The discovery of a tooth bleeding from its center is an alarming event that signals a significant internal problem. This symptom means the protective layers of the tooth have been breached, exposing the highly vascularized tissue deep within. Unlike bleeding from the gums, which often indicates periodontal disease, internal tooth bleeding points to damage within the tooth structure itself. This condition requires prompt professional evaluation because it indicates the tooth’s vitality is compromised.
The Anatomy Behind Internal Tooth Bleeding
A tooth consists of three hard outer layers: the enamel, dentin, and cementum. Beneath these protective shells lies the central pulp chamber, often called the “middle” of the tooth. This chamber is filled with soft tissue known as the dental pulp, a network of nerves, connective tissue, and blood vessels.
The dental pulp provides nourishment to the tooth and relays sensation. When the outer layers are damaged, the pulp becomes exposed to the bacteria-filled oral environment. Bleeding occurs because the fragile blood vessels within the pulp are severed or damaged. This exposure leads to inflammation, known as pulpitis, which is the biological process underlying the bleeding symptom.
Specific Causes of Bleeding from the Tooth Center
Severe Dental Decay
One frequent cause of pulp exposure and subsequent bleeding is severe dental decay (caries). Untreated cavities erode the hard enamel, penetrate the softer dentin layer, and eventually reach the pulp chamber. Once bacteria enter the pulp, the inflamed tissue bleeds easily upon contact or pressure.
Physical Trauma
Another common scenario involves significant physical trauma to the mouth. A sudden impact, such as from a fall or sports injury, can cause a complicated crown fracture that extends directly into the pulp. Even without a visible fracture, a deep crack running vertically through the tooth structure (a vertical root fracture) can expose internal tissues, leading to hemorrhage and potential infection.
Complications from Dental Procedures
The issue sometimes arises from complications related to previous dental procedures. A deep filling placed close to the pulp chamber may fail, or the remaining dentin may be too thin to protect the pulp from bacterial micro-leakage. In rare cases, the procedure itself may have inadvertently caused a minor, unnoticed pulp exposure that later becomes symptomatic. These events allow bacteria to breach the pulp’s protective barrier, leading to swelling and bleeding.
Immediate Actions and Triage
Managing the situation at home focuses on temporary measures to control bleeding and prevent further contamination before a dental appointment. The first step is a gentle rinse of the mouth with lukewarm water to clear away debris or visible blood. Avoid aggressive swishing or spitting, as this can dislodge any forming clot and prolong the bleeding.
To help stop the hemorrhage, apply light, consistent pressure directly to the bleeding site using a clean piece of gauze or a dampened tea bag. The tannic acid in a tea bag acts as a mild astringent, which helps constrict blood vessels and encourage clotting. Keep the pressure steady for several minutes, then check carefully without scrubbing the area.
For pain, over-the-counter pain relievers can be used, but avoid non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, until speaking with a dental professional. While effective for pain, NSAIDs slightly interfere with the body’s clotting mechanism. Any sign of uncontrolled bleeding, severe facial swelling, or pain unmanageable with medication requires immediate contact with an emergency dental service.
Clinical Diagnosis and Definitive Treatment Pathways
Upon arriving at the dental office, diagnosis begins with a thorough examination and diagnostic imaging. Dental X-rays are taken to assess the extent of internal damage, look for signs of decay, and determine if infection affects the bone surrounding the tooth root. The dentist will also perform pulp vitality testing, often using a cold stimulus, to determine the functional status of the nerve and blood vessels.
The definitive treatment pathway is determined by the severity of the damage and the health of the remaining pulp tissue. If the pulp is minimally exposed and the bleeding can be stopped quickly, vital pulp therapy may be possible. This involves applying a biocompatible material, such as Mineral Trioxide Aggregate (MTA), directly over the exposure site to seal it and encourage healing. This approach is often reserved for exposures caused by trauma or in younger patients.
If the internal bleeding is profuse, or the pulp shows signs of irreversible inflammation or infection, the most common definitive treatment is root canal therapy. This procedure involves completely removing the compromised soft tissue from the pulp chamber and root canals. The internal space is then meticulously cleaned, disinfected, and filled with an inert material to prevent future bacterial colonization.
In situations where the tooth structure is severely compromised, such as by an extensive vertical root fracture, the damage may be too great to save the tooth. In these cases, the only viable treatment option is extraction to prevent the infection from spreading to the jawbone. The goal of any treatment is to eliminate the source of the bleeding and infection while preserving the tooth’s function whenever possible.