The Pink Tooth

One of the reasons for a tooth appearing pink is the presence of External Cervical Resorption (ECR) or Invasive Cervical Resorption.  This type of resorption has been described and classified by Heithersay.

Some of the predisposing factors for ECR include: trauma, orthodontics, periodontal therapy, surgical procedures, intracoronal bleaching/restorations, etc.  For the reasons that are poorly understood, odontoclastic activity below the epithelial attachment would cause resorption that advances inwardly and, if untreated, eventually result in significant loss of crown and root structure. Resorptive process does not usually involve the pulp tissue and in most cases the tooth stays vital.  Teeth with Class 3 or 4 resorption have poor prognosis.  So, the key to saving these teeth is to catch the resorptive defects early on.

One of the telling signs is the presence of pinkish discolouration in the cervical area of vital teeth.  A resorptive defect harbouring a very touch-sensitive granulation tissue can be detected easily by running the sharp, curved end of the explorer below the level of CEJ.  The treatment of the resorptive defect is open-flap restoration.  The tissue residing inside the defect is usually very easy to remove as it appears detached.  As mentioned before, the pulp tissue is unaffected by this resorptive process and therefore, root canal therapy is not needed.

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4 responses to “The Pink Tooth

  • Mario

    Hi Dr. E. What was used to restore this tooth?
    Thank you.
    Mario

    • Dr E

      Mostly composite.
      If the entire restoration will be submerged and covered by gingival tissue, Geristore is the best material. But if it will be exposed to saliva and above CEJ, the Geristore will probably start showing signs of decay and stains with time.

  • Jon

    What options are available, if any, to treat Class 1 or 2 external resorption? I had a local endodontist tell me that external resorption is untreatable, and if it gets worse, the only option is extraction.

    • Mahmoud R. Ektefaie, DMD, Cert (Endo), MSc, FRCD(C)

      Class I and II cervical resorptions are really easy to treat and are predictable. I have done many of those without needing to perform endodontic treatment, because they usually do not involve the pulp tissue. In both cases, open-flap root repair by Geristore (if it can be covered completely by gingival tissue) or by composite (if exposure to saliva is expected) will suffice. Class III or IV (resorption is usually wrapping around the pulp canal and extends below the level of crestal bone) present with poor prognosis. Treatment for those cases are not recommended.

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