Your teeth are alive and contain a pulp chamber situated at the center. The chamber has blood vessels, nerves, and soft and connective tissue connected to the root canal, which is why your tooth has sensations and looks nourished. Untreated decay, severe swelling, or trauma can cause the pulp chamber to lose access to blood, leading to its death. The death of the pulp chamber is called pulp necrosis.
If not treated, pulp necrosis can cause severe complications like dental abscess, systemic infection, facial swelling, and bone resorption. But you can salvage the tooth and prevent complications by proper diagnosis and treatment through root canal or extraction.
Pulp Necrosis Overview
Pulp necrosis is the death of cells, blood vessels, and tissue inside the pulp chamber due to severe bacterial infection or trauma. In order to understand just how destructive pulp necrosis can be, one needs to highlight the role of the pulp when healthy.
The pulp is filled with soft connective tissues, nerves, and blood vessels. It is located in the center of the tooth and its role is to give the tooth sensation. Additionally, it keeps the tooth nourished by forming and supplying nutrients to the dentin. A nourished dentin is the first defense against tooth irritation, sensitivity, and injuries. Therefore, when you develop pulp necrosis, your tooth is prone to many complications.
Pulp Necrosis Causes
The primary causes of pulp necrosis are:
Deep Dental Cavities or Caries
Cavities or caries are the most prevalent causes of pulp necrosis. When you allow cavities to advance, they eat away the enamel and dentin until they reach the pulp chamber. Once the chamber is exposed, bacteria can easily penetrate, leading to infections, swelling, and eventually the death of the pulp. The infection prevents blood vessels from supplying blood to the nerves, gradually leading to the pulp’s death.
Trauma or Injuries to the Teeth
During contact sports or an accident, you can sustain injuries or trauma to the teeth. If the trauma is extensive, it can damage the neurovascular blood vessels that supply blood to the tooth root, cutting the blood supply. When the pulp is not provided with oxygen, ischemic necrosis happens. You should go for a dental exam after an injury to the tooth, even when there are no visible fractures, because the trauma could have occurred even without the signs. Trauma to the teeth is the primary cause of non-bacterial pulp necrosis in children and adolescents.
Undergoing Multiple Restorative Procedures
If your teeth have undergone several restorative procedures, like dental fillings and crowns, your pulp is at risk of irreversible death. The cumulative irritation the tooth experiences, whether mechanical or thermal, lowers the pulp’s defense mechanisms or barriers, leading to chronic swelling that sometimes causes the soft tissues, nerves, and cells in the pulp chamber to die.
Cracks and Fractures
The cracks or fractures in your tooth could also cause necrosis. The enamel is the hard outer layer of the tooth. It protects the pulp and dentin from harm or exposure to harmful oral bacteria. When the enamel cracks or fractures, but the damage does not go past this outer layer or the dentin, your dentist can address the issue using dental fillings. However, when these fractures extend to the pulp, they expose the chamber to oral bacteria, leading to infection.
Advanced Periodontitis
When your gum disease spreads from the gum margins to the pulp, it could cause an infection and eventually the pulp’s death.
Pulpitis Progression
Pulp necrosis is the final stage of pulp infection. When the harmful oral bacteria access the pulp, they irritate the soft tissues, causing inflammation. The swelling is known as pulpitis. The initial stages of the inflammation caused by infection are characterized by sharp pains caused by high sensitivity to cold or hot substances. If you prevent the oral bacteria from accessing the pulp through cracks, cavities, or fractures, pulpitis can be reversed. You can do this by undergoing a dental filling procedure to seal the pathways that enable the harmful bacteria to access the core of your tooth.
If you do not act and the irritation continues, it may result in severe swelling. Pulpitis at this stage is irreversible and characterized by severe pain that can happen spontaneously and lasts for a few minutes until you remove whatever is irritating. Even after removing the irritant, the damage cannot be reversed.
Without early intervention, pulpitis will progress to the final stage, which is pulp necrosis. At this stage, you may not experience any pain, as the tooth has already lost its sensation due to the death of the nerves and cells.
Pulp Necrosis Symptoms
Necrosis's clinical presentation manifests in various signs and symptoms. The typical clinical symptoms are:
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Tooth Discoloration
You can tell you suffer from pulp necrosis if your tooth begins to discolor. The tooth can turn grey, dull, or brownish compared to the surrounding teeth. The discoloration happens when the blood hemoglobin in the pulp breaks down to create iron sulfides that stain the dentin. The discoloration can indicate your pulp is starting to die, particularly years after an injury or trauma to the teeth.
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Tooth Pain and Sensitivity
If the pulp dies completely, you stop experiencing pain or sensitivity. However, you are not free from discomfort. You will experience a dull ache from the apical nerves that are still alive. Besides, you might experience sharp pain when chewing, although not from the affected tooth, but from the swollen ligaments and bones surrounding it. You should be alarmed when the dull aches or throbs stop, as it indicates a dead pulp.
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Inflammation and Dental Abscesses
Once the bacterial infection kills the pulp, it spreads to the jawbone and other soft tissues, causing inflammation and pus pockets called abscesses. You could also develop pus-filled pimples on the gums. If you are experiencing these signs, it is a sign that your pulp is already dead and you are experiencing complications because of failing to arrest the infection.
Pulp Necrosis Diagnosis
Your dentist can diagnose pulp necrosis during routine dental checkups or when you visit with signs of pulp disease. When diagnosed with the condition, the dental expert will refer you to an endodontist, a dental expert with training and skills for treating dental pulp issues.
The symptoms you are experiencing could indicate pulpitis or pulp necrosis; hence, a thorough examination is needed for an accurate diagnosis. The tools used for diagnosis by dental experts are:
Thermal Tests
Your dental expert can use a cold test to determine if you have necrosis. The dentist applies a cotton swab containing a refrigerant against the tooth surface. The dentist will then ask if placing the swab causes any sensation. Typically, you should feel a sharp, non-lingering pain when a dentist places a cold cotton swab on your tooth surface. It is a sign of necrosis if you do not feel the sensation. Lack of sensation indicates a dead pulp. If the pain lingers and lasts for at least ten seconds after removing the swab, you have pulpitis, and some nerves are still alive.
Another thermal test is the heat test. The dental expert covers the affected tooth using a dental dam and then places a swab dipped in water on the tooth surface. If you do not feel any sensation, your pulp is dead.
Electric Pulp Testing (EPT)
Another way the dentist can determine if your tooth is necrotic is by using an EPT. The test entails using a special instrument to apply a tiny electrical current or pulse to an affected tooth. If the pulse does not cause any sensation, your tooth is necrotic. Any sensitivity indicates the nerves are alive.
Dental X-rays
An X-ray is crucial to examine the teeth and jawbone for changes in the structure. The images generated from the procedure help identify defects in the pulp chamber and the periapical bone. If you have dark spots around the tip of the root or signs of bone loss, it could indicate pulp necrosis. However, there might be no signs of bone loss because the pulp is dead.
Accurate diagnosis requires your endodontist to combine all these techniques. For instance, the thermal test could show the tooth has lost sensation, but this does not necessarily mean it is necrotic. You could have a filling covering the pulp, causing the tooth to lose sensation. However, the conclusion would be misleading, requiring additional tests. Loss of sensation is indicative but not definitive of necrosis.
Treatment for Pulp Necrosis
Early intervention is crucial in preserving the affected tooth and preventing tooth loss. Pulpitis does not reverse itself unless it is in the reversible stage. Nevertheless, when it becomes irreversible or advanced to pulp necrosis, you must undergo treatment to prevent severe complications like the spread of infection.
Not every dental expert can provide treatment for the pulp. Your dentist should refer you to an endodontist with extensive knowledge of root canals, as it is the prevalent solution for necrosis. The available treatment options are:
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Root Canal
Your general dentist or endodontist can perform root canal therapy to extract the dead material and infection from the pulp chamber. The treatment starts with an accurate diagnosis and development of a detailed treatment plan.
The next step entails accessing the pulp. This phase of the treatment can be painful, so the dental professional will administer anesthesia to keep you comfortable. They will then drill an access hole to expose the pulp chamber. All the dead cells, nerves, and soft tissue will be extracted, and the root canal channel will be cleaned thoroughly to remove bacterial infections. The endodontist shapes an endodontic file once the material is removed and the chamber is cleaned. The final step of this phase of the treatment is to disinfect the pulp using antibacterial irrigants.
After cleaning and disinfecting the canals, your dental expert fills them using biocompatible material.
A cover is then introduced to prevent oral bacteria from reaccessing the canals. The seal is usually in the form of a permanent restoration, like a dental crown. The restoration protects the tooth from bacterial reinvasion and strengthens the tooth, which has already been weakened by the extraction of dead pulp material and reshaping.
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Tooth Extraction
When the trauma to the affected tooth is extensive and reaches the tooth root, it cannot be reversed, and the only alternative is to extract. Endodontists prioritize saving the tooth. However, the dental expert will recommend extraction when the damage is extensive and all treatment options have been explored without success. Tooth removal is the last option. Even though you lose your tooth, it goes with the infection, meaning the problem will not recur. There are several options for replacing the lost tooth, such as implants and bridges.
Success of Pulp Necrosis Treatment
Endodontic therapy, such as root canal therapy, has successfully treated necrosis. The success of the treatment depends on several factors. Diseases like diabetes and a poor immune system can lead to a prolonged recovery duration and elevate the risk of complications.
Maintaining good dental hygiene and visiting the dentist frequently also increases the chances of a successful endodontic procedure. When leaving the dental clinic, your dentist will give you post-procedure instructions. Adhere to them because they protect the tooth from bacterial reinvasion.
Also, when the necrosis has significantly advanced, leading to complications like bone loss, the healing rate will be substantially reduced, increasing the likelihood of treatment failure.
Pulp Necrosis Prevention
After recovery, you should employ measures to prevent caries and fractures. Maintaining proper oral hygiene will also prevent the growth and spread of harmful oral bacteria. You can minimize the risk of necrotic teeth through:
- Regular brushing and flossing
- Routine dental cleaning and evaluation
- Reporting dental symptoms to your dentist
- Wearing a night guard if you grind teeth to prevent cavities, fractures, or cracks
Find an Experienced Endodontist Near Me
Many factors contribute to the death of the pulp, including dental trauma, deep cavities, cracks extending to the pulp, and pulpitis. However, you can prevent the condition by taking measures that prevent bacteria from accessing the pulp, like dental fillings for cavities and fixing fractures immediately. However, if you have already developed the condition, an experienced orthodontist can administer a root canal procedure to save the tooth.
At the Lasting Impressions Dental Spa, we will administer endodontic therapy to save the tooth, and extraction will be only a last resort. Call us today at 818-751-5100 for a thorough examination, accurate diagnosis, and an excellent treatment plan in Encino, CA.
