A “dead tooth,” medically termed a non-vital tooth or pulp necrosis, refers to a tooth whose innermost living tissue has died. The pulp, a soft core of nerves, blood vessels, and connective tissue, sustains the tooth’s vitality. When this tissue is damaged beyond repair, usually by trauma or deep decay, the blood supply is cut off, causing the pulp to die. This condition is serious because the dead tissue can become infected, potentially affecting the surrounding gum and jawbone. Fortunately, a dead tooth can often be successfully treated and preserved, avoiding extraction.
Identifying a Non-Vital Tooth
Recognizing the signs of a non-vital tooth is the first step toward saving it, as prompt treatment offers the best prognosis. The most visible indicator is a change in the tooth’s color, which may progress from a yellowish hue to gray, bluish-gray, or even black. This discoloration results from the breakdown products of the dead internal tissue seeping into the surrounding dentin.
Pain symptoms can be misleading; some people experience intense, lingering pain or sensitivity, while others feel mild discomfort or no pain once the nerve is fully necrotic. When pain is present, it is often caused by an infection spreading to the sensitive nerve endings outside the tooth’s root (the periodontal membrane). Other signs of infection include gum swelling, a painful, pus-filled pocket called an abscess, or a persistent bad taste and foul odor.
Pulp death is primarily triggered by physical trauma and severe, untreated tooth decay. A blow to the face, even without a visible fracture, can sever the blood vessels at the root tip, cutting off the pulp’s blood supply. Deep cavities that are neglected allow bacteria to penetrate the enamel and dentin, eventually reaching the pulp chamber and causing severe infection. Cracked teeth and repeated dental procedures can also create pathways for bacteria, leading to irreversible pulp inflammation and necrosis.
The Primary Method for Saving a Tooth
The standard and most effective procedure for salvaging a non-vital tooth is Root Canal Treatment (RCT). This endodontic procedure eliminates the source of infection from within the tooth structure, allowing the tooth to remain without its dead or infected pulp. The process begins with the dentist making a small access opening through the crown to reach the pulp chamber.
The infected and necrotic pulp tissue is then removed from the chamber and the root canals, which can number from one to four depending on the tooth. Specialized instruments are used to clean, enlarge, and shape the internal canals, followed by thorough disinfection to remove bacteria and debris. This cleaning and shaping ensures the removal of the source of infection and prevents its recurrence.
Once the canals are clean and dry, they are filled with a biocompatible, rubber-like material, most commonly gutta-percha, and sealed with an adhesive cement. This sealing prevents future bacterial contamination from entering the root canal system. Following the root canal, the tooth requires a final restoration, often a dental crown, which provides structural integrity and protects the brittle tooth from fracturing.
Modern root canal therapy has a high success rate, generally reported between 85% and 97% when performed correctly and followed by appropriate restoration. If a tooth has become discolored due to internal tissue breakdown, a conservative approach called internal bleaching can be performed after the root canal. A whitening agent, such as sodium perborate, is placed inside the tooth and sealed temporarily, working from the inside out to restore the tooth’s natural color.
When Saving the Tooth is Not Possible
While root canal treatment is highly successful, some damage makes saving the tooth unfeasible. Common reasons for unsalvageable teeth include severe structural damage, such as a vertical root fracture that extends deep into the root. Extraction may also be necessary if an infection is too extensive, if a previous root canal has failed, or if the remaining tooth structure is insufficient to support a restoration.
In these cases, extraction is necessary to eliminate the source of infection and prevent further complications to the surrounding bone and gums. Once removed, replacement options must be considered to maintain proper bite alignment, function, and aesthetics, as neighboring teeth can shift into the empty space. The three primary methods for replacing a missing tooth are dental implants, fixed bridges, and removable partial dentures.
Dental implants are often the preferred long-term solution, involving a titanium post surgically placed into the jawbone to act as an artificial root for a new crown. Implants help prevent jawbone deterioration, a natural consequence of tooth loss, and function most similarly to a natural tooth. A dental bridge is a fixed restoration that uses adjacent healthy teeth for support, with a false tooth filling the gap. Removable partial dentures offer a less permanent and more economical solution, using clasps to attach replacement teeth to the remaining natural teeth.