The necrotic tooth is also called non-vital tooth or dead tooth and refers to the situation in which the dental pulp inside the tooth has died, is no longer vascularized, and the space left inside the root becomes vulnerable to bacterial colonization.
Most of the time pulp necrosis does not have a specific cause but is the end result of a process of tissue degeneration. Once the dental pulp has suffered an injury from which it cannot recover, it begins a process of degradation and finally reaches necrosis of the pulp tissue.
These teeth usually have a history of repeated trauma, extensive caries, periodontal disease or rapid orthodontic movements. Sometimes a process called “calcic metamorphosis” can be installed, in which the dental cells deposit excessive amounts of repair dentin at an alert rate.
The result is a tooth that seems to no longer have a root canal (although it still has a microscopic one). These teeth can appear non-vital after vitality tests, just like necrotic teeth.
Teeth with necrotic dental pulp respond negatively to thermal or electrical stimuli, but they can be sensitive to pressure (percussion, biting), or even painful in certain situations, but this is not mandatory. It is possible for a tooth to exist in this state for several years, without causing the patient any discomfort.
Aggravation of the infection
Necrosis of the dental pulp occurs in aseptic conditions, that is, without the involvement of bacteria, and as long as this condition is maintained, the teeth is almost asymptomatic.
When the bacteria manage to infiltrate the necrotic dental pulp (through a cavity, fissure, dental fracture, etc.), the process of bacterial colonization begins and the tooth becomes painful, with all the symptoms of an acute infection: significant continuous or pulsating pain and/or local inflammation. In addition, sometimes the tooth may appear “outgrown” (higher than the others).
Frequently, necrotic teeth are darker in color than the neighboring teeth, an aspect caused by metabolic products resulting from the process of pulp degradation. Blood cells, rich in iron (red-brown in color) enter the dentine layer, resulting in a darker color of the tooth. This effect is more obvious in the front teeth (incisors and canines).
Necrotic teeth can in some situations present a gingival abscess or a fistula through which the infection drains from inside the root. Most of the time, the appearance of the fistula is accompanied by the reduction of symptoms.
A tooth diagnosed as necrotic and having accessible root canals is generally treated by endodontic treatment (root canal treatment). It is usually possible to remove the gray shade of the tooth after endodontic treatment by applying a special whitening substance in the pulp chamber for a few days.
After the endodontic treatment, the tooth will require a coronal restoration which can be a filling, a cover crown or an inlay/onlay, depending on the amount of dental structure left.
The tooth with calcium metamorphosis usually does not require endodontic treatment. A retroalveolar radiograph can be taken to find out if a root canal is visible and if treatment is possible to correct the color of the tooth. An alternative in this regard can be the application of a veneer or the covering of the tooth with a crown.
If you have a tooth that is darker in color or that you feel is different from the others, we recommend that you make an appointment for a consultation and together we will establish, if necessary, a treatment plan that will help us avoid a possible exacerbation of the infection.
Your Tooth Can Die Without You Even Noticing.
The enamel, dentin, and pulp are the three tissues that make up the majority of a tooth. Problems in this last structure can cause pulpal necrosis.
When pulp necrosis occurs , the tooth dies without you noticing. Often this problem is only noticed by the person because it causes a slight discoloration of the tooth, which looks different from the others.
Pulp necrosis is the failure of the nerve system and blood supply of the tooth that are in the region called the dental pulp. When this happens, the vascular and nervous system that brings vitality to the tooth stops working, that is, the tooth dies.
The process is asymptomatic, therefore, the affected person does not feel pain. Often, necrosis in the dental pulp begins to bother only when it reaches the supporting structure of the tooth. Thus, there is the emergence of high sensitivity and local swelling.
What Causes Pulp Necrosis?
Pulp necrosis results from the evolution of inflammation in the dental pulp. Thus, any stimulus that can provoke an inflammation stronger than the defense of the pulp can be considered a cause of the disease.
Bruxism, untreated trauma and cavities, periodontitis, chemical irritations and even advanced age can trigger the problem.
At first, it is very difficult to detect necrosis, and even when discomfort begins, the patient has difficulty identifying the nature of the pain.
The diagnosis is made from complementary exams. A common technique is to stimulate the possibly affected teeth with hot or cold temperatures while the dentist observes the patient’s reactions.
Depending on the individual, the discomfort may last for a few minutes. However, if it takes time to pass or the teeth does not respond, possibly the patient has irreversible pulpitis or a necrotic teeth .
When the case is reversible, the pain ends as soon as the professional stops stimulating the teeth. But when the condition is irreversible, the patient needs to undergo a surgical procedure to get rid of the problem.
Treatments For Pulp Necrosis Tooth
Performing root canal treatment is the main solution for a necrotic tooth . Endodontic treatment consists of removing necrotic or contaminated pulp tissue.
From then on, the path is clear so that the professional can clean and disinfect the inside of the canal and seal it with filling material.
When root canal treatment is satisfactory, the lesion decreases over time and so the bone can occupy the affected region again.Following surgery, the patient might need to take medications including painkillers and antibiotics.
The prevention of pulpal mortification is mainly based on excellent oral hygiene. Thus, it is necessary to brush after meals and use floss or dental tape.
Additionally, the patient must visit the dentist on a regular basis. With this, he will be able to identify possible cavities or other irritating agents of the pulp at the beginning of the process and thus avoid pulp necrosis .