Q: I had a healthy natural tooth with no fillings or any dental work on it. The other day half the tooth just broke away leaving a tender red, bulging stump that hurt anytime anything touched it. The doctor took an x-ray and one look at the tooth and said it needs to go! He said I had a very rare condition that did not quite understand. Can you help me out on this one? What do I have?
A: So this guy walks into the doctor’s office to go over some tests results. The physician says: “Arthur. I have good and bad news.” The patient asks for the good news first: “The good news is you have one month to live.” The patient exclaims: “Wow. What’s the bad news?!” The doctor replies sadly: “It’s February.”
You likely have what is called internal resorption and a pulp polyp. (A classic dental board exam question and a great topic for after dinner conversation at chez Josephs when my son (Dr J. Jr.) is town. Better after dinner, as these conversation can get a bit graphic and gory.) We don’t know what causes these issues. They could be from a small crack that goes unnoticed for months or years. An x-ray will not pick it up. The trauma seems to set up an inflammatory process that eats away the tooth form the inside out. Like the old arcade game Pacman at Stella’s Pizza on Long Island.
Internal resorption is an uncommon resorption of the tooth, which starts from the root canal and destroys the surrounding tooth structure.
A pulp polyp, also known as chronic hyperplastic pulpitis, is a “productive” (i.e., growing) inflammation of dental pulp in which the development of granulation tissue is seen in response to persistent, low-grade mechanical irritation and bacterial invasion of the pulp.
These conditions hollow out the tooth which leads to fracture like a raw eggshell. Here, once again, the internet is wrong: The web states:” It is easy to control the process of internal root resorption via severing the blood supply to the resorbing tissues with conventional root canal therapy.”
I cry “foul” (or B.S.). These teeth have a guarded prognosis at best. Don’t throw good tooth- money after bad tooth- money. It is often better to remove them and replace them with a dental implant.