Pulp necrosis is a clinical diagnosis indicating the death of the dental pulp, the inner soft tissue of a tooth made up of nerves, blood vessels, and connective tissue. But when a severe toothache suddenly disappears, it may seem like the problem has gone away. The reality, however, is much more serious.
Pulp necrosis represents the end of a pathological process that started long before the pain disappears. It occurs when the inflammation in the pulp, which is referred to as irreversible pulpitis, goes beyond the stage of recovery, cutting off the blood supply and causing tissue death. It is critical to understand this silent process since pain may not be evident, severe infection and possible complications in the surrounding tissues, and the mouth's overall health may remain undetected. Read along to understand how pulp necrosis occurs, the symptoms often overlooked, and the steps needed for timely diagnosis.
Understanding Pulp Necrosis
To appreciate the severity of pulp necrosis, it is vital to have a firsthand understanding of the functions of the dental pulp. The pulp is the essential center of your tooth, containing blood vessels and nerves enclosed within a protective chamber.
This vital tissue supplies the tooth with nutrients and relays sensations such as heat or cold. The death of this tissue results in the loss of vitality of the tooth and its internal defense mechanism. This pulp death is called pulp necrosis, and it indicates that the tooth has been overpowered by an infection or trauma to the extent that it cannot heal.
The death of the pulp is not abrupt but is the final stage of irreversible pulpitis. In irreversible pulpitis, the pulp is highly inflamed but still alive. Unattended, the inflammation blocks the blood supply, which starves the tissue of oxygen and nutrients until death.
When necrosis has taken place, the dead tissue and bacteria within your tooth start to putrefy, forming a perfect breeding ground where a severe infection can grow and extend outside the walls of your tooth.
The Primary Causes of Pulp Necrosis
Pulp necrosis usually occurs when bacteria enter the pulp chamber or an injury cuts off the tooth’s blood supply. You should also know the conditions that may cause this because knowing them at the onset is vital to avoid irreversible harm.
A deep, untreated cavity is the most prevalent cause of pulp necrosis. In cases where tooth decay is left unattended, it spreads out of the surface enamel into the underlying dentin. The closer the decay gets to the pulp, the more bacteria may enter this sterile space and trigger a serious inflammatory response.
Your body's immune system sends cells to combat the infection, but in the rigid, inflexible walls of the tooth, the resulting swelling puts pressure on it and limits blood circulation. This bacterial invasion and consequent inflammation will eventually result in the total death of the pulp tissue.
The other major cause is severe tooth trauma. When you hit a tooth with a sharp blow in a sports injury, an accident, or a fall, the force can cut the delicate blood vessels at the end of the root. This sudden shock blocks the blood to the pulp.
Without this vital circulation, the pulp tissue will starve due to a lack of oxygen and nutrients and gradually die, although there may be no crack or cavity on the tooth. This may be a gradual, silent process; the first indication may be a gradual darkening of the tooth over months or even years.
Lastly, bacteria can easily infect the pulp when a tooth cracks or breaks. A crack that is so small that one cannot see it with the naked eye can be big enough to allow oral bacteria to ooze in and start colonizing the pulp chamber.
In contrast to the gradual decay process, a fracture may cause an acute and sudden pulp infection. The continual exposure of bacteria to a crack guarantees that the inflammation is irreversible, and soon, the pulp necrosis occurs and preconditions the spread of the infection.
Symptoms of Pulp Necrosis
Identifying the symptoms of pulp necrosis is vital since they tend to evolve misleadingly. The issue has been resolved, but has progressed to its most dangerous stage. The shift from an inflamed living pulp to a necrotic state follows a predictable sequence of warning signs.
Irreversible pulpitis is just before necrosis, usually marked by severe and persistent pain. You might experience a sharp, stabbing pain that begins without cause or preceding symptom.
This is usually made worse by hot or cold temperatures. Unlike the transient sensitivity of a healthy tooth, it will persist up to thirty seconds or even longer after you remove the stimulus. This causes a persistent, acute pain, a sign that the pulp is highly inflamed and cannot heal itself.
Pulp necrosis is most suggestive and misleading when the pain or sensation is suddenly absent. You might wake one morning to find the tooth no longer painful after enduring persistent pain from irreversible pulpitis.
When your tooth stops reacting to hot or cold, it might seem like it’s getting better, but it means the nerves are dead. The nerve tissue is no longer functional, which means that the tooth cannot send any sensory signals, and hence the false feeling of relief as the underlying infection continues to smolder unnoticed in the closed pulp chamber.
Once the pulp dies, tooth discoloration is often visible. As the internal tissue breaks down, pigment from blood cells seeps into surrounding dentin, turning the tooth gray, brown, or black. This blackening is a vivid sign that the tooth is no longer alive.
Although the nerve within the tooth is dead, you may still feel severe pain when the tooth is tapped or pressed. This is because the infection is no longer confined to the tooth. The bacteria and their toxic products escape through the small hole at the end of the root and into the surrounding periodontal ligament and jawbone.
This initiates another inflammatory reaction in the tissues that support the tooth, making biting down, chewing, or even touching the tooth tenderly painful. This pain, caused by pressure, clearly indicates that the infection has spread and is now spreading to the bone.
Diagnosis of Pulp Necrosis by a Dentist
If you present symptoms suggestive of a dying or dead tooth, your dentist will perform specific diagnostic tests to confirm pulp necrosis. It is a diagnostic procedure that is systematic and aimed at distinguishing between a healthy tooth, an inflamed but alive tooth, and a necrotic one.
Thermal and electric pulp testing is one of the most conclusive diagnostic tests. Your dentist will use a cold stimulus, usually a frozen cotton pellet, to the suspect tooth to determine the vitality of the pulp.
A healthy tooth will experience a short, sharp pain that will vanish after removing the cold substance. A tooth with irreversible pulpitis will experience an exaggerated, lingering, painful reaction.
However, you will feel nothing when you have pulp necrosis because the dead nerves cannot react to the temperature change. Equally, an electric pulp tester can be applied, which applies a small, harmless electrical current to the tooth. The absence of response to this stimulus also proves that the pulp is no longer alive.
Your dentist will also conduct a percussion test. This is done by tapping the biting side of your tooth and others with the handle of a dental tool. A tooth with a necrotic pulp will not be sensitive to temperature, but acutely sensitive to this tapping.
This is because the infection has probably extended to the periodontal ligament around the root, and the pressure of the tapping aggravates this inflamed tissue. Painful reaction to percussion is a good indicator of periapical infection.
Dental X-rays are critical in the diagnosis of the outcome of pulp necrosis. Though the dead pulp tissue cannot be seen on an X-ray, a clear picture of the bone structure in the root tip is visible.
A dark spot or shadow in the apex of the root will be common in a long-standing case of pulp necrosis. That dark spot on the X-ray, known as a periapical radiolucency, means the infection has eaten away some of the bone around the tooth. The existence of this shadow is an affirmation that the necrotic pulp has caused periapical disease, or a dental abscess, which should be treated as soon as possible.
Treatment Of A Necrotic Tooth
Once pulp necrosis is diagnosed, it will not resolve spontaneously. The infected, dead tissue within your tooth should be removed to remove the source of infection and ensure that it does not cause any further harm to your jawbone and general health. Two primary treatment methods can be used to deal with a necrotic tooth, and the decision to use one or the other depends on the state of the tooth and your long-term oral health objectives.
Root Canal Therapy
Root canal therapy is the standard treatment to preserve your natural tooth. In a root canal, the dentist or endodontist drills a small hole in the tooth to reach the pulp chamber. Using specialized tools, they carefully cleanse all the dead pulp tissue, bacteria, and debris in the tooth's root canals. The canals are then well cleaned, disinfected, and shaped. Once the inside of the tooth is thoroughly sterilized, the canals are stuffed with a biocompatible rubber substance known as gutta-percha and sealed to prevent any future infection.
Since a tooth with a root canal is more vulnerable, a dental crown is always added to give it strength and protection to restore its full functionality.
Tooth Extraction
Under certain circumstances, though, you may undergo a tooth extraction procedure. This is so when the tooth is so severely decayed or fractured that the restoration cannot be done using a crown, or when there is extensive loss of bone around the tooth's root because of an old infection.
If the tooth is not salvageable, it has to be extracted to remove the infection. Although losing a tooth is not the best thing, it is sometimes the only option to save your health because of a spreading disease.
After an extraction, you should talk to your dentist about replacing the tooth with a dental implant, bridge, or partial denture to ensure proper bite alignment and that the remaining teeth do not drift.
The Risks of Not Treating Pulp Necrosis
The most dangerous thing you can do to your oral and systemic health is ignore a necrotic tooth, even though it does not hurt anymore. The absence of pain indicates that the tooth’s internal warning system is no longer functioning, while the infection continues progressing. Unattended pulp necrosis will cause severe and painful complications as the bacteria multiply in the closed chamber and find a way out.
The direct effect of failing to care for a necrotic tooth is the development of a painful abscess in the mouth. The infection within your tooth would spread out of the small hole at the tip of the root and into your jawbone.
Your body's immune system will seek to quarantine the infection, forming a pus pocket of dead white blood cells, bacteria, and tissue debris. This abscess causes an enormous amount of pressure in the bone, causing a severe, constant, and throbbing pain that is much more severe than the original toothache. You may also experience swelling in your gums, face, or jaw, fever, and an overall feeling unwell.
Moreover, this local infection can be transmitted, leading to more serious health problems. Unless the abscess is emptied and the cause of the disease is eliminated, the bacteria may erode through the bone and soft tissue and spread to the surrounding areas.
This may cause a life-threatening skin infection on the face known as cellulitis. The disease may spread to other areas of your body, including the sinuses, the brain, or even the airway, a condition called Ludwig's angina, resulting in swelling that may cut off your breathing. When a tooth infection is left to develop this far, it becomes a medical emergency requiring urgent dental and possibly medical intervention.
Find Efficient Dental Services Near Me
Pulp necrosis is the irreversible death of the tooth's inner tissue and requires urgent treatment by an experienced dentist. After the pulp dies, bacteria can spread beyond the tooth, potentially causing severe pain, bone damage, and infection in the surrounding tissues. The fact that pain disappears after a severe toothache is not an indication of healing; it is a symptom that the disease has progressed. Timely intervention at this step may help avoid severe complications and preserve your oral health.
If you notice tooth discoloration, sensitivity, or a sudden cessation of pain after severe discomfort, do not wait; seek evaluation immediately. Contact Northridge Advanced Dentistry at 818-701-3010 today to schedule your appointment and obtain expert diagnosis and treatment.
