A person once visited his dentist and while a routine examination was being done, a hole was discovered at the gum line in his upper front tooth. The dentist informed him that he was dealing with a “root resorption” and that it was not clear whether the could be saved. If you ever receive such a prognosis, it is important to know exactly what you are dealing with.
What is Root Resorption?
Root resorption in adults is a troublesome but uncommon dental condition where the body’s own cells dissolve and eat away the structure of the tooth. It is not a problem for growing children, but it is a natural process by which the roots of a baby’s teeth are removed thus facilitating their replacement with the permanent teeth.
Root resorption in permanent teeth can start on the inside of the tooth also known as internal resorption or it can start outward then work its way inward also known as external resorption. External resorption is the most common of the two.
The effects of cervical or external resorption the patient in the example was describing occurs near the gum line at the cervical region of the tooth. In the early stages, the condition produces pink spots where the enamel has been compromised and filled with pink colored cells that cause the damage. The spots eventually progress to cavity-like areas.
Deposition (adding to) and resorption (breakdown) are normal processes used by the body to maintain balance. It is especially true of bone where it is a response to the usual stressors of tension and pressure. The processes are actually responsible for allowing the orthodontic movement of the teeth to happen. However, once adult teeth form they don’t typically resorb.
The exact nature of external cervical resorption (ECR) is still not completely understood, but several factors can increase the chances of a person developing it. Root resorption can happen in later years if excessive orthodontic force is applied to teeth. Traumatized teeth can equally suffer damage to the periodontal ligament. The ligament attaches teeth to bone and if disturbed can cause resorption.
Habits such as bruxism or grinding of teeth as well as some dental procedures such as the intra-coronal bleaching of teeth can make a person more predisposed to external cervical resorption. However, the majority of people with the risk factors still never develop the problem.
ECR is typically observed in the upper front teeth and on the lower first molars. The condition is painless and can go unnoticed for a while, first appearing as a distinct dark spot on a routine x-ray examination. However, this is rather unfortunate since the longer it stays untreated, the more the damage it is likely to do.
The progression of the damage further results in an erosion of the structure of the tooth’s root with both the inner and outer layers being eroded away. Eventually, the affected tooth appears like it has a cavity. Unlike cavities that are much more common problems, the damaged area (lesion) caused by the ECR does not feel sticky to a dental probe.
Upon the discovery of root resorption, it should be treated without delay to prevent further damage since the destruction can be rapid. However, as the dentist in the example above stated, it is not always possible to save the affected tooth. The treatment method will depend on the progression of the problem when it was detected.
For small lesions, it is sometimes possible to expose the affected portion of the root of the tooth with minor gum surgery. The tissue cells responsible for the damage are removed and a filling material in the color of the tooth usually a glass ionomer cement or composite resin is used for repairing the tooth.
A single-tooth orthodontic procedure is sometimes recommended prior to surgery. With the treatment, the tooth is moved outward from the jawbone gradually. As the tooth moves, the gum tissue also moves along with it, and new bone is built behind. The final contours of the gum line eventually line up and gum recession at the affected tooth can be prevented.
If ECR reaches the area close to the dental pulp, root canal treatment may be needed. The more invasive and extensive the resorption, the less the chances of saving the tooth. Often, in cases of advanced ECR, the better option would be to extract the tooth and have it replaced with a dental implant.
It is not possible to see the extent of the damage sometimes or even determine whether or not extraction is necessary until the root is exposed by surgery. However, Cone Beam Computed Tomography (CBCT) scans are able to identify small anatomical structures inside the tissues in 3 dimensions with much more accuracy than a standard x-ray. CBCT is a high-tech imaging technology that can help increase the accuracy of advanced treatment planning.
Hopefully, this brief explanation has helped you understand more about root resorption. Root resorption might be uncommon, but it can be treated successfully!