A “dead tooth” is the common term for pulp necrosis, which occurs when the soft inner tissue of the tooth—containing nerves and blood vessels—dies. This inner pulp keeps the tooth alive and nourished, so its death signals a dental problem. Most people worry if the compromised tooth structure can be saved or if extraction is necessary. In the majority of cases, a dead tooth can be preserved, allowing the patient to retain their natural tooth. Successful outcomes depend entirely on seeking immediate professional treatment once symptoms appear.
Understanding Tooth Death
The pulp inside a tooth dies primarily due to severe decay, physical trauma, or repeated extensive dental procedures. When deep decay or a crack allows bacteria to penetrate the outer layers, the resulting infection causes inflammation (pulpitis) within the pulp chamber. This inflammation restricts the blood supply, leading to the death of the nerves and vessels. Symptoms initially include intense pain and heightened sensitivity to hot or cold temperatures. Once the nerve dies, the pain often gives way to a misleading sense of relief, but the infection continues to progress. The most visible sign is discoloration, as the tooth can gradually turn yellow, gray, or black due to the breakdown of internal tissues.
Root Canal Therapy: The Primary Solution
Root canal therapy (RCT) is the standard procedure designed to save a tooth affected by pulp necrosis by eliminating the infection while keeping the external structure intact. The dentist creates a small access opening in the crown to reach the infected pulp chamber and root canals. Instruments are used to remove the necrotic pulp tissue, bacteria, and debris from the internal canal system.
Following the cleaning, the canals are disinfected using antiseptic solutions to eliminate all traces of infection. The empty space is then filled with gutta-percha, a biocompatible, rubber-like material, which is compacted with adhesive cement to achieve a complete seal that prevents future bacterial re-entry.
Once the root canal is complete, the access hole is sealed with a filling. Since the tooth loses its internal blood supply, it often becomes brittle and susceptible to fracture from chewing forces. To protect the restored tooth and ensure long-term functionality, the final step involves placing a custom-fitted dental crown over the treated tooth.
Repairing Appearance and Replacement Options
Even after a successful root canal, discoloration caused by necrosis or residual blood products can persist. For these cases, internal bleaching can be performed to restore the tooth’s natural color. Unlike external whitening, internal bleaching involves placing a bleaching agent directly inside the tooth chamber and sealing it temporarily. This technique targets internal staining and may require multiple applications until the treated tooth matches the shade of adjacent teeth.
In instances where structural damage is too extensive, such as a severe fracture or massive bone loss from chronic infection, the tooth may be deemed unsalvageable and require extraction. The two most common replacement options are dental implants and dental bridges. A dental implant involves surgically placing a titanium post into the jawbone to act as an artificial root, which prevents natural bone loss. A bridge replaces the missing tooth by anchoring an artificial tooth (pontic) to the adjacent healthy teeth, which must be prepared and crowned. While a bridge is a faster solution, an implant typically offers superior longevity and preserves the integrity of neighboring teeth.
Risks of Delaying Treatment
Ignoring a dead or infected tooth allows the underlying bacterial issue to progress. One outcome is the formation of a periapical abscess, a painful pocket of pus that accumulates at the tip of the tooth root in the jawbone. This abscess can cause swelling and tenderness and may rupture, leading to a foul taste in the mouth. The chronic infection causes the body to break down surrounding bone tissue, which can destabilize the tooth so much that extraction becomes necessary. Furthermore, bacteria can enter the bloodstream and spread, leading to systemic conditions like cellulitis or sepsis; seeking treatment immediately mitigates these health risks and maximizes the chances of saving the tooth.