometimes it does not. Treatment is usually a root canal.

princess said...

my 10 yrs old daughter when for her 6 months evaluation, no visual cavities, when they took the xrays, they found 3 white spots inside her molars, her father lost his molars at different times because he didn't know he had cavities until had lots of pain and they all had cavities, they were never on the outside, doctor is going to do fillings on her.why do this happend?is it hereditary? can she take something to prevented it? Thank you

Dr. Dean Brandon said...

Cavities sometimes are initially visible only on x-ray. Cavities are caused by a bacteria--read more here about cavities etc.

Robyn said...

Hi Dr. Brandon,

My almost 3 year old daughter accidentally banged her tooth into the picture moulding in our dining room on April 30th. It bled around the top of the front left tooth initially, and her lip blew up and went away after a week. Then, her front left tooth turned grey and a month 1/2 later it turned back to close to normal color in the front (a little yellow), but underneath it's still dark. The dentist thinks her root is shortening a little and says there is danger to the permanent tooth and wants to do a root canal with no crown. I want to leave it alone, since it's not bothering her and looks fine. Would that be ok, or is that endangering her permanent tooth? She said the root canal would take 30 minutes and she would take out the nerve and she won't notice that she doesn't have feeling anymore, and it would save the tooth.

Dr. Dean Brandon said...

Whenever a tooth is bumped and turns dark (see my post on Baby tooth turning dark). it could abscess. One sign of an abscess can be visible on x-ray. If a baby tooth is abscessed, the usual treatment is removal. Rarely, an asymptomatic dark tooth with evident abscess can be treated with a baby tooth root canal, etc, but that's pretty rare. If a tooth is truly abscessed the priority is protecting the permanent tooth in addition to eliminating infection and symptoms. If a dark tooth looks ok, feels ok and shows no sign of a problem on x-ray, we usually observe it.

Robyn said...

Hi Dr. Brandon,

Thanks. I got a 2nd opinion today and they basically said what you wrote.

The x-rays don't show an abscess, but a black line above the root of the tooth that is probably showing the tooth becoming loose and knocked a little out of the socket from the trauma, which should tighten up in 2 months, 3 months after the trauma. She will return for a check-up in 2 months for another x-ray to see how it's doing. I think what you're saying is that once a tooth abcesses, there may be internal resorption and and an eating away at the root, but my daughter does not have an abscess, so I think she's ok for now.

Christy said...

My 5-year old came downstairs, excited that she had her first loose tooth. Except that it was one of the teeth she's not supposed to lose until about age 12 ... sort of like a pre-molar. The dentist x-rayed it and although there is no sign of a cavity, the tooth is almost entirely black inside. He called it resorption. Said the root is still embedded but that the crown has loosened and may break off, so he'd have to go in and dig out the root. What causes this? She has never had any trauma that we know of, nor any illnesses. Should we be watching or concerned for other teeth? We have her scheduled for lab work at her doctor's just to check everything out. Thanks in advance!

Dr. Dean Brandon said...

Sometimes I see molars getting loose prematurely. If they said it was internal resorption, that can be caused by reaction to a cavity, trauma, or sometimes for no apparent reason. I have also seen it on un-erupted teeth as well. I have a post somewhere on that like, can you get a cavity on a tooth before it is erupted. One baby tooth doing something like that does not seem too weird to me. The main dental problem with loosing a baby molar prematurely is space maintenance for the new teeth.

James said...

Dr. Brandon, I have found your answers to the best available on the internet. We have some REALLY strange things going on in our kids. My 8 year old has hypodontia and is missing 6 teeth (lateral incisors and premolars). We just found out today that both deciduous incisors have resorption. One tooth has internal resorption and the other has both internal and external resorption. Obviously, there is not a permanent tooth to replace these. Hypodontia does not run in either of our families and I am worried about a possible auto-immune disorder. Honestly, I am just grasping for any answers to why this is happening. None of this makes any sense and I was hoping you could provide some insight. Thank you so much for all that you do!

Dr. Dean Brandon said...

You may want to read my post on congenitally missing teeth somewhere over there in the all posts list. I see missing teeth every week. Multiple missing teeth can be associated with syndromes but 90% of what I see are not.

Dr. Dean Brandon said...

Oh on the internal resorption. I do wonder because when I do see strange things it seems that other teeth are prone to the same problem. I do not recall any auto immune conditions that we gave ever pinpointed.

Elle said...

My 7yo son had an abscessed molar extracted today. It had internal reobsorption. He is seeing an orthodontist to have a holding arch put in. The orthodontist has said all of his teeth have some level of reobsorption and premature root loss. He will probably lose all of his molars too soon. Is there anything I can do to help save my son's developing adult teeth? No one else in our family has had any problems like this.

Dr. Dean Brandon said...

I very much doubt the same condition would occur on the permanent teeth.

Kristen said...

I have a 24 month old, we found she had baby bottle carries in may, in her front 4 teeth. Since then we have made several appts to get the nusmile crowns, twice the dr has rescheduled, and once she got to sick to go; evrrtime we make an appt, we usually have a month wait. We went today to have them done, finally, and we weren't able to because the two outer ones where to bad and said would need extraction. She referred me to a specialist who does all this kind of stuff. She says if it was her, since the two middle teeth also have decay on them she would extract them as well. Would it be possible to extract just the outer ones and put a nusmile crown on the two middle ones? Or would full extraction be better? I have read your other blog on the partials, if all 4 have to be extracted would a partial be a good replacement, not really for cosmetic purposes, but more for eating and for speech. As of right now she doesn't talk.

Dr. Dean Brandon said...

Partials for front baby teeth are only for looks. Having upper front teeth removed does not affect speech. I do not reccomend them for eating or speech. Crowns are ok if indicated (doctor can determine). Partial or fake teeth tend to look fake and the partial teeth may look a little different than crowns (which actually are fake too but just cover the tooth.). I have cases where we removed all four with no problems. Still we generally give the option to restore if possible. Good luck.

Anonymous said...

Is referral necessary? 7 Yo female with distal cervical resorption of A. #3 clinically present with mesial marginal ridge equal height of A's distal marginal ridge. Proximal contact of 3 and A intact and caries free. Right side class II. In my area a specialist trip is 60 miles or greater (often times I am able to schedule government transportation for families in need). Is this pt best served by a pedo or ortho eval or cab this be monitored at recalls for tooth A symptoms?

Dr. Dean Brandon said...

What you have described sounds a lot like ectopic eruption of the upper permanent 1st molars causing premature resorption of the distal root of the primary second molars. I see this frequently especially in crowded cases. If the six year molar erupts into occlusion and the primary molar (A) is asymptomatic, I usually just observe it. Each case is different. It's more complicated if the permanent molar gets stuck up under the primary molar or causes premature loss of the primary molar.

The resorption of primary roots is a normal process. However, the permanent tooth that is supposed to dissolve the primary roots of that tooth is not the permanent molar. The permanent molar erupts too far mesially (forward). It can be complicated and difficult to treat. I always advise seeing a pediatric dentist, but you can see what I have commented.

Anonymous said...

Hello Dr. Dean,
Thank you for your informative website. I have a puzzling six year old son...he now has his third and fourth molars loose and ready to come out (these are all his first molars on each side). In the last few months he has lost two others due to internal absorption. He has not ever had any dental trauma or caries. He has since also lost a front top and bottom tooth. The permanent teeth do not appear to be ready to erupt...not even in the front. A blurry pano X-ray appeared to have permanent teeth there but low. I have taken him to two local dentists and no real answers or plan of action. Spacers have been mentioned as a possibility. Not sure what we will do when the poor child has no teeth left!
One dentist thought it may be genetic although no other known dental concerns with family. Feeling really helpless and frustrated. He also has a rare visual impairment, so we are searching for many answers. Any insight or advice would be greatly appreciated!

Dr. Dean Brandon said...

Well there are variations on tooth exfoliation that fall within the range of normal. I have seen some kids with early loss of primary teeth with no consequence. Still, there are some conditions which might bear further investigation. I would suggest seeing a Pediatric Dentist (specialist) if you haven't already. Sometimes it does not matter as far as the teeth, so long as it can be managed with space maintainers, etc. Other (sometimes serious) conditions might be better detected with a blood test or other tests a pediatrician can have done. I would suggest further investigation by both of them.

Hope said...

My 5 year old daughters lower front baby tooth developed a pink spot on it. The dentist said nothing was wrong. I swore it was getting smaller and pinker. And it is! It's pretty loose, but now I'm really concerned. She has never had a cavity. What should we do? Will all of her teeth do this?

Dr. Dean Brandon said...

In baby teeth with internal resorption I usually just observe to see if it continues to the point removal or some kind of intervention is warranted. Most of the time it does continue--sometimes you can do a baby root canal but that is not common.

Misstindal said...

My daughter lost her first tooth about a week ago and now I see a little small bump well it looks like maybe it's a tad swollen and red where the tooth came out. I also see the big tooth coming peeping through the gums behind this swelling. Is this normal???

Dr. Dean Brandon said...

Sounds normal to me. If it does not resolve after a few weeks, I'd get the pediatric dentist to look.