Tooth resorption is a biological process where specialized cells called odontoclasts break down and absorb parts of the tooth structure, including the dentin and cementum. While this is a natural function for shedding baby teeth, its occurrence in permanent teeth is pathological, signaling damage or irritation. The process can progress silently, often without pain or noticeable symptoms, making early detection difficult without professional dental imaging. Modern dentistry, however, has developed targeted diagnostic tools and treatment protocols aimed at halting this destructive progression and saving the affected tooth.
Understanding the Types of Resorption
Resorption is primarily categorized as internal or external, based on where the process originates within the tooth structure. This distinction is important because the location of the damage determines the diagnosis and the appropriate treatment strategy.
Internal resorption begins within the pulp chamber or root canal space and progresses outward. This relatively uncommon type is caused by inflammation or infection inside the pulp tissue, which triggers the body’s resorptive cells. If the process is extensive, it may cause the tooth to display a pinkish discoloration, sometimes referred to as a “pink tooth,” due to the proximity of the vascularized resorptive tissue to the enamel.
The more frequently encountered type is external resorption, which starts on the outer surface of the tooth root. This process is initiated by damage to the periodontal ligament (PDL) and the protective cementum layer. External cervical resorption (ECR) is a particularly aggressive subtype that starts near the gum line, often leading to deep, destructive lesions.
Common Triggers and Contributing Factors
The initiation of pathological resorption in permanent teeth requires damage to the protective layers of the root, allowing odontoclasts to begin their destructive action. One of the most common causes is significant trauma to the tooth, such as an impact injury or a dental accident. This physical damage can injure the periodontal ligament, triggering an inflammatory response that leads to resorption over time.
Another significant factor is chronic infection or inflammation, such as untreated pulpitis or long-standing periodontal disease. Bacteria and their byproducts can stimulate the inflammatory reaction, leading to the activation of the resorptive cells. Furthermore, excessive pressure from orthodontic tooth movement can also initiate external resorption, especially at the root apex. Certain dental procedures, like internal bleaching, have also been implicated as a potential trigger for external cervical resorption.
Treatment Approaches for Stopping Damage
The primary goal of treating tooth resorption is to completely remove or inactivate the tissue causing the destruction and then repair the resulting defect. The treatment method chosen depends entirely on the type and extent of the resorption identified. Advanced imaging, such as Cone Beam Computed Tomography (CBCT) scans, is often necessary to precisely map the three-dimensional extent of the damage before treatment.
For internal resorption, the standard and highly successful treatment is root canal therapy. This procedure involves accessing the pulp chamber, removing the inflamed and resorbing pulp tissue, and cleaning the internal space to eliminate the source of the destructive cells. Once the process is stopped, the space is sealed with a filling material. In some cases, a temporary intracanal medicament, such as calcium hydroxide, is placed to ensure the resorptive activity is fully arrested before the final filling.
External resorption, particularly the aggressive external cervical type, often requires a more complex surgical approach. The procedure involves surgically lifting the gum tissue to fully expose the external defect on the root surface. The fibro-osseous resorptive tissue is physically removed from the defect using specialized instruments. After the area is thoroughly cleaned, the defect is repaired and sealed using a biocompatible material, most commonly Mineral Trioxide Aggregate (MTA).
MTA is favored for its ability to seal the defect and its capacity to promote the healing and regeneration of surrounding tissues. If the external lesion has already communicated with the internal pulp space, a combined treatment is necessary, involving both surgical repair of the external defect and root canal therapy. When the tooth structure is too compromised, extraction becomes the only viable option. Following extraction, the tooth can be replaced with options like a dental implant to restore function and aesthetics.
Long-Term Management and Prevention
Successfully stopping tooth resorption is followed by active long-term management to monitor for healing and prevent recurrence. Routine follow-up appointments include periodic radiographs to confirm that the resorptive lesion has fully healed and the destructive process has not reactivated. Clinical and radiographic success is defined by the absence of symptoms and the appearance of bony fill-in around the previously damaged area.
Preventive measures focus on minimizing the known triggers that initiate the condition. Wearing a custom-fitted mouthguard during contact sports is recommended to protect teeth from traumatic injuries. Following any dental trauma, immediate evaluation by a dentist is necessary because timely intervention can mitigate the inflammatory cascade. During orthodontic treatment, careful monitoring and controlled force application are important to minimize the risk of pressure-induced root damage.