Internal Resorption

Question:

“I have a terrible toothache triggered by cold food and drinks and only lasts for a few seconds. My dentists says he can’t find any[thing] wrong clinically and my xray comes out fine. It’s been 2 weeks now and now one tooth is discoloring, turning slightly purple. Pain is not going away when I [eat] cold foods and drinks. What could it be and how can I treat it?? Plz help…”

Answer:

A tooth that is sensitive to cold is a very common dental complaint. A toothache triggered by cold drinks or food usually indicates that there is some kind of inflammation occurring.  Tooth inflammation occurs as the body’s way of trying to fight a stimulus or anything that can cause injury (such as untreated tooth decay). In so doing, inflammation is an attempt by the body to initiate a repair. Inflammation can occur at the beginning of tooth decay, or later on as a reaction to untreated tooth decay.

Causes of Tooth Discoloration

If the process of tooth decay is not suspected, a number of factors may be identified as reasons for tooth discoloration. These include:

• Tooth discoloration after trauma (after a fall for example)
• Discolored teeth due to medication (some antibiotics may cause this)
• Tooth discoloration caused by treatment of diseases (head and neck radiation and chemotherapy can be a cause)
• Discolored teeth due to internal resorption.

What is Internal Resorption

A discolored tooth that has pink spots or is generally pink/purplish is usually an indication of internal resorption. The process of internal resorption essentially involves a disappearance of the normal pulpal tissues from the center outwards.

Causes of Internal Resorption

Although it is unclear what causes internal resorption, it can be the result of many factors, including:

• Trauma
• Decay
• Removing part of the pulp
• A cracked tooth

Internal resorption generally has no symptoms. If there are symptoms, there is most likely a connection of the internal resorption to the periodontal ligament. The periodontal ligament is the structure that surrounds the tooth and holds it in the socket. This channel results in a combined internal-external resorption.

Treatment of Internal Resorption

Internal resorption by itself is usually asymptomatic and successfully managed by root canal therapy, and the likely outcome is usually good. Recall visits are usually necessary because the resorption can recur.  Where there is a channel that connects the periodontal ligament and the internal resorption, it must be closed off. Tooth resorption symptoms of this nature include sensitivity to cold.  The likely outcome is more questionable when there is a channel/communication.  Internal resorption or a combined internal-external resorption is not uncommon to dental professionals. Patient history is very important in order to establish a proper diagnosis and treatment management.

Please refer to your dental professional immediately for comprehensive evaluation and treatment.

Hopefully this was helpful to you!

Save My Smile Team

Toothache Got Cha Down?

Tooth pain is definitely a sign of bad things to come if not treated properly.  Please do not ignore these signs!!  It’s best to find out a cause early on then wait until it’s too late to be saved.  The first question to ask yourself is, what type of pain is it?  The type of pain can tell you a tremendous amount of information as to the next step in treatment.

Type of pain

• Brief, short pain
• Pain when eating or drinking cold food/liquids or exposed to air
• Long lasting pulsating pain
• No sensation/tooth discoloration

Brief short pain:

If the pain only occurs occasionally, such as when drinking cold liquids, this is a sure sign of reversible pulpitis.  Depending on the extent of bacterial invasion and condition of tooth structure, this condition can usually be treated with pulp cap.  The good news is that the pulp of the tooth can likely be saved.

Long lasting pulsating pain:

Long lasting lingering pain is usually indicative of irreversible pulpitis.  This means the bacteria has invaded the tooth’s pulp and, depending on the extent of invasion, the entire pulp or portion of the pulp may have to be removed.  If the amount of bacterial invasion is extensive, or if a substantial amount of tooth structure has been destroyed, the tooth may have to be extracted.  The treatment options for irreversible pulpitis include:

• Extraction
• Pulpotomy/Pulpectomy
• Root Canal Therapy

No sensation/tooth discoloration:

If you noticed a major discoloration of the tooth in question, necrotic pulp is probably the culprit.  This means the pulp of the tooth is dead.  If the pulp is dead, the tooth is dead and it needs to be removed.  If substantial tooth structure remains, the dentist may be able to retain the tooth by performing root canal therapy.  The only treatment for necrotic pulp is extraction or root canal therapy.

Keep in mind that a series of tests must be performed by the dentist before a diagnosis can be reached.  Tooth pain can also indicate a fractured root, impacted tooth, gum disease, or even problems with the temporomandibular joint.  So, if you experience any type of pain with a tooth or any structure in your mouth, be sure to contact your dentist as soon as possible for the best possible treatment options.