Overview

Pulp necrosis refers to a condition where the pulp inside your teeth die. This is often the last stage of chronic pulpitis. It can lead to other problems with your teeth.

The innermost part of each tooth has tissues called pulp. The pulp extends from the root to the crown. Pulp itself is a complex design of blood vessels and nerves that help keep your teeth healthy on the inside. The two parts of pulp are the root canal, which is at the bottom of your teeth, and the pulp chamber, which is located in the crown.

When you have dental (oral) diseases, the pulp can be affected and eventually die off. This can lead to other oral health issues if not treated promptly.

Symptoms

Most of the symptoms that indicate issues with your tooth and inner pulp occur before necrosis. This is because once the onset of necrosis happens, the nerves may stop sending signals that alert you to any pain or discomfort, because the pulp has died.

In the early stages of pulp issues, your tooth is especially sensitive to cold foods or drinks. Sweets can also bother the affected tooth. According to the Merck Manual, this discomfort lasts for about one to two seconds at a time.

Once pulp necrosis develops, you can’t feel cold at all. However, you might feel heightened pressure in the affected tooth from eating or grinding your teeth. This pressure also lasts for several minutes at a time, compared to just a couple of seconds. If you have no feeling in your tooth at all, this could be a sign of necrosis. A tooth can be necrotic due to untreated decay, trauma, or multiple large fillings. When the pulp is necrotic, you have irreversible pulpitis. In this case, you will need a root canal or a tooth extraction.

Tests

Before testing for pulp necrosis, your dentist will first perform an examination of your teeth, gums, and other surrounding tissues. Sometimes, this condition isn’t known to the patient. It may only be discovered after undergoing a dental examination. Dental X-rays are also helpful in narrowing down areas of decay or abscess that may be harboring pulp necrosis.

If pulpitis or necrosis are suspected, your dentist may use a tool called an electric pulp tester. This tool delivers small shocks to the tooth. If you can feel the shock, then the pulp is alive. If not, then necrosis could be possible.

Causes

Pulp necrosis usually starts off with tooth decay. According to the Nemours Foundation, tooth decay usually occurs in the form of cavities. A cavity starts off with plaque buildup, which leads to holes in your enamel. When caught early, cavities are filled in by a dentist and don’t cause any further issues. However, if a cavity continues to decay your tooth enamel, the effects eventually move into the pulp. Eventually, the pulp can die.

Another cause of pulp necrosis is chronic pulpitis. This involves long-term inflammation (swelling) of pulp from long-term decay, trauma, and multiple large restorations. At the stage of necrosis, pulpitis is considered irreversible.

Treatment options

Treatment options for pulp necrosis may vary based on the stage and severity of the condition. Your dentist might recommend one or more of the following:

  • Fillings. Your dentist may fill existing cavities to prevent further decay of the tooth. At the same time, old or failing fillings may be removed and replaced. This helps to protect not only your tooth, but also the pulp that’s inside your tooth.
  • Root canal. In this procedure, your dentist removes dead tissues throughout the pulp chamber and root of your tooth to eliminate infection. A gentle irrigation solution is used to thoroughly clean out the canal. Then, your dentist will apply a special filling called gutta-percha. Sometimes you need more than one appointment before your condition improves and the root canal is complete.
  • Pulp removal. This is a method of treatment used in pulp necrosis from irreversible pulpitis. During the procedure, your dentist makes a small hole in the tooth and manually removes the dead pulp. This is also done in conjunction with a root canal.
  • Tooth replacement. Depending on the severity of pulp necrosis, your dentist may remove the entire tooth. You can choose from a number of tooth replacement options depending on your budget and preferences.

Complications and associated conditions

Necrotic pulp can’t be revived without performing a root canal and/or extracting the affected tooth. Complications may develop over time if the tooth is left untreated. However, treatment itself can also lead to complications. With pulp necrosis and its treatment, you’re at risk for:

  • infection
  • fever
  • jaw swelling

Pulpitis and subsequent necrosis may be associated with:

  • cellulitis
  • abscesses (including those in the brain)
  • sinusitis
  • periodontitis (deep pockets of bacteria and inflammation)
  • bone loss

Outlook

When it comes to oral health, any form of inflammation or decay in your teeth and surrounding tissues can create a domino effect. Therefore, pulp necrosis is present when there are other problems with your teeth already. Dead pulp can’t be reversed. Root canals and tooth extractions are your two options.

Overall, the best way to prevent pulp necrosis is by taking care of your teeth and gums. This also includes seeing your dentist twice a year for checkups.