Tooth Resorption

By February 3, 2019Family Pet Veterinary Blog

As described in a
recent post, dental
conditions are often hidden and painful. The following posts are
going to help describe conditions that pets can get as well as
treatment. Many people I talk with are surprised how we can help pets
with dental conditions and save teeth whenever possible.

Whole books could be
written on tooth resorption (TR) alone.

Periodontal disease
and tooth resorption are the two most common diseases in cats. Tooth
resorption in cats has many names – kitty cavities, FORL, and more.
The prevalence has been reported in different age groups ranging from
20-100%. One can say for certain that it is more prevalent in cats as
they age (typically age 5+). One study showed 69% of mixed breed cats
age 10+ had tooth resorption and 100% of pure bred cats age 10+ did
as well. In the same study only ~ 20% of these patients had these
findings on awake visual exams. Another study showed 2.4 times as
many TR lesions were found on x-ray as compared to clinical exams.

Here’s an awake
finding that is certain to have a painful process:

This one is similar
and can be found awake but is more easily missed:

The x-ray of this
site under anesthesia:

Revealing a focal
‘black’ spot of tooth (inflammatory tooth resorption) and loss of
architecture of the root on the left (replacement resorption). A
modified extraction technique (MET) can be used for the root on the
left so that the remaining parts are below the gingival margin, but
the root on the right must be removed in entirely or will continue to
cause problems. Fragments of roots not having replacement resorption
(aka retained tooth roots (RTR)) will not resorb. Tooth resorption
is a painful often hidden disease usually happening along with
periodontal disease. It is important to ensure your veterinarian uses
intraoral radiographs or detailed 3D imaging for all cat dental
procedures, as TR is not confined to the crown, but in fact, is a
generalized recurring process. As stated above, due to the increased
incidence of tooth resorption when inflammation is present, when you
treat TR through extraction of teeth you slow the recurrence.

Some cats have
canine teeth that are being extruded:

It is important to evaluate the whole mouth with intraoral x-rays in all of these cases as there is a significant correlation between extrusion of canine teeth in cats and tooth resorption. Other symptoms one may see on awake oral exam are buccal bone expansion (BBE) – this is enlargement of the bone usually surrounding the canine teeth in cats. (Green arrow)

83% of BBE biopsy
sites showed tooth resorption, another reason to ensure cats have the
entire mouth evaluated with intraoral x-rays as well as probing for
periodontal health measurements. Cats with tooth resorption can also
have inflammation in the back of the mouth (caudal stomatitis):

This condition is painful and medical therapy alone will not solve the problem. Check out the stomatitis blog post to learn more.

In some cases, tooth
resorption in cats and dogs are similar, but more likely they are

Dogs are more likely
to get external root resorption:

This condition is
the exception to the extract right away rule. This type of resorption
tends to not be painful until it involves the pulp (but then it’s
no longer external root resorption) or extends above the gumline.
Should probing depths or tooth contour become abnormal, extraction
then becomes needed.

Other less common
findings are internal resorption:

This problem is painful and requires extraction; we cannot watch and wait.

Tooth resorption can also occur uncommonly in exotic cheek teeth. Most of the time, the occlusal table needs to be equilibrated (aka floating teeth in horses), and the tooth will continue to erupt resolving the problem with frequent occlusal adjustments.

to learn more about tooth resorption.