A completely dead tooth doesn’t hurt, as it’s devoid of living pulp. However, the pain caused by changes in the tooth can be felt in the surrounding tissue.

If a sudden, severe attack of toothache has occurred and disappeared, this can sometimes mean that one of the teeth is “dead”.

I. What does a dead tooth mean?

In a healthy tooth, the hard outer layers enable the masticatory organ to function normally. This is only possible thanks to the living tissue inside the tooth cavity and canals, called the pulp.

The very term “tooth death” means that the nerve and vascular tissue inside the tooth is necrotic.

This means that it no longer receives nutrition and innervation, and inside is a decomposed mass infected by bacteria and micro-organisms left behind after inflammation.

II. Why does a tooth die?

The tooth, and the soft tissues inside it, otherwise known as the pulp, die after long-term inflammation – pulpitis.

The most common cause of pulpitis is untreated tooth decay and dental trauma.

III. Can dead teeth be fixed?

The most commonly used treatment is root canal therapy (endodontics), which is one of the most complex dental procedures. However, it is being used more and more frequently, thanks of course to modern diagnostic methods that enable pulpal pathologies to be identified precisely, as well as increasingly advanced treatment tools.

The approximate percentage of teeth treated by root canal with changes in periapical tissue is around 30-40%.

In such cases, treatment consists of removing the dead pulp, cleaning and disinfecting the canals, and filling it with an appropriate biocompatible material.

One of the methods used is pulpotomy, which involves partially removing the pulp and lining the root canal with a bioactive material. The aim is to preserve the viability and function of the remaining pulp tissue. Root canal treatment will be problematic when the canals are fused.

When a patient comes to the dentist’s office with pulpitis and severe pain, endodontic treatment is performed under local anesthetic, as this is a painful procedure.

The next part of the treatment is the restoration of the tooth’s crown. As a rule, prosthetic crowns or ceramic inlays are used.

Root canal therapy carried out by specialists in the field of endodontics is successful in over 90% of cases.

The efficacy of such treatment can be checked using an X-ray or cone-beam computer scan, which accurately shows the filling of all canals and the structure of the various services.

In some cases, root canal treatment of a tooth with pulpitis is not possible. This is the case when tissue changes are very extensive and the endodontic treatment applied will not prevent the further development of inflammation. In such cases, the “dead tooth” must be removed.

IV. Should a dead tooth be extracted?

In most cases, a dead tooth can be treated. Dead and necrotic masses are removed from the tooth using special instruments and tools, the former nerve site is filled with a particular material, and the canals are sealed.

V. When should a dead tooth be extracted?

Several reasons can be distinguished:

1. Completely damaged tissue

The tooth is extracted when there is so much surrounding tissue damaged by decay (in the coronal part of the tooth).

And even after the canals have been cleaned and filled, the doctor still won’t be able to restore the coronal part effectively, so the tooth won’t be suitable for dentures or fillings.

The restoration in such cases will not be durable and of very poor quality when done.

2. Tooth left untreated for a long time

When a necrotic tooth is left untreated for a long period, bacteria from the infected necrotic tissue penetrate the root scales through the top of the dental canal into the jaw, leading to periodontitis (inflammation of the surrounding dental tissue).

In the course of this, the disease can sometimes progress without much pain, with the occasional sensation of the tooth lifting or, in the event of exacerbation, swelling.

In the case of very severe inflammation, in which a large amount of surrounding bone is destroyed, the tooth must be extracted.

3. Trauma

And also in the case of major trauma, which develops not only inflammation of the nerve and its death but also division of the tooth root and sometimes less common complications, such as the death of other teeth.

The only thing to bear in mind is that the death of the dental nerve is not directly transmitted from tooth to tooth, but the accumulation of bacteria in one tooth is bound to be transmitted to the mouth and healthy teeth, creating a long-term environment conducive to decay in other teeth.

So, if a tooth has already suffered very deep lesions that have resulted in advanced nerve damage, it’s sometimes best to extract it to avoid creating a nest of bacteria.

V. Does a dead tooth change visually?

Yes, a color change is easily observed. The tooth becomes dark and greyish.

It’s often possible to feel or see a cavity forming in the tooth. You can even see a hole in the tooth or cracks in its outer wall.

Most of the time, tooth loss is accompanied by a severe toothache, so as soon as you feel it, you should consult a dentist immediately.

It’s important to remember that nerve inflammation that has already begun will not be cured with painkillers, and even after the symptom of pain has been removed, necrosis of the tooth’s nerve will occur and the tooth will die inexorably if left untreated.

VII. Is a dead tooth something to worry about?

A dead tooth is the gateway to infection in our body. Infected tissue can migrate through the root apex, and abundant quantities of micro-organisms cause diseases such as apical periodontitis – abscesses, cysts, and bone melting form in the jaw.

Untreated necrotic teeth in the upper jaw can lead to sinusitis.

It’s worth mentioning that from any source of infection, even a dead tooth, the bloodstream can carry micro-organisms throughout the body, affecting our weakest areas the most, and weakening them further.

In ongoing studies, numerous links are being found between untreated dental nerve damage and diseases such as infective endocarditis, Sjogren’s syndrome, joint disease, arthritis, and diabetes.

VIII. Other possible complications

Although a dead tooth doesn’t hurt, the infection can sometimes spread to neighboring structures, leading to several serious complications.

Inflammation and infection can spread from the dead pulp to the periapical region, forming a periapical abscess.

The disease passes through stages, forming a subperiosteal and submucosal abscess. Pain, facial swelling, or redness, although disturbing, are not the worst effects of these conditions.

In fact, bacteria around the mouth have easy access to a variety of structures – not only the head but also distant organs. The spread of pathogens can lead to brain abscesses, mediastinal abscesses, infective endocarditis, or reactive arthritis.

Oral bacteria are also thought to be involved in the development of autoimmune diseases in susceptible individuals.

In extreme cases, microorganisms attacking the pulp can cause life-threatening septicemia – the body’s general reaction to infection, with the onset of multi-visceral failure.

This is why so much attention must be paid to the principles of good oral hygiene and rapid response to diseased or dead teeth.

IX. How is a necrotic tooth diagnosed?

People may first notice inflammation of the nerve, which manifests itself as intense pain that goes away on its own, felt most acutely in the evening and at night.

At this stage, you may notice changes in the color of the tooth (grayish), there are large cavities in the coronal part, and you may feel that the tooth is lifted and does not react to the cold.

During the examination, dentists carry out the necessary tests to determine the viability of the tooth – a detailed history of past or present pain, examination, cold test, percussion test, and X-ray tests confirming the diagnosis.

Useful Links:

Radiographic and Clinical Findings of Single-Visit Root Canal Treatments with Apical Enlargement in Necrotic Teeth: A Retrospective Cohort Study

Pulp necrosis and root resorption