When people hear of the phase ‘dead tooth’ they often think of Halloween or something ominous. Actually, it is very common and easily treated if attended to early. A dead or non-vital tooth is a tooth that has no access to blood flow. A healthy tooth contains pulp tissue in the center of the tooth. Pulpal tissue is composed of nerves, blood vessels, lymph tissue, and connective tissue. Lymph tissue plays a role in transporting white blood cells and the vascular tissue is responsible in transporting other components of out immune system which keeps the inside of a tooth sterile and healthy. A ‘dead pulp’ means no pulp tissue is contained in the tooth and hence there are no immune cells present to keep the tooth free of bacteria. Whenever a warm moist environment is present inside a tooth devoid of immune cells, bacteria will often find a way to accumulate resulting in a bacterial infection of a tooth.
Untreated tooth decay is the most prevalent cause of a dead tooth. When a dental cavity gets very large it may reach the inner pulp layer of the tooth. This will usually cause the tooth to start hurting because the dental pulp will be inflamed. Eventually the pulp in the tooth may become necrotic because the inflammation is too much for the pulp to handle. In this situation the pulp is trying to protect itself from the decay by constricting its vessels. This increases the pressure inside the pulp, causing the blood supply to be siphoned, which can kill the pulp.
To learn more about dental decay and its treatment please visit us here:
Tooth trauma can be caused by sports injuries, children or adults falling on their front teeth, severe grinding, and physical altercations – any form of physical knock on the tooth can result in a dead tooth. When knocked, the blood supply at the tip of the root can be severed. This can cause the pulp to die. To prevent dental injuries, sports mouth guards are recommended for contact sports activities. A custom fitted sports mouth guard can protect against dental trauma better than a standard ‘boil and bite’ one found in sports stores. If you need a night guard for hockey or other contact sports please let the staff at St. Lawrence Dentistry know and they will assess your individual situation. Dr. Hawryluk was the dentist for the Toronto Maple Leafs Hockey Club for many years so has ample experience making sports guards aimed at preventing necrotic teeth and other potential injuries.
Not every traumatic incident results in a tooth losing its vitality. After a tooth has had trauma, Dr. Hawryluk will assess the area and see if further treatment is necessary. Sometimes the blood supply to the tooth is only temporarily disabled. This means that the diagnosis of a dead tooth may take several weeks to definitively make. In these cases the tooth often can be mildly symptomatic for a few weeks and then tighten up over time. Waiting to see what happens over time can avert the need for root canal treatment sometimes. Dr. Hawryluk has ample experience with teeth it these circumstances and will ensure an accurate diagnosis is made between a non vital and vital tooth.
It’s not easy to identify a dead tooth by just looking at it. A visit to the St. Lawrence Dentistry can be helpful as we can spot the signs of a dead or non-vital tooth. One main symptom of a dead tooth is tooth darkening. A tooth that has a yellow, grey or black shade is a sign of a dead tooth. This usually happens in untreated non-vital teeth. The discoloration is sometimes due to “bruising” from the dying blood cells. Tooth darkening will not disappear on its own – it needs to be treated. If your tooth has been discolored from stagnant blood sitting in a tooth Dr. Hawryluk can usually mask the stain by treatment. The tooth can be bleached internally and a very light shade of composite can be placed after treating the dental pulp. Sometimes a porcelain crown is indicated to regain the original shade of the tooth.
Dr. Hawryluk said that in his experience the most common tooth he has seen become non-vital at his Mississauga Dental Office is the primary upper central incisor in children. Children around 3-5 years often fall and these teeth get knocked a lot. Parents often come in distressed to see their child’s tooth becoming dark. Fortunately, in many cases no treatment is needed and the tooth will naturally exfoliate around 7-8 years of age. The tooth is assessed and then it is checked again a few weeks later. Treatment on these primary teeth may be needed if the tooth is still tender, a bubble forms around the root area of the tooth, or if it is mobile. An x-ray may be needed to make a diagnosis and the treatment options may include removal of the primary tooth and or cleaning out the root of the tooth (primary pulpotomy).
Pain is a common symptom of a dead tooth. It can vary, from mild, non-existent, to more severe. When the tooth pulp dies bacteria builds up in the tooth and this eventually can spread outside of the tooth at the end of the root creating a dental abscess. The pressure the abscess puts on the tooth periodontal ligament creates the pain. If abscess is present, you may notice a bad taste, swelling, an altered smell of the area, or a pimple on the gum. The dentist should be able to tell you if these signs are a manifestation of a dead tooth. An x-ray will often show radiolucency at the end of the tooth. This lucency represents where the abscess has eaten away the bone and replaced it with bacteria laden tissue (dental abscess). The dead tooth may eventually loosen up and be tender to percussion and chewing.
Root Canal therapy is the main treatment needed to retain a dead tooth which has become infected. A root canal completely cleans out and sterilizes the middle part of the tooth which once contained the dental pulp. After the bacteria is cleaned out the root is filled (obturated) with Gutta Percha rubber. This completely seals the canal space and corks off the end of the root. At the end of root canal treatment there should be no bacteria left in the tooth but there may be some still lingering in the bone at the end of the root. This is because root canal treatment only cleans out the tooth and not the surrounding bone. However, once the root is completely corked off the immune cells in the bone can usually start to dissipate and eventually rid the bone of bacteria. Root canals at St. Lawrence Dentistry are done with the latest technology and Dr. Hawryluk has done thousands of successful root canals. One indispensible part of our treatment armamentarium is the Global Dental Microscope. This allows the dentist to see with unprecedented clarity to make sure no area of the canal is left unfilled. If the abscess does not heal from the root canal treatment alone, sometimes simple endodontic surgery (apicoectomy) is needed to clean the rest of it.
To learn more about root canal procedures at St. Lawrence Dentistry please visit us here:
To learn more about apicoectomy (root-end) procedures please visit us here:
If you feel you may have a tooth with is dead and would like to confirm your assumptions please call the reception desk at St. Lawrence Dentistry. They will book a consultation with the dentist and he will see what the status of your tooth is. We will do several tests which may include percussion, heat and cold sensitivity tests. We will see if any abscess tissue exists around your tooth and discuss treatments to eradicate it.
Sometimes dead teeth need to be removed. This is done when the tooth is no longer qualified for repair options or the patient declines to save it. Several factors are considered when deciding whether to save or remove a dead tooth. These include the probability of success with repair options, whether or not additional procedures like crowns would be needed, the length of the roots, and the position of the tooth in the mouth. Removal is a practical option for some people with budget restrictions as this is the least expensive procedure. The extracted tooth can be replaced later by a dental implant, partial denture, and in some cases a fixed bridge.
To learn more about tooth extractions please visit us here:
To learn more about the tooth replacement discussed above options please visit us here:
Dead teeth can lead to dental abscess which can catch people by surprise by the rate at which they fair up. Since having a nice set of teeth is an asset to our overall health, taking good of any non-vital teeth is an investment your well being. If you live in the Mississauga/Oakville area and think you may have a dead tooth please call our office.