Is This a Tooth Cavity or Internal Resorption?

Posted by AllSmiles

I’ve seen two dentists in the last three weeks, and both say my tooth has a large cavity inside it. They told me the damage was extensive and said they were surprised I wasn’t experiencing severe pain. After the first dentist showed me the X-ray, I got a second opinion because I had no symptoms, but the diagnosis was the same.

Today I felt throbbing in the gum below that tooth, and I’m concerned it may be getting worse. Both dentists said the tooth could eventually fracture, causing significant pain, so maybe it fractured.

Would it be better to try to save the tooth with a root canal, or should I have it removed and replaced with an implant? The tooth above it already needs an implant because a previous root canal and crown didn’t help, and the post repeatedly fell out. – Thanks. Whitley from Tacoma, WA

Whitley,

A hole that develops inside a tooth is often the result of a condition called internal resorption.

Since two dentists have provided the same diagnosis, you can be reasonably confident about the cause of your symptoms. Internal resorption is a rare condition in which inflammation inside the tooth causes the tooth structure to break down from within. Because the process starts inside the pulp chamber, it can sometimes look very different from a typical cavity.

Can a Dentist Save a Tooth Affected by Internal Resorption?

Many teeth affected by internal resorption can be saved. When a dentist diagnoses it before extensive damage occurs, root canal treatment is often the most conservative approach. Removing the inflamed tissue stops the resorption process and allows the tooth to be restored. Saving natural teeth whenever possible often provides the best long-term function and comfort.

What Factors Affect Treatment Decisions?

The right treatment depends largely on how far the resorption has progressed.

Every case is different, but these are some of the factors to consider:

• The extent of the internal damage
• Whether the root has been perforated
• The amount of remaining healthy tooth structure
• The likelihood of long-term success after treatment

If you’ve had a failed root canal in the past, it is understandable to feel hesitant about repeating that treatment.

When Is it Best to Replace the Tooth?

A dental implant may be the better choice if the resorption has severely weakened the tooth. Also, if the damage extends through the root, treatment becomes more challenging. Even if the perforation can be repaired, the remaining tooth structure may not be strong enough to withstand normal chewing forces over time. In those situations, extraction and replacement with an implant can provide a more predictable long-term outcome.

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