Root Resorption
What is root resorption?
Resorption is the process of breaking down or dissolving tissues and the term is often used to describe the dissolving of hard tissues. Although this is a rare phenomenon in adults, root resorption in children is natural and enables the roots of baby teeth to dissolve so that permanent teeth can serve as replacements.Resorption is not an autoimmune disease or cancer. There are many types of resorption and it can be a very complicated subject.
Although there is a lot that is not known about Resorption, it is important to understand that almost all resorption occurs from these specialized cells doing their normal job, but in an abnormal location.
Resorption v. Decay
Root resorption is similar to decay in that it results in a destruction of the hard substance of a tooth. That are also similar in that the location, the extent, and accessibility are generally the factors in determining whether or not the tooth can be saved.
Decay is caused by bacteria that dissolve the tooth, whereas resorption is facilitated by your own body’s cells. Decay usually occurs on the visible surfaces of the tooth, where as resorption occurs in the roots which are submerged deeper into the surrounding gums and bone.
What does root resorption look like?
It is most common for root resorption to begin on the outside of a tooth near the gum line and work its way inward in a process called external cervical resorption (ECR). Pink spots are a common indicator that ECR is taking place. The eventual effects appear as holes, or cavity-like areas, at the gum line of the tooth.
Not nearly as common as ECR, internal resorption begins in the root of the tooth and is often due to chronic pulp inflammation. Because resorption is usually asymptomatic, most patients are unaware of their condition until well into the resorption process.
Different Types of Root Resorption
Resorption is generally divided in to 2 main categories – internal and external. As the names imply, internal resorption occurs from within the tooth, where as external occurs on the outer surfaces of the tooth. A Cone Beam CT scan is an invaluable tool for determining the type, location, and extent of the resorption. It has greatly improved the accuracy is assessing resorption and whether or not a tooth should be saved. Assessing resorption was previously much more difficult, uncertain, and may have even required exploratory surgery.
Internal Root Resorption
Resorption initiated on the inside of the tooth by an inflamed pulp. Severe cases of internal resorption can peforate the surface of the tooth leading to a guarded prognosis. Root canal therapy can often stop internal root resorption by removing the pulp.
External Root Resorption
External is a more complicated category of resorption with many subtypes, but odds are if you have referred to a specialist to evaluate resorption, it it because of “external or cervical resorption”. The formal name for this resorption type is Extra-Canal-Invasive-Resorption (ECIR) and. Most dentists are reporting seeing an increase in the number of ECIR cases. One problem with ECIR is that it is very difficult to detect in its early stages. This is because there are typically no symptoms until the later stages, and because it can be very difficult to see on x-rays.
Frequently Asked Questions
We often do not know the cause of root resorption in permanent teeth, but there are several factors which could act as contributors. Pressure and tension are normal stressors that can lead to breakdown in tissue, so years after excessive orthodontic force, a tooth may experience resorption. Likewise, trauma to a tooth may damage gum ligaments, resulting in the beginnings of resorption. Extreme teeth grinding and tooth-bleaching have been found to initiate resorption as well. The good news? Most patients with these risk factors never go on to develop any indicators of root resorption.
If the initial pink spots on the tooth’s enamel are spotted and treated in time, no further dental care should be necessary. If, however, the enamel has experienced enough damage that cavities have resulted, root canal therapy may be needed. Extraction and dental implant procedures are required in the rare case that decay has affected the tooth pulp.
Since resorption is usually asymptomatic, detecting its presence in the initial stages isn’t always easy. Nonetheless, early treatment is crucial when it comes to saving the tooth, and as endodontists, our primary concern is to save your natural teeth. Call us at the first sign of root decay or resorption, so we can safely and gently provide you with the best possible care for maintaining your oral health well into the future.
Surprisingly, no. Root resorption is generally asymptomatic. If you are experiencing pain, another cause is the culprit, and we encourage you to call us today to schedule a consultation.