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
Case Report. This report describes a rare case of a
19-month-old girl with pre-eruptive intracoronal
resorption in the lower left first primary molar
which had erupted a few weeks earlier and had
deep caries. The treatment is described.
Introduction
Hidden caries, dentin caries that is not visual-
ized on the occlusal surface but shows up in
radiographs as radiolucency in the dentin, has
been described only once in primary dentition1.
Intracoronal dentin resorption occurs in the
crown of teeth that had not yet erupted into
the oral cavity, so when they erupt and are
diagnosed with caries, it is difficult to determine
whether pre-eruptive resorption had been pre-
sent2. The affected tooth would be asymp-
tomatic before erupting, but once it is exposed
to the oral cavity, caries will develop rapidly2.
The lack of cases describing pre-eruptive
intracoronal resorption in the primary denti-
tion is probably due to the fact that routine
radiographs are usually not performed until
approximately 45 years of age, and by this
time, primary teeth had already erupted1.
We describe a buccal abscess and its treat-
ment in a 19-month-old girl with caries in a
recently erupted first primary molar.
Case report
A 19-month-old girl of an Ethiopian origin with
no remarkable medical history presented to the
Correspondence to:
Dr Moti Moskovitz, Department of Pediatric Dentistry,
Hadassah School of Dental Medicine, P.O.Box 12272,
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
Conclusion. Dentists who treat children must take
into consideration the possibility of pre-eruptive
lesions in the primary dentition that may cause
involvement of the pulp, either before or shortly
post-eruption.
emergency room at Hadassah medical centre
complaining of a symptomatic swollen left side
of the face of approximately 5 cm diameter.
Her mother reported that the mandibular left
first primary molar had erupted a few weeks
earlier and that the surrounding soft tissues had
been inflamed and swollen for the past 24 h.
On admission, the swelling was tender and
warm on palpation. An ultrasound examination
revealed swelling around the left parotid gland.
Thus, parotitis or lymphadenitis was initially
suspected. Intraoral examination revealed
intact primary dentition; the second primary
molars had not yet erupted. No dental decay
was noted, and general oral hygiene was fair.
The gingival tissue around the mandibular left
first primary molar was severely inflamed. The
tooth looked intact and stable, and no clinical
defects were detected on the enamel surface.
The patient was hospitalized and treatment
was initiated immediately with a course of
Amoxicillin IV. In the next 24 h, the facial
tenderness persisted, although there was a
reduction in the swelling. Intraorally, there
was buccal gingival swelling with apparent
pocketing around the first left primary molar
(Fig. 1). A bitewing and a periapical radio-
graph (Fig. 2) revealed intracoronal dentin
resorption and inter-radicular radiolucency.
The later finding was probably a result of
necrotic pulp due to caries that ensued from
pre-eruptive intracoronal resorption.
1
2 Y. Schwimmer, R. Zeltser & M. Moskovitz
Fig. 1. Left lower first primary molar with buccal mucosa
swelling and sound morphology.
Fig. 2. Pre-treatment radiograph. (a) bitewing, (b) periapical
radiograph.
Due to her young age, the importance of
preserving the tooth and the identified aetiol-
ogy endodontic therapy was performed under
conscious sedation and local anaesthetics. The
canals were obturated using Metapex (Meta
Biomed co. Ltd., Yeonje-ri, Cheong-won-gun,
Chungcheongbuk-do, Korea).
One week post-treatment, a check-up revealed
uneventful healing, the swelling had decreased
significantly and the treatment was considered
successful. A routine check-up seven months
post-operative showed normal tissue around the
left lower first primary molar (Fig. 3).
2017 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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-
tion, and not the cause of the lesion1.
In the present case, the fact that the tooth
erupted a few weeks before the abscess
appearance with intact coronal enamel and a
large lesion in the dentin led us to assume
that we were dealing with a pre-eruptive
intracoronal resorption. Once in the oral cav-
ity, the lesion became infected and it was
only a matter of time until signs and symp-
toms of the dental abscess appeared.
As in Seow and Hackleys report, the differ-
ential diagnosis of an abscess of unknown
aetiology should always include internal non-
carious defects1. It is most likely that in this
case, the aetiology of the defect was dentin
 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.

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

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