Question: Hi Dr. B, I am currently facing extraction of two teeth in the smile zone and implants. The teeth developed internal resorption. I have been a faithful attendant to my teeth all my life — checkups twice a year. I am now 55 years old. I saw the dentist in April, no problem. I returned in July to check out an odd sensation and was told I will have to lose two teeth.
Here’s my question: was my dentist negligent? He had taken bitewing x-rays in April which didn’t show the front teeth (#6 and #7). My last full mouth x-ray was 2008. Should he have taken full mouth x-rays since? How could he miss this problem?
Given my experience, am I right to advise my friends to be sure they have full mouth x-rays more frequently? How should I manage my tooth resorption?
Answer: Hi Lisa, First, a little background information on tooth resorption: [/answer]
Tooth resorption is when part or all of a tooth’s structure is broken down when the body begins to remove mineralized tissue.
Internal or external resorption to the teeth is somewhat common. For you, Lisa, it probably occurred after a bump to the front teeth or aggressive orthodontics as a child. I have some external resorption of my own front teeth.
Resorption often requires extraction of the teeth, which you mention, but not always, which I’ll get to in a bit.
Regarding your dentist taking x-rays of the front teeth, I’m not too concerned. I don’t think your dentist was negligent. Bitewings are the most frequently taken x-ray since that’s the area where cavities occur most often. Since you want to identify cavities when they’re small, we take bitewing x-rays more frequently than full mouth x-rays.
The reason for not taking full mouth x-rays more frequently is that dentists always have to consider how much radiation they are exposing their patient to versus the chance that the x-ray will reveal a problem. As a dentist, I’m always considering how much radiation I’m exposing my patients to and want to keep it as minimal as possible. Obviously, x-rays are necessary in many circumstances, but I wouldn’t want to do an x-ray and expose my patient to radiation needlessly.
In terms of extraction of those teeth, here’s the question I would ask my dentist if I were you: What would happen if you left the teeth in place? As always, get a second opinion and compare the answers you get.
Resorption is typically occurs over a long period of time and can be observed in five year increments to monitor how it’s changing. If the teeth are a little loose and the resorption is inactive, meaning they haven’t changed position in the last five to ten years, then I’d leave them. Occasionally, resorption can be very aggressive and happen very quickly.
If the rate of resorption has not changed, then I would do nothing. If the teeth are very loose and affecting your chewing and you’re in pain, then that’s a different story.
To recap, find out if the resorption is active. My own resorption isn’t active and I’ve been able to live with it for twenty years without extracting the teeth. Don’t load the teeth heavily — don’t chew on ribs or bite into an apple, use your cuspids and back teeth for chewing heavier foods.
Hope that helps, Lisa. Let me know what happens.