What Happens When a Tooth Nerve Dies?
The tooth pulp is a soft tissue inside the tooth containing blood vessels, nerves, and connective tissue. It provides nourishment to keep the tooth alive. When the pulp becomes infected or injured due to dental decay, trauma, or other causes, the blood supply is cut off. This leads to inflammation of the pulp known as pulpitis.
Over time, as the inflammation worsens, the pulp tissue starts to necrose or die from the lack of blood flow. This is called pulp necrosis. With the nerve signals gone, the tooth becomes unresponsive to stimuli that would normally trigger pain.
While the tooth may now be pain-free, bacteria and infection remain active inside the root canals and pulp chamber. Lacking a blood supply, the body’s immune response cannot fight this infection. The bacteria and their toxic products will start to spread beyond the ends of the tooth roots, infiltrating the surrounding bone.
This leads to a dental abscess – a pocket of pus forming in the jawbone surrounding the tooth roots. The pus is a mixture of dead cells, bacterial waste, and inflammatory fluids walled off by the body’s attempts to contain the infection. An abscess places pressure on surrounding tissues, causing bone loss and sometimes painful swelling.
Over time, it creates an osteomyelitis, where chronic inflammatory infection causes progressive destruction and death of the supporting jawbone around the problem tooth. This is a serious condition and a major reason dead teeth usually require treatment.
Signs and Symptoms of a Dead Tooth
How do you know if your tooth nerve has died and become infected? Some common signs and symptoms include:
- Pain in the tooth that is severe, constant, and lingering
- Tooth sensitivity to hot or cold temperatures
- Swelling, bumps, or tender spots in the gums near the infected tooth
- Bad breath or bad taste coming from the tooth and gums
- Dark discoloration of the tooth, from off-white to grey, yellow, or brown shades
- A pimple, blister, or pus bubble on the gums signaling an abscess
- Loosening of the tooth or sensitivity to biting down
- Numbness or altered sensations in the teeth, gums, lips, or face
However, a dead tooth may not always be painful or conspicuous. The nerve dies silently in some cases, leaving no overt symptoms except on x-rays showing bone changes around the roots. Regular dental exams are crucial to identify these “quiet” cases before they worsen.
Risks of Leaving a Dead Tooth Untreated
While a dead tooth itself may not cause issues, the bacteria and infection inside it remain active and continue to spread into surrounding bone. Potential risks of leaving a dead tooth include:
- Abscess formation – An abscess will likely form at the root tip, putting pressure on bone. This can destroy large amounts of jawbone before becoming obvious.
- Cellulitis – The abscess may rupture and allow infection to spread into surrounding gum, lip, cheek, or facial tissues. This cellulitis is very painful and can progress to a life-threatening condition.
- Osteomyelitis – Chronic infection in the bone causes osteomyelitis, which can be very difficult to eliminate even with aggressive antibiotic treatment. This causes irreversible bone loss over time.
- Systemic infection – Though rare, infection spreading from the tooth could reach the bloodstream, lymph nodes or other organs. People with compromised immunity are at higher risk for this potentially fatal outcome.
- Tooth fracture – The walls of the tooth become brittle and prone to fracture with normal biting forces. This may lead to rupturing of the tooth below the gumline and necessitate extraction.
- Harm to adjacent teeth – The infected bone around the dead tooth may start to compromise health of nearby tooth roots as infection spreads through bony contacts.
Rarely does a dead tooth improve on its own or become asymptomatic permanently. Monitoring with x-rays may detect warning signs before major damage develops. But most dentists recommend definitive treatment within weeks to months even for stable cases.
Can a Root Canal Be Done on a Dead Tooth?
Root canal treatment is usually the first choice for saving a dead tooth. During this procedure, the endodontist will:
- Anesthetize the tooth to keep the area numb during treatment.
- Drill an opening through the biting surface into the pulp chamber and root canals to access the nerve space.
- Use specialized tools to remove all infected and dead pulp tissue from inside the tooth.
- Irrigate and disinfect the interior tooth spaces with antibacterial solutions.
- Fill and seal the empty root canals with an inert rubbery material called gutta percha.
- Seal the access cavity temporarily then permanently restore with a filling or crown.
Root canals have a high success rate of over 90% when done properly and in a tooth without extensive structural defects. However, they do not address any infection already present at the root ends or in surrounding bone that has “escaped” from the canals. Additional treatments may be needed to control this.
Follow up appointments are required to evaluate healing before the final restoration is placed. Root canals do not last forever and have an annual failure rate of around 5-10%. So ongoing monitoring is necessary even for treated teeth.
When Is Tooth Extraction Necessary for a Dead Tooth?
In some cases where the nerve has died, extraction may be the only reasonable option. This includes:
- Non-restorable fractures from trauma or decay that have destroyed too much tooth structure.
- Severely curved, fused, or blocked roots that prevent access for root canal treatment.
- Teeth underneath old crowns, bridges, or dental implants that cannot be accessed.
- Significant infection in the root tips and jawbone that is unlikely to resolve.
- Medical conditions that increase risks of long dental procedures in susceptible patients.
- Financial constraints and cost concerns that rule out a root canal.
Extractions are also often needed for dead teeth that have already developed large abscesses, cellulitis, or other spreading infections. Draining the pus and removing the tooth may be the quickest way to resolve the infection.
The extraction procedure involves numbing the area, gently loosening the tooth, and using instruments to remove it carefully without leaving root fragments behind. Stitches, pain medication, and detailed post-op instructions are provided afterward. Healing can take 3-6 months as the bone gradually fills in the socket.
A dead tooth that is stable and asymptomatic may potentially be monitored without treatment for a short time in select cases. However, this is considered a temporary measure only, and definitive root canal therapy or extraction is still recommended for most necrotic teeth within a few months following diagnosis.
Close follow up and x-rays at regular intervals are crucial to detect any signs of infection or damage around an observational tooth. But more often than not, preventive treatment will be advised to avoid the serious complications that can occur from leaving a tooth with a dead nerve untreated long-term. With proper assessment and timely care, dead teeth can be managed safely.