What Is Tooth Resorption?

Tooth resorption is when the immune system breaks down a tooth, essentially eating away at it. This causes the tooth to be non-restorable, indicating extraction. 

While tooth resorption isn’t common, it happens from time to time.

Resorption can occur in both adult and primary (baby) teeth, but it's normal and not usually harmful in baby teeth. Without the normal resorption of baby teeth, they won’t fall out easily and make space for the adult teeth to erupt. 

Types of Tooth Resorption

Tooth resorption can typically occur in three ways: internal, external, or combination. 

External Resorption 

External resorption occurs from outside the tooth, where the cementum is located. 

It’s common and has three main classifications (depending on the appearance of the X-ray and clinical symptoms):

1. Inflammatory external resorption is when chronic resorption occurs (usually after trauma or surgery).
2. Surface external resorption is usually limited to the root surface and is a transient condition that may heal on its own. 
3. Cervical external resorption is located at the cervical area of the tooth, rarely affecting the pulp. It usually occurs from prolonged trauma.

Internal Respiration 

Internal resorption is much less prevalent than external resorption and occurs from the inside of the tooth. 

It is typically asymptomatic, and most patients are unaware of the condition until an X-ray is taken. It occurs from blunt trauma or from a previously done deep filling that irritates the nerve. 

An X-ray will show dark spots inside the tooth's pulp where the resorption occurs.

What Causes Tooth Resorption?

Resorption has numerous causes, but the most common occurs after a trauma or dental surgery. 

Other causes of tooth resorption include the following:

• Chronic teeth grinding
• Consistently bleaching the teeth with teeth-whitening products
• Rapid orthodontic treatment
• An untreated cavity or a chronic dental abscess

According to the American Association of Endodontics, the location of trauma (or damage to the tooth) and its supporting structures determine the type of resorption. 

How is Tooth Resorption Diagnosed?

Tooth resorption is diagnosed through dental X-rays and a clinical examination. Here's what you can expect:

Dental X-rays

X-rays like bitewings or periapical radiographs can be used to diagnose tooth resorption.

Sometimes it’s difficult to determine the type of resorption, which is important in determining the best type of treatment. In these cases, a 3D Cone Beam X-ray can better visualize the condition.

Clinical Examination

A clinical exam for resorption may include a visual inspection or both a visual and an endodontic examination. Pulp exams may be used during your visit. This exam uses hot and cold temperature changes to examine the tooth.

What are the Symptoms of Tooth Resorption? 

Many people don’t report pain when first diagnosed with tooth resorption. However, this depends on the severity and the location of the resorption. 

For example, some people notice sensitivity if the resorption is near the root surface. Other common symptoms include: 

• Brittle and loose teeth
• Holes in the teeth
• Unusual spaces between teeth
• Gum inflammation
• Pain all around the tooth or root

Most people are completely unaware that they have tooth resorption until it becomes a severe condition. Resorption is usually diagnosed during a routine X-ray when dark spots are found around the tooth root.

How to Manage Tooth Resorption

Tooth resorption is managed by preserving the affected parts of the tooth. 

If an external factor causes resorption, sometimes treatment is needed. This may include a night guard or removing an orthodontic appliance. 

Depending on the severity of resorption, several types of dental treatment are available to preserve the tooth, including:

Root Canal Treatment

Endodontists can place calcium hydroxide for younger teeth with immature roots to limit the amount of root resorption. The goal is to stop the progression of root resorption and allow it to continue to form normally.

Gum Surgery

If the root is completely formed, it usually requires a surgical endodontic procedure to remove harmful, damaged cells so the resorption does not continue. 

Dentists sometimes perform a small surgery to remove the damaged cells for teeth that show early resorption. A root canal and crown can help preserve the natural tooth for more severe cases.

Tooth Extraction and Replacement With a Dental Implant

In cases of severe root resorption, the tooth may need to be extracted and replaced with a dental implant. This is the most effective way to restore the function and aesthetics of the affected tooth.

How to Prevent Tooth Resorption 

To prevent tooth resorption, you must do the following:

• Brush and floss regularly 
• Maintain a healthy diet to avoid tooth decay
• If you play any contact sports, wear a mouthguard to prevent trauma
• If you grind your teeth, talk to your dentist about a night guard to help protect the teeth from damage
• Visit your dentist for routine visits, so X-rays and proper clinical examinations can be performed

Early diagnosis of tooth resorption can help avoid long-term dental problems. If your dentist notices any signs of tooth resorption, they may want to see you sooner for follow-ups and monitor the tooth for any changes. 

Summary

Tooth resorption is when the tooth structure is damaged or destroyed. There are different ways to manage tooth resorption, but it's best to prevent it in the first place. 

If you notice any signs of tooth resorption, make sure to see your dentist immediately so they can diagnose and treat it as soon as possible.