When people hear of the phrase dead tooth, they often think of Halloween or something ominous. It is widespread and fortunately 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 for transporting other components of our immune system, which keeps the inside of a tooth sterile and healthy. A dead pulp means no pulp tissue is present in the tooth, and hence there are no immune cells present to keep the tooth free of bacteria. Whenever a warm moist environment is inside a tooth devoid of immune cells, bacteria will often find a way to accumulate, resulting in a bacterial infection of a tooth.
U ntreated 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–resulting in pain and inflammation. Eventually, the pulp in the tooth may become necrotic because the swelling is too much for the pulp to handle. In this situation, the dental pulp is trying to protect itself from the decay by constricting its vessels—consequently, the pressure inside the tooth increase, leading to less (and eventual no) blood flow.
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Tooth trauma can result from sports injuries, children or adults falling on their front teeth, severe grinding, and physical altercations – any form of a 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, causing the pulp to die. St. Lawrence Dentistry recommends Sports Mouth Guards for contact sports activities. A custom-fitted sports mouthguard can protect against dental trauma better than a standard ‘boil and bite’ one found in sports stores. If you need a nightguard for hockey or other contact sports, please let the staff at St. Lawrence Dentistry know, and they will assess your situation. Dr. Hawryluk was the dentist for the Toronto Maple Leafs Hockey Club for many years, so he has ample experience making sports guards aimed at preventing necrotic teeth and other potential injuries.
N ot 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–hence the diagnosis of a dead tooth may take several weeks to make definitively. In these cases, the tooth can often 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. Dr. Hawryluk has ample experience with teeth in these circumstances and will ensure an accurate diagnosis.
I t’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 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. The discoloration is sometimes due to bruising from the dying blood cells. Dr. Hawryluk can return your tooth to the proper shading by dental bleaching or application of a porcelain crown.
Dr. Hawryluk said that in his experience, the most common tooth he has seen become non-vital 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. Treatment on these primary teeth may be required if the tooth remains 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).
P ain is a common symptom of a dead tooth. It can vary, from mild, non-existent, to more severe. When the tooth pulp dies, bacteria build 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 is responsible for the pain. If an abscess is present, you may notice a bad taste, swelling, and 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 primary treatment needed to retain a dead tooth that has become infected. A root canal thoroughly cleans out and sterilizes the middle part of the tooth, which once contained the dental pulp. After cleaning the bacteria, the root is filled (obturated) with Gutta Percha rubber, which completely seals the canal space. At the end of the root canal treatment, there should be no bacteria left in the tooth. Some lingering discomfort may be present for a few days due to inflammation/infection of the surrounding tooth tissues. However, once the root is ‘corked-off,’ the immune cells in the bone can usually start to dissipate and eventually rid the bone of bacteria. At St. Lawrence Dentistry, we use the latest technology, and Dr. Hawryluk has done thousands of successful root canals. One indispensable part of our treatment armamentarium is the Global Dental Microscope. With it, Dr. Hawryluk can see with unprecedented clarity, ensuring no canal space 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.
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I f 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 Dr. Hawryluk Jr., 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.
S ometimes dead teeth need to be removed. To determine if tooth removal is the best option, Dr. Hawryluk Jr. will consider 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. A 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.
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Dead teeth can lead to a dental abscess, which can catch people by surprise by the rate at which they fair up. Since having a beautiful set of teeth is an asset to our overall health, taking good of any non-vital teeth is an investment in your well being. If you live in the Mississauga/Oakville area and think you may have a dead tooth, please call our office.