A “dying tooth” refers to a condition where the soft tissue at the tooth’s center, the dental pulp, is irreversibly damaged or dead. The pulp is a collection of nerves, blood vessels, and connective tissue that resides in the pulp chamber and root canals, providing sensation and nourishment to the tooth. When severe decay, a fracture, or trauma allows bacteria to invade, it causes inflammation (irreversible pulpitis), leading to tissue death (pulp necrosis). Once the pulp dies, the tooth is non-vital, and the dead tissue provides space for infection to proliferate, potentially leading to a painful abscess at the root tip.
Recognizing the Warning Signs
The transition from a healthy tooth to a dying one often begins with pain. Initial symptoms of inflammation (reversible pulpitis) may involve a short, sharp sensitivity to cold or sweets that disappears almost immediately after the stimulus is removed.
As the inflammation progresses to the irreversible stage, the pain becomes more intense, sometimes throbbing, and lingers for 30 seconds or more after exposure to hot or cold temperatures. Spontaneous pain, occurring without any trigger, is a strong indicator of a severe issue. The infection can also cause tenderness when biting or chewing, swelling in the gum tissue, and the formation of a pimple-like bump on the gum, which signals an abscess. A tooth with full pulp necrosis may stop hurting because the nerve is dead, but the infection persists and can cause the tooth to appear discolored, often turning gray or dark.
The Primary Saving Procedure: Root Canal Therapy
Root Canal Therapy (RCT) is the gold standard for saving a tooth with irreversible pulpitis or pulp necrosis. This endodontic procedure eliminates the infection while preserving the tooth’s outer structure. The process begins with the dentist creating a small access hole in the crown to reach the infected pulp chamber and root canals.
Using specialized instruments, the dentist removes the diseased and dead pulp tissue, followed by cleaning and shaping the canals. The canals are thoroughly disinfected using antibacterial and antiseptic solutions to eliminate remaining bacteria. This step stops the infection and prevents its spread into the jawbone.
Once the canals are clean and dry, they are filled and sealed with gutta-percha, a rubber-like material, often combined with an adhesive cement. The gutta-percha is heated and compressed to ensure it completely fills the space and seals the canals off from future bacterial contamination. After the internal chamber is sealed, the access hole is closed with a temporary or permanent filling.
A tooth that has undergone RCT is no longer vital and can become brittle because it loses its internal blood supply. Therefore, a permanent crown is typically placed over the treated tooth, especially a back molar, to protect the weakened structure from fracturing during chewing. The goal is to retain the natural tooth, allowing it to continue functioning normally.
When Extraction Becomes Necessary
While root canal therapy has a high success rate, extraction becomes the only viable option when the tooth cannot be saved. One common reason is a severe vertical fracture that extends deep below the gum line and into the root, compromising the tooth’s integrity beyond repair.
Extensive tooth decay that has progressed far below the gum line makes it impossible to restore the tooth with a crown or filling, leaving no sound tooth structure to work with. If a tooth has a persistent infection that fails to resolve even after a second root canal treatment, or if significant bone loss from advanced gum disease has compromised the tooth’s support, extraction may be recommended.
Following the removal of the tooth, replacement is strongly advised to prevent complications like bone loss in the jaw and the shifting of adjacent teeth. Common replacement options include a fixed dental bridge, which uses adjacent teeth for support, or a dental implant. A dental implant involves surgically placing a titanium post into the jawbone to act as a root for a prosthetic crown. Implants are often preferred because they help maintain the width and density of the jawbone, offering a long-term, stable solution that mimics a natural tooth.