Pulp Necrosis – Dead Tooth

Introduction

Pulp necrosis occurs when the innermost tissue of your tooth (the pulp) dies. Pulp tissue is underneath the hard tooth enamel and extends down into the roots. It consists of blood vessels, nerves and other types of cells that help keep your teeth healthy.

How does pulp necrosis develop

When you have a cavity or a crack in your tooth, bacteria can get into the pulp and cause inflammation (pulpitis). Your teeth have some ability to recover from pulpitis on their own. But if left untreated, pulpitis  will eventually lead to pulp necrosis. The stages include:

1. Reversible pulpitis: The tooth can heal on its own if a dentist repairs and seals it.
2. Irreversible pulpitis: The inflammation progresses and the tooth can’t heal on its own.
3. Pulp necrosis: The pulp tissue dies.

The infection can also spread beyond the pulp into your jaw, neck and chest if not treated. These conditions can be very serious.

Symptoms and Causes

The main symptoms of pulpitis and pulp necrosis are a toothache and sensitivity. The type of pain and sensitivity you feel may vary based on the stage:

• Reversible pulpitis: You may have a short, sharp pain with cold or sweets, but it goes away quickly. Usually, you’re not sensitive to heat.
• Irreversible pulpitis: This can be a low-grade ache, throbbing or sharp pain that lasts 30 seconds or more after exposure to heat, cold or sweets.
• Pulp necrosis: If the nerve dies, you may not have any sensitivity to heat, cold or sweets. You may feel pain when your dentist taps your tooth.

What causes pulp necrosis?

The most common cause is a cavity. Most people will develop a cavity at some point in their lives. If not detected and repaired, it can allow bacteria to enter the pulp. Other causes include:

• Cracked tooth: A crack in your tooth can be a route for bacteria to enter the pulp.
• Dental procedures: Multiple or unsuccessful dental procedures can make a tooth more susceptible to pulp necrosis.
• Trauma: An injury to your tooth can expose the pulp. It can also affect blood supply to the pulp, causing tissue death.
• Worn tooth enamel: This can be a result of aggressive brushing or your teeth. The worn areas can allow bacteria to enter your tooth.

Management and Treatment

Once the pulp tissue dies, your dentist must remove it. This will prevent the infection from spreading and causing further damage. Options for treatment include:

• Root canal: General dentists and endodontists perform root canal. They remove the pulp, clean out the root, then fill and seal the empty root canal. After your tooth has had a few weeks to heal, your dentist will usually cap your tooth with a crown.
• Tooth removal: This is the extraction of your tooth.

What are the possible complications of pulp necrosis?

Complications occur when the infection in the pulp spreads. If it reaches the tip of the root, it can cause a pocket of pus (abscess) that can be very painful.

Other complications include:

• Ludwig’s angina, an infection in the soft tissues under your tongue and in your neck.
• Mediastinitis, an infection in the space around the organs in your chest.
•  Osteomyelitis of the jaw, an infection of the jaw bone.

Prevention

You can prevent cavities and keep your teeth healthy by:

• Brushing your teeth two times a day.
• Flossing every day.
• Seeing your dentist for routine cleanings and checkups.
• Reporting any new dental symptoms, such as pain and sensitivity, right away.
• Using a mouth guard to protect your teeth if you grind your teeth in your sleep.