Is rapid tooth resorption possible?

Normally I would say no, but yesterday a patient came in with tooth pain under a crown I did three years previously. A bitewing I had taken last October showed nothing extraordinary. It sounded to me that she needed a root canal and I took an X-ray just to check for any other "badness".  I was really surprised to find that below the crown the distal portion of the tooth was missing all the way down to her osseous crest. Furthermore the defect look clean with a "hard" border. Most decaying areas have a "fuzzy" radiolucent appearance and do not exhibit well defined borders. This made me think that tooth resorption might be present, but in my experience this usually is a slow process and not one that causes noticeable destruction in less than 4 months!

I had my patient come back later in the day and I removed the crown and low and behold the defect was full of living hemorrhagic tissue. When I scooped it out with my spoon excavator,the adjacent tooth looked clean and exhibited no decay. It looked a little bit like the caverns made from eons of water flow that cause the tunneling to form.

The tooth's pulp was exposed and had been connected with the hemorrhagic tissue that was removed and I reasoned that this was indeed a type of tooth resorption caused by osteoclastic cells that attack tooth tissue. Was it the internal or external type? I  assume it was internal but I am not sure.  I called my colleague Phil Pack in for a consultation and he agreed that although unusual ,  the defect appeared to be  due to a resorptive process.

In retrospect, probably this had been going on for sometime, but the presence of the crown had hid the process when viewed on a bitewing radiograph and it was only noticeable later on a radiograph when the defect had greatly enlarged.






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