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DOI: 10.1111/ipd.

12283

CASE REPORT

Deep caries due to Pre-eruptive intracoronal resorption in a


newly erupted primary molar

YAIR SCHWIMMER1, REPHAEL ZELTSER2 & MOTI MOSKOVITZ1


1
Department of Pediatric Dentistry, Founded by the Alpha-Omega Fraternity, The Hebrew University- Hadassah School of
Dental Medicine, Jerusalem, Israel, and 2Department of Oral and Maxillofacial Surgery, Founded by the Alpha-Omega
Fraternity, The Hebrew University- Hadassah School of Dental Medicine, Jerusalem, Israel

International Journal of Paediatric Dentistry 2017 Conclusion. Dentists who treat children must take
into consideration the possibility of pre-eruptive
Case Report. This report describes a rare case of a lesions in the primary dentition that may cause
19-month-old girl with pre-eruptive intracoronal involvement of the pulp, either before or shortly
resorption in the lower left first primary molar post-eruption.
which had erupted a few weeks earlier and had
deep caries. The treatment is described.

emergency room at Hadassah medical centre


Introduction
complaining of a symptomatic swollen left side
Hidden caries, dentin caries that is not visual- of the face of approximately 5 cm diameter.
ized on the occlusal surface but shows up in Her mother reported that the mandibular left
radiographs as radiolucency in the dentin, has first primary molar had erupted a few weeks
been described only once in primary dentition1. earlier and that the surrounding soft tissues had
Intracoronal dentin resorption occurs in the been inflamed and swollen for the past 24 h.
crown of teeth that had not yet erupted into On admission, the swelling was tender and
the oral cavity, so when they erupt and are warm on palpation. An ultrasound examination
diagnosed with caries, it is difficult to determine revealed swelling around the left parotid gland.
whether pre-eruptive resorption had been pre- Thus, parotitis or lymphadenitis was initially
sent2. The affected tooth would be asymp- suspected. Intraoral examination revealed
tomatic before erupting, but once it is exposed intact primary dentition; the second primary
to the oral cavity, caries will develop rapidly2. molars had not yet erupted. No dental decay
The lack of cases describing pre-eruptive was noted, and general oral hygiene was fair.
intracoronal resorption in the primary denti- The gingival tissue around the mandibular left
tion is probably due to the fact that routine first primary molar was severely inflamed. The
radiographs are usually not performed until tooth looked intact and stable, and no clinical
approximately 45 years of age, and by this defects were detected on the enamel surface.
time, primary teeth had already erupted1. The patient was hospitalized and treatment
We describe a buccal abscess and its treat- was initiated immediately with a course of
ment in a 19-month-old girl with caries in a Amoxicillin IV. In the next 24 h, the facial
recently erupted first primary molar. tenderness persisted, although there was a
reduction in the swelling. Intraorally, there
was buccal gingival swelling with apparent
Case report
pocketing around the first left primary molar
A 19-month-old girl of an Ethiopian origin with (Fig. 1). A bitewing and a periapical radio-
no remarkable medical history presented to the graph (Fig. 2) revealed intracoronal dentin
resorption and inter-radicular radiolucency.
Correspondence to:
The later finding was probably a result of
Dr Moti Moskovitz, Department of Pediatric Dentistry, necrotic pulp due to caries that ensued from
Hadassah School of Dental Medicine, P.O.Box 12272, pre-eruptive intracoronal resorption.
Jerusalem 9112102, Israel. E-mail: motim@md.huji.ac.il

2017 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1
2 Y. Schwimmer, R. Zeltser & M. Moskovitz

Fig. 1. Left lower first primary molar with buccal mucosa


swelling and sound morphology.

Fig. 3. (a) Seven-month post-treatment check-up reveals a


complete healing of the abscess. The second primary molar
erupted into place. (b) a periapical radiograph reveals a
successful root canal treatment with healing of the inter-
radicular area.

Discussion
To the best of our knowledge, this is the first
report of a case of pre-eruptive intracoronal
resorption in a first primary molar and only
the second case describing such a lesion in
primary teeth.
It is likely that the bacteria from the oral
cavity penetrating a microscopic defect in the
newly erupted teeth were the cause for the
pulp necrosis due to post-eruptive coloniza-
Fig. 2. Pre-treatment radiograph. (a) bitewing, (b) periapical
radiograph.
tion, and not the cause of the lesion1.
In the present case, the fact that the tooth
Due to her young age, the importance of erupted a few weeks before the abscess
preserving the tooth and the identified aetiol- appearance with intact coronal enamel and a
ogy endodontic therapy was performed under large lesion in the dentin led us to assume
conscious sedation and local anaesthetics. The that we were dealing with a pre-eruptive
canals were obturated using Metapex (Meta intracoronal resorption. Once in the oral cav-
Biomed co. Ltd., Yeonje-ri, Cheong-won-gun, ity, the lesion became infected and it was
Chungcheongbuk-do, Korea). only a matter of time until signs and symp-
One week post-treatment, a check-up revealed toms of the dental abscess appeared.
uneventful healing, the swelling had decreased As in Seow and Hackleys report, the differ-
significantly and the treatment was considered ential diagnosis of an abscess of unknown
successful. A routine check-up seven months aetiology should always include internal non-
post-operative showed normal tissue around the carious defects1. It is most likely that in this
left lower first primary molar (Fig. 3). case, the aetiology of the defect was dentin

2017 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Pre-eruptive resorption in a primary molar 3

resorption and the pulpal infection probably Authors contribution


did not occur until the eruption of the tooth
Dr. Yair Schwimmer carried out the dental
when it was exposed to the oral environ-
treatment under the supervision of
ment.
Dr. Rephael Zeltser and Dr. Moti Moskovitz.
It is usually possible to discover pre-erup-
Dr. Yair Schwimmer, Dr. Rephael Zeltser and
tive intracoronal resorption in permanent
Dr. Moti Moskovitz conceptualized and
teeth by regular check-ups that include
designed the study, drafted the initial manu-
bitewings of the primary dentition. Thus,
script, critically reviewed the manuscript and
teeth can be treated before or immediately
approved the final manuscript as submitted.
after eruption. As dental radiographs are
rarely performed before the age of three,
when all primary teeth are erupted, it is Conflict of interest
difficult to diagnose early pre-eruptive
The authors declare no conflict of interest.
lesions3.

References
Why this case report is important to paediatric 1 Seow WK, Hackley D. Pre-eruptive resorption of dentin
dentists in the primary and permanent dentitions: case reports
This is the only known documented case of occult car- and literature review. Pediatr Dent 1996; 18: 6771.
ies in the first primary molar that has deteriorated into
2 Seow WK. Pre-eruptive intracoronal resorption as an
a dental abscess.
Dentists who treat children must take into account
entity of occult caries. Pediatr Dent 2000; 22: 370376.
the possibility of pre-eruptive lesions in primary denti- 3 Davidovich E, Kreiner B, Peretz B. Treatment of sev-
tion that may cause involvement of the pulp, either ere pre-eruptive intracoronal resorption of a perma-
before or shortly post-eruption. nent second molar. Pediatr Dent 2005; 27: 7477.

2017 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd