A “dead tooth” is the common term for pulp necrosis, describing the death of the living tissue inside the tooth’s core. This inner part, the dental pulp, contains the nerves, blood vessels, and connective tissue. Necrosis typically occurs when bacteria from severe tooth decay or a traumatic injury reach the pulp chamber and cause an irreversible infection. Addressing a dead tooth promptly is important because the decaying tissue inside can become a source of infection that spreads beyond the confines of the tooth itself.
Identifying Necrosis: The Signs of a Dying Tooth
A dying tooth often signals its condition through a combination of physical and sensory changes noticed by the patient. One of the most common physical indicators is a noticeable change in color, where the tooth may gradually appear darker, sometimes turning a gray, brown, or black hue compared to neighboring teeth. This discoloration is often due to the breakdown of dead blood cells and tissue inside the tooth structure.
Sensory changes can be varied, ranging from a sudden absence of sensation to intermittent severe discomfort. In the early stages of inflammation leading up to necrosis, a person might experience lingering pain after exposure to heat or cold. However, once the pulp tissue has fully died, the nerve is no longer functional, which can result in a complete lack of sensitivity to temperature stimuli.
The pain associated with a dead tooth can shift from sharp sensitivity to a dull ache or throbbing sensation, which may be felt when biting down. A dentist confirms the diagnosis using tests such as thermal testing (checking the tooth’s response to cold) or an electric pulp tester to determine vitality. X-rays are also used to visualize the root tips and the surrounding bone for signs of infection.
The Internal Process: Why Dead Teeth Become Infected
The dental pulp is contained within the rigid walls of the dentin and enamel, which limits its ability to swell and heal when faced with injury or infection. This soft tissue provides nourishment and sensation through its network of blood vessels and nerves. When deep decay or trauma breaches the outer layers, bacteria gain access to the pulp chamber, causing inflammation known as pulpitis.
The rigid structure of the tooth prevents the inflamed pulp from expanding, which quickly constricts the blood vessels and cuts off the blood supply at the root tip. This lack of blood flow, or ischemia, leads to the death of the tissue, a process called pulp necrosis. Once the pulp dies, the entire root canal system becomes colonized by bacteria and their toxins, transforming the core of the tooth into a reservoir of infection.
This dead, infected tissue within the root canal system provides an ideal environment for microbial growth, as the immune system cannot reach the area to fight the infection. The presence of these bacteria is the primary reason a dead tooth poses a significant health risk. If this colonization is not removed, the infection will inevitably progress beyond the tooth’s confines.
Potential Complications of Untreated Necrosis
When the bacterial infection progresses through the tip of the tooth’s root (the apex), it exits the tooth structure and enters the surrounding jawbone and soft tissues. This spread often results in the formation of a periapical abscess, which is a localized collection of pus at the root tip.
An abscess causes inflammation that can lead to significant discomfort, and the pressure buildup can cause swelling in the jaw or face. Chronic infection in this area can also trigger periapical periodontitis, which is the destruction of the bone supporting the tooth. Over time, this bone loss can weaken the tooth’s foundation and compromise its stability.
A more serious risk of an untreated dead tooth is the potential for the infection to spread systemically through the bloodstream. While rare, a severe infection can lead to life-threatening conditions like sepsis or the formation of an abscess in other parts of the body, such as the brain. This potential for infection to spread into the head and neck underscores the importance of prompt professional treatment.
Restoring Health: Treatment Options for a Dead Tooth
The primary goal in treating a dead tooth is to remove the source of infection and prevent its spread while preserving the natural tooth structure. The most common procedure is Root Canal Therapy (RCT), which cleans out the infected pulp tissue. During RCT, the dentist creates a small opening in the crown to access the pulp chamber and the root canals.
Tiny instruments are used to meticulously remove the dead pulp, thoroughly clean, and disinfect the entire internal canal system. Once the canals are fully cleaned and shaped, they are filled with an inert, rubber-like material called gutta-percha and sealed to prevent re-infection. Following the root canal, the tooth is typically restored with a permanent filling or a dental crown to protect the now non-vital tooth from fracture and restore its proper function.
Extraction is the alternative treatment when the tooth is too severely damaged or structurally compromised to be saved by a root canal procedure. This option is also necessary if a previous root canal has failed or the infection is extensive. Once the dead tooth is extracted, the missing tooth must be replaced to maintain the alignment of the bite and the health of the jawbone.
Replacement options typically include a dental implant, which surgically replaces the root and tooth with a titanium post and crown, or a fixed dental bridge that uses adjacent teeth for support. The choice between extraction and a root canal depends on an assessment of the tooth’s remaining structure and the extent of the infection.