Multiple internal resorption in permanent teeth associated with hyperparathyroidism

Nagaraj, E; Kaur, Roopam Pal; Raghuram, P; Kumar, Priya

doi:10.4103/0970-9290.114917

Cited by 11 publications

(8 citation statements)

References 6 publications

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“…Another unusual finding in our case is that multiple teeth were affected, both simultaneously and consecutively. In fact, there are only a few reports in the literature of cases with multiple IR (14)(15)(16). The occurrence of IR in monozygotic twins further suggests that genetic disposition may play a role in its pathogenesis (17).…”

Section: Discussionmentioning

confidence: 99%

Radiological and Histopathological Features of Internal Tooth Resorption

Koehne¹,

Zustin²,

Amling³

et al. 2020

In Vivo

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Background: Internal root resorption is an endodontic disease characterized by progressive resorption of dentin from the inside of the pulp chamber. It is a comparatively rare finding in the permanent dentition, and the underlying pathology is not fully understood. Case Report: A 45-year-old patient was referred to our Department for the evaluation of the lower right canine and the upper left wisdom tooth. Pulp sensitivity tests, cone-beam tomography, and magnetic resonance imaging were used to determine the extent of lesions of the affected teeth. The teeth were subsequently extracted due the extent of the lesions. The same was the case for the upper right canine, which developed a severe internal resorption 10 months later. Micro-computed tomography of the extracted teeth revealed that all lesions had a well-defined border with no evidence of sclerosis or hypomineralization. Pulp stones were evident inside the pulp chamber. Ground sectioning of the upper right canine revealed pulp necrosis and an acute infection that had gradually moved in the apical direction. Large multi-nucleated resorbing cells were found on the dentin surface. Importantly, the apical half of the pulp exhibited comparatively normal tissue without substantial inflammatory changes. Decalcified histology of the upper left wisdom tooth demonstrated a completely different histopathological appearance characterized by chronically inflamed granulation tissue with pseudoepitheliomatous hyperplasia and massive bacterial colonization. Conclusion: Our analyses demonstrate that internal root resorption is a multifaceted dental disease with considerable variability in the rate of the underlying inflammatory changes. Oral surgeons should take this into consideration when evaluating the need for extraction of teeth with internal root resorption. Resorption of calcified tissues, such as bone, dentin, and cementum, is a prerequisite for skeletal homeostasis and tooth eruption. Resorption of permanent teeth, however, is a pathological condition that may result in the loss of the affected teeth. Tooth resorption can occur externally on the root surface or internally within the pulp chamber. External and internal tooth resorption should be considered as discrete entities which differ in terms of prevalence and etiology. External tooth resorption may affect up to 5% of all permanent teeth, and it is usually caused by trauma, ectopic teeth, or orthodontic tooth movement (1). In contrast, internal tooth resorption (IR) is a comparatively rare finding, and its etiology has not been fully elucidated (2). IR is predominantly a lesion within the upper third of the pulp chamber and may affect both the crown and the root of the tooth. The initial finding is resorption of the inner wall of the root canal that progresses in a centrifugal direction. Accompanying changes such as the resorption of the root surface or the alveolar bone may occur, but are not mandatory findings in IR. In fact, the diagnosis of IR can only be made if external factors such as root caries or cer...

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Section: Discussionmentioning

confidence: 99%

Radiological and Histopathological Features of Internal Tooth Resorption

Koehne¹,

Zustin²,

Amling³

et al. 2020

In Vivo

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“…This interesting case of a patient with primary hyperparathyroidism who had likely been hypercalcemic for a significant period of time prior to presentation can educate us on some of hypercalcaemia's protean complications that include nephrolithiasis, osteopenia, pancreatitis and tooth resorption [1].…”

Section: Discussionmentioning

confidence: 99%

“…In the early clinical description of primary hyperparathyroidism, some patients developed a peculiar type of bone disease known as Von Recklinghausen disease or osteitis fibrosa cystica, characterized by increased generalized osteoclastic bone resorption, particularly involving the phalanges causing subperiosteal resorption, and the skull causing the 'salt and pepper' appearance on X-ray [4]. Oral manifestations include but are not limited to external and internal root resorption of teeth and jaw lesions such as cysts, fibro-osseous lesions and odontogenic tumours [1,5]. This is much less common in the current era, given the earlier recognition of primary hyperparathyroidism and subsequent hypercalcemia on biochemical testing.…”

Section: Discussionmentioning

confidence: 99%

The Rise of Calcium and Control of its Fall

Higgins¹,

Casey²,

Tarmey³

2016

JCR

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Abstract:This case highlights an atypical presentation of primary hyperparathyroidism with significant life-threatening hypercalcemia in an 83 year old lady admitted with non-specific symptoms of malaise, dyspnoea and epigastric discomfort. On imaging she was subsequently discovered to have two distinct unexpected findings, a parathyroid mass and a cystic pancreatic mass. Initially an underlying genetic syndrome linking the two structural lesions was considered, possibly a pancreatic neuroendocrine tumor in the presence of a parathyroid mass. However further investigation with a CT pancreatic protocol, revealed her pancreas to show evidence of previous pancreatitis with resultant pseudocyst formation, likely all induced by hypercalcemia of unknown duration. She denied any prior acute episodes of epigastric pain. Whilst previous case reports describe the diagnosis of a parathyroid lesion presenting with acute pancreatitis, our case is rare in that the pancreatitis was an incidental discovery. Although relatively asymptomatic, the pancreatic inflammation induced by hypercalcaemia was significant resulting in development of a large pseudocyst in the pancreatic tail and radiological evidence consistent with previous episodes of pancreatitis. The patient's hypercalcemia had also resulted in nephrocalcinosis and tooth resorption. This case acts a reminder that although primary hyperparathyroidism is often considered a relatively benign entity, life-threatening hypercalcemia can develop and requires urgent management. It highlights the multi-systemic sequelae that can occur with chronic hypercalcemia and reminds us that parathyroid carcinoma although rare, must always be considered when markedly elevated levels of parathyroid hormone and hypercalcemia are encountered.

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“…In some of these conditions, dysregulated resorption affects the skeleton, leading to reduced bone mineral density or osteolytic lesions. Examples of conditions associated with root resorption include: hypothyroidism ( 21 ), hyperparathyroidism ( 22 , 23 ), systemic sclerosis ( 24 ), Gaucher’s disease ( 25 ), hereditary hemorrhagic telangiectasia ( 26 ), Paget’s disease of bone ( 27 , 28 ), Goltz syndrome ( 29 ), Papillon–Lefévre syndrome ( 30 ), and Turner syndrome ( 31 ). To date, no studies have firmly established causality between these conditions and MICRR.…”

Section: Systemic Conditions and Genetic Factorsmentioning

confidence: 99%

“…Potential Risk Factors for multiple idiopathic cervical root resorption (MICRR). , hyperparathyroidism(22,23), Systemic sclerosis (24), Gaucher's disease(25), Hereditary hemorrhagic telangiectasia (26), Paget's disease of bone(27,28) SyndromesGoltz syndrome(29), Papillon-Lefe'vre syndrome(30), and Turner syndrome(31) …”

mentioning

confidence: 99%

Multiple Idiopathic Cervical Root Resorption: A Challenge for a Transdisciplinary Medical-Dental Team

et al. 2021

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The goal of this perspective article is to use multiple idiopathic cervical root resorption (MICRR) as a model to demonstrate the need for transdisciplinary collaborations, from basic science to treatment planning, to improve the quality of health care for all. This is not a review of the literature on the current state of MICRR. Tooth root resorption is a normal physiological process required for resorption and exfoliation of primary teeth; however, root resorption of adult teeth is largely pathological. MICRR is an aggressive form of external root resorption, which occurs near the cemento-enamel junction (CEJ). The cause of MICRR remains elusive, however, it is mediated primarily by osteoclasts/odontoclasts. Accumulating case studies and experiments in animal models have provided insights into defining the etiologies and pathophysiological mechanisms for MICRR, which include: systemic conditions and syndromes, inherited genetic variants affecting osteoclast/odontoclast activity, altered periodontal structures, drug-induced root resorption and rebound effects after cessation of anti-resorptive treatment, chemotherapy, exposure to pets or viral infections, and other factors such as inflammatory conditions or trauma. To determine the causative factors for MICRR, as well as other oral-dental conditions, at minimum, a comprehensive health history should be collected for all patients by dental care providers, discussed with other health care providers and appropriate collaborations established. The examples highlighted in this perspective emphasize the need for transdisciplinary research collaborations coupled with integrated management strategies between medicine and dentistry in order to identify cause(s) early and improve clinical outcomes.

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Multiple internal resorption in permanent teeth associated with hyperparathyroidism

Cited by 11 publications

References 6 publications

Radiological and Histopathological Features of Internal Tooth Resorption

Radiological and Histopathological Features of Internal Tooth Resorption

The Rise of Calcium and Control of its Fall

Multiple Idiopathic Cervical Root Resorption: A Challenge for a Transdisciplinary Medical-Dental Team

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