An exposed tooth nerve occurs when the protective outer layers of a tooth are breached, leaving the inner, soft tissue vulnerable. This inner tissue, known as the dental pulp, contains the tooth’s nerves, blood vessels, and connective tissue. Pulp exposure results from deep decay, a fractured tooth, or a lost filling that compromises the enamel and underlying dentin layers.
When the dental pulp is exposed to the external environment, including air, bacteria, and temperature changes, the sensory nerves register intense, sharp, and often throbbing pain. This discomfort signals a dental emergency requiring professional attention without delay. While immediate home care offers temporary relief, no at-home measure can permanently resolve the problem or prevent infection.
Immediate Home Care and Temporary Protection
Managing the pain involves over-the-counter medication and physical protection of the site. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are effective because they reduce inflammation of the irritated nerve tissue. Acetaminophen is also an option to manage discomfort until a dental professional can be seen.
For localized relief, topical anesthetics containing benzocaine can be applied sparingly to the painful area. These gels provide a temporary numbing effect by blocking nerve signals at the surface. They are short-acting and should only be used as directed for immediate relief.
The most direct way to cover the exposed site is by using a temporary dental repair kit, available at most pharmacies. These kits contain dental cement or temporary filling material that can be packed gently into the cavity or fracture to create a physical barrier. Alternatively, a small piece of sugarless gum can be molded over the affected area as an interim measure to shield the nerve from external stimuli.
A warm salt water rinse helps cleanse the area and reduce local inflammation. Mix about half a teaspoon of salt into a cup of warm water and gently rinse the mouth several times a day. Another option is clove oil, which contains eugenol, a compound with natural analgesic and antiseptic properties. A small amount of clove oil can be applied to the site with a cotton swab for a temporary numbing effect.
Managing Triggers While Seeking Treatment
Behavioral adjustments are necessary to prevent pain from flaring up before the dental appointment. Since the exposed pulp is highly reactive to stimuli, avoiding extreme temperatures is necessary. Steer clear of very hot liquids, such as coffee or tea, and ice-cold beverages or ice cream, as both can trigger sharp pain.
Dietary changes are also important; eliminate sugary and acidic foods like citrus fruits, sodas, and candies, which can chemically irritate the exposed tissue. Choose soft foods that require minimal chewing and consume them on the side of the mouth opposite the affected tooth.
Maintain careful oral hygiene to prevent infection, but brush and floss with caution around the exposed area. Use a soft-bristled toothbrush and avoid direct contact with the site to prevent mechanical irritation. When in cold environments, breathing through the nose helps prevent cold air from hitting the exposed nerve.
When lying down, keep the head slightly elevated using extra pillows. This adjustment minimizes blood pressure in the head, which can reduce the throbbing sensation associated with an inflamed nerve.
Definitive Dental Procedures for Nerve Exposure
Once the patient reaches the dentist, the goal shifts from temporary coverage to a definitive treatment that saves the tooth and eliminates infection risk. The procedure chosen depends on the extent of the pulp exposure and the overall health of the dental pulp.
For minimal exposure or decay close to the pulp, the dentist may attempt a pulp capping procedure. This preserves the tooth’s vitality by placing a protective material over the exposed or nearly exposed pulp. In a direct pulp cap, a biocompatible material, such as Mineral Trioxide Aggregate (MTA) or calcium hydroxide, is placed directly onto the exposure. This material encourages the pulp to heal and form a layer of reparative dentin, creating a new barrier.
If the exposure is larger or infection has progressed deeper, the tooth may require a pulpotomy. This procedure involves the partial removal of infected pulp tissue from the crown portion of the tooth, leaving the healthy pulp in the root canals intact. Pulpotomies are often used on primary teeth or permanent teeth with limited exposure where the remaining root pulp is healthy.
The most common definitive treatment for full nerve exposure or irreversible damage is Root Canal Therapy (endodontic treatment). This procedure involves removing all infected pulp tissue from the chamber and root canals. The canals are then cleaned, shaped, and disinfected before being filled and sealed with a rubber-like material to prevent re-infection.
Following a root canal, the tooth often requires a permanent crown to protect the treated structure, as the tooth may become brittle. Extraction is considered the last resort, reserved for situations where the tooth structure is severely compromised or cannot be salvaged.