Expert: Lawrence Spindel DDS, www.lspindeldds.com - 11/1/2008

Question
Hi my dad is 65 and has impacted lower wisdom teeth. On the OPG one of
them seen to have a radiolucency in the crown that may be external or
internal resorption. It has a round radiolucency 2mm in diameter in the
crown of the third molar. The tooth has gums completely covering it but does
not have bony covering so i guess it can communicate with the oral cavity.   
There haven't been any symptoms from the tooth or area. The dentist says
there is no caries, pericoronitis or periodontitis. Does he need to extract that
wisdom tooth based solely on that pathology? What happens if we leave it?
Thanks for your help! Much appreciated!

Answer
Dear Michael,

Assuming that what is going on is idiopathic external resorption, probably it is safe to leave it alone.  External resorption is usually assymptomatic.  

There is a very small chance that the radiolucency is caused by some other type of lesion, so the area does bear watching.  A biopsy and or tooth removal would be necessary to be sure of the diagnosis.

Given the facts as you have presented them, leaving the tooth as is for now seems to be an Ok decision. If he has no symptoms and he should have a  check up X-ray taken once per year to allow your dentist to monitor the situation. If the radiolucency grows in a pattern not suggestive of external resorption or the area gets symptomatic, then the tooth can be removed and a biopsy performed.

I hope I have answered your questions and please feel free to contact me again with your dental questions.