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Root Canals

Hereditary condition affecting the nerve root

02/01/2008

Question:

Is there a proper diagnostic name for a genetic conditon that destroys the nerve on the front tooth only? I ask because my father, brother, aunt (on my father`s side), my niece and now my 14yr old son all have or have had a graying of the front tooth on the right side and most have had to have several root canals on that tooth and the area comes back. The nerve dies for no apparent reason. Is a simple root canal the tx of choice in this incident?

Answer:

I looked into the situation you described but could not find a named neural syndrome for it. A number of tooth pathologic entities could be the cause of the problem, however. The most common cause is usually due to a deep lingual pit on the front teeth. This is where the back side of the front teeth develop (as a fetus) a deep invaginated form that is impossible to keep clean. Eventually bacteria are able to enter the dental pulp from the depth of this pit and kill the nerve of the tooth. This could have a genetic component to it. These teeth may also have a "lingual groove" where the invagination is not limited to the crown of the tooth, but runs down the entire side of the root. These teeth are very difficult to treat and often get periodontal disease because of the bacteria that are harbored within the groove.

A more severe form of this would be called "dens invaginatus" or "dens-in-dente" (tooth within a tooth) but this is rare and has no familial component. Another possibility is a syndrome called "dentinogenesis imperfecta" or "hereditary opalescent teeth". However in this syndrome, all the teeth are affected and the appearance of the teeth ranges from gray to brown-violet. Radiographs of the teeth would show the defect and would have a specific clinical appearance.

My final thought on this is that the changes could be due to trauma of some type and there is just a coincidence that all these people in your family have had this problem. That is a long-shot, but possible. Trauma to a tooth can cause the tooth to discolor and sometimes require a root canal. Recurrence of the lesion on the tooth could be due to a number of things. I would recommend an evaluation by a root canal specialist if the symptoms continue to return.

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Response by:

John M Nusstein, DDS John M Nusstein, DDS
Associate Professor of Endodontics
College of Dentistry
The Ohio State University