Bleeding Gums: What It Means and When to See Your Dentist
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?
Lisa
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.
Dr. B
how do I tell if the resorption is inactive? I had a little accident when I was 10 that resulted to tooth trauma. It was only after 19 years when I started to notice the slight discoloration of my tooth. It wasn’t aching, and there is no tooth movement. Should I leave them as it is? What would be the long-term effects of this?
Hi I am 15 years old… 5 years ago I suffered an accident where a swing knocked my tooth out. The whole root came out so the dentist I went to put it back in. 5 years later which is now I began to have really bad pains and an abscess occurred above the tooth. This is my front left tooth… I went to an Endodontics which he told me my old dentist was supposed to give me a root canal 7 days after he put it back in but that never happened… They tried ever 3 months to drain the infection and fill it with medicine and seal it. Finally this happened last month… They told me there’s nothing they can do for me it’s in resorption because it’s leaking stinky stuff and smells and is turning grey in the back. This hurts really bad. Every dentist keeps saying I can’t get an implant because I’m too young?
Hi, and thank you for the article.
I have been diagnosed with root resorbtion in 2nd incisor (top), the one on right side. I’ve never had trouble with incisor teeth, and this is new to me. The tooth looks healthy, same colour as the others. It isn’t loose. But on the X ray I see it has a small ‘black’ area at one side where I guess there is no root left. The dentist also says there is NO root canal there! He says the nerve is dead, but I can feel the tooth just like the others, when I bite on it or touch it and it hasn’t changed colour.
He says the only option as he can’t do a root canal treatment is to take out the tooth. Then he says I’d have to wear a denture for months no matter if I decide to have an implant there or a bridge, because the other teeth would spread if I don’t.
I can’t bear the idea of having to wear a ‘plate’ in my mouth. It would drive me nuts. I just know.
So I asked him what will happen if we just leave that tooth? So far (8 months later) nothing has happened to it, and it hasn’t loosened or anything. He’s not really in favour of me leaving it for fear it will get infected. He said as it has no nerve I wouldn’t know if it got infected (?) And if that happened I would need a bone graft, I feel I probably would know about it pretty quickly -but obviously would like to avoid infection as I take antibiotics very badly, with the exception of Amoxycillin which I can just about tolerate!
But so far, no problem with it. I know I could get an implant but am scared in case the implant fails, plus it will cost me over two thousand (British) pounds. It’s so invasive too, and I’m a bit of a wuss when it comes to all that.
My body says ‘leave it alone’. My head says maybe I should do something to get it fixed….I cannot decide about it.
Louise if you decide to have the tooth removed ask your dentist about an essix retainer with a fake tooth or a snapon smile instead of the denture (hopefilly he/she is actually referring to a flipper for your temporary instead of a denture which would only cover part of the roof of your mouth). There are othe options too that can be done. We can sometimes extract the tooth, place an implant and put a temporary on the implant the same day!
Hope this helps! Dr kory blythe
Hi Louise
I’ve just had mine extracted following an abscess and infection. The pain of the infection was horrific! 2 different antibiotics and pain killers for 5 days and it didn’t ease it at all.
I’d have it out. It’s not going to get better. I’m having a bridge done as mine is near the front too and can be seen.
Good luck with your decision x
What toothpaste would you recommend for tooth resorption?
Hi Linda:
Unfortunately there is no toothpaste that can have an effect on tooth resorption. This phenomena occurs inside the jawbone and inside of the tooth, both areas that are not exposed to the application of toothpaste.
drb
Hi Linda:
Unfortunately there is no toothpaste that can have an effect on tooth resorption. This phenomena occurs inside the jawbone and inside of the tooth, both areas that are not exposed to the application of toothpaste.
drb
Hi Linda:
Unfortunately there is no toothpaste that can have an effect on tooth resorption. This phenomena occurs inside the jawbone and inside of the tooth, both areas that are not exposed to the application of toothpaste.
drb
What could possibly cause resorption other than trauma? Ibuprofen? Synthroid? Listerine?
Hi Linda:
Unfortunately there is no toothpaste that can have an effect on tooth resorption. This phenomena occurs inside the jawbone and inside of the tooth, both areas that are not exposed to the application of toothpaste.
drb
Hi Linda:
Unfortunately there is no toothpaste that can have an effect on tooth resorption. This phenomena occurs inside the jawbone and inside of the tooth, both areas that are not exposed to the application of toothpaste.
drb
Hi Linda:
Unfortunately there is no toothpaste that can have an effect on tooth resorption. This phenomena occurs inside the jawbone and inside of the tooth, both areas that are not exposed to the application of toothpaste.
drb
Hi Linda:
Unfortunately there is no toothpaste that can have an effect on tooth resorption. This phenomena occurs inside the jawbone and inside of the tooth, both areas that are not exposed to the application of toothpaste.
drb
how do you get over the fear of going to the dentist with out medication to clam you when you had a bad experience at a prior dentist.
I am a 60 year old healthy woman recently diagnosed with resorption on my front tooth. I also wonder how on previous X-rays there was no clue until my dentist noticed a pink gum. I was basically rushed to the endodontist who took various X-rays and panoramic. She sent me onto the periodontist who performed gum surgery. Now I’ll get a root canal and then crown with post. I think they want to do something to match the other front tooth with the new crown. The whole thing has made me depressed. Can I never eat a bagel again? Will this start happening in other teeth? Does the course of treatment seem proper? Thank you.
What did the dentist say caused your resorption?
He said it’s kind of rare but just happens. I’m a mess. I had to wait for My gum surgery to heal before I can proceed and all the specialists made me so nervous not to bite or brush my front tooth. I’m so paranoid it’s just going to crack. I was lucky my hygienist caught it.
I have resorption in my front tooth. I’ve already had periodontal gum surgery to prep for my root canal next week and then onto post and crown, which seems to be the best path. My question, is, do you think the tooth could just fall out before I finish treatment. All the professionals have made me so nervous about biting and I feel like I’m beginning to see some kind of film, perhaps the eroding. Will it survive the 2 weeks before I can get to the temporary crown?