Dead tooth

introduction

A so-called “dead” tooth is a tooth whose vital functions are no longer intact. The nerve vessels and blood vessels within the tooth pulp have died and can no longer supply the tooth from the inside.

The tooth is now insensitive to thermal changes: it feels neither warm nor cold.
The hard tooth substances that are no longer supplied become unstable and brittle over time and the tooth can discolour. If the tooth is not crowned after a certain period of time after the root canal treatment, there is a risk of breakage.

What symptoms can a dead tooth cause?

Symptoms that accompany necrosis of the tooth can vary widely. These include:

• severe pain, tenderness and bite discomfort (while the tooth dies)
• severe pain subsides completely after a few days
• Formation of an abscess (with pus-filled, encapsulated cavity)
• strong, putrid halitosis
• Taste disorders
• Tooth discoloration (black)

Pain in the dead tooth

Teeth that have lost their vital function can be very painful. In the case of a causative tooth root inflammation, it often manifests itself as pressure pain, which can even cause difficulties when chewing and biting open. The gums around the root of the tooth are often so inflamed that they swell and hurt badly even if you just touch them with your finger. It is very red and usually warmer than the rest of the gums.

Those affected often feel a throbbing pain that results from the increasing pressure inside the tooth. If the tooth structure is weakened by tooth decay, sweet or spicy foods often lead to pain. Cold or warm food and drinks are usually no cause for pain in a dead tooth. Nevertheless, the tooth is at great risk of breaking due to the weakening of the substances.

If the tooth breaks off above the gums, bacteria can infiltrate the entire tooth easily accessible, which can lead to inflammatory pain again. If the tooth breaks off in its longitudinal axis below the gums, it can loosen and lead to severe bite pain. In this case, the tooth is no longer worth preserving and must be removed. In the case of any kind of pain, a dentist must definitely be visited for further diagnostic clarification.

You can also read more under: Toothache - What To Do?

Pain when biting on it

A non-vital tooth is symptom-free in many cases, but it can also cause pain.
If this is expressed in bite pain, this is due to an inflammation around the tip of the root of the affected tooth. The bacteria begin to decompose the soft tissue inside the canal and then reach the surrounding tissue via the tip of the tooth.

The tooth around the root tip becomes infected with bacteria and becomes inflamed, which can then also be seen in the X-ray image as a “dark, mostly rounded shadow” around the root tip. The inflammation is accompanied by swelling. The tissue increases in consistency, which is why the tooth appears minimally raised. This can lead to a slight preliminary contact. The patient bites and because the tooth appears to be slightly raised by the swelling, the tooth is subjected to increased pressure. Furthermore, each time the tooth is bitten, it is pushed downwards into the fibrous apparatus, which causes pain due to the inflammation.

The bite symptoms indicate that the tooth has been devitalized for a certain period of time and the condition has advanced. The patient should therefore go to the dentist immediately as soon as bite pain occurs so that the tooth can be treated as quickly as possible. The root canal treatment is accompanied by a subsiding of the inflammation, so that the sensitivity decreases until it finally disappears completely.

Tooth turns black or discolored

It is not uncommon for devital teeth to discolour. They can turn gray to black.
After the pulp vessels have died, there is no longer any supply of the hard tooth substances and the dentin becomes brittle. The discoloration is caused by the decomposing blood of the dead pulp tissue, which can no longer be removed because of the root filling.

If the root canal is not bloodless or optimally disinfected before filling, the remaining blood will react. Bacteria mainly metabolize iron from the oxygen carrier molecule hemoglobin into iron sulfide. Iron sulphide is made from iron in the blood, which reacts with the sulphurous metabolic products of the bacteria.

Throbbing pain and bad breath

The typical signs of inflammation are usually present in non-vital teeth and those affected often complain of a very unpleasant taste and unbearable bad breath.

The inflammation within the tooth builds up pressure by metabolizing the dead tissue. Gases that cannot escape and pus form.
The bacteria metabolize the dead tissue, releasing gases that are unpleasant. For some sufferers, the taste is also severely affected.

Another accompanying symptom in addition to the smell is the feeling of throbbing of the whole tooth. Those affected have an almost pulsating sensation of pain that recurs from time to time. This pain can also lead to headaches and aching limbs outside the oral cavity and indicates an inflammatory process.

Read more on the topic: Causes of Bad Breath

Dead tooth wobbles

If generalized periodontitis is the previous cause of the devitalization of the tooth, it is not uncommon for a loosening, in the worst case, for the tooth to fall out. With periodontitis, the entire periodontium is weakened.

Read more on the topic: Causes of Periodontal Disease

The ligamentous apparatus that holds the tooth in the bone compartment no longer has the strength of a healthy periodontium. If the tooth is now also dead, there is a greater risk that it will loosen more easily from this ligamentous apparatus and become very loosened. The degree of loosening can increase so much that the tooth almost falls out of the tooth socket itself.

In the case of severe tooth root inflammation, the tooth can also begin to wobble. The tooth is in the tooth socket, but on a manifested inflammation below the tip of the root.
If the inflamed nerve tissue is completely removed, the tooth is rinsed, disinfected and successfully treated with the root canal, the inflammation recedes and the tooth can solidify again. It is important not to exert any mechanical force on the tooth, not to move it and not to load it with the full chewing force.

It is entirely possible that the tooth regains its former strength and that the tooth can be fully integrated into the dental arch with a later crowning.

Read more on the topic: Symptoms of root inflammation

Dead tooth has broken off - what to do?

Since a tooth with dead blood vessels and nerves can no longer be supplied with fluids and nutrients, it usually breaks faster than a tooth that is still vital.

Especially if the tooth has already been treated in the root canal, or if at least it has been started, then it is overall more unstable. In order to be able to reach the root canals, the tooth has to be reamed.
Depending on which tooth is affected, how many roots and root canals there are and whether the tooth has already been filled or provided with a crown, the larger the hole that the dentist drills must be (Trephination opening) and the less hard tooth substance is left.

Because the root canal treated tooth has less stability and thus less resistance to the chewing forces, it breaks off faster than the healthy tooth.

It is best to see the dentist quickly so that he can rebuild the tooth with either a temporary or a permanent filling.
If the tooth breaks off during the appointments for the root canal treatment, it is often necessary to first fill it up so that work can continue. A top-up filling is also useful when there is very little tooth substance left.

If the tooth has broken off completely, so that nothing can be seen of the tooth above the gums, then the dentist has to weigh up whether the tooth needs to be extracted or whether it can still be preserved with a pin that is placed in the canal.

Find out more at: Broken tooth - you should do this immediately

Inflammation on a dead tooth

If the death of a tooth nerve is not treated, the bacteria multiply and migrate through the root tip into the surrounding tissue. This tissue and the bone are inflamed by the bacteria, which is diagnostically important in the X-ray image.

The inflammation can remain inactive, so that it remains located locally under the tip of the root or is active and tends to spread. If left untreated, spreading tendencies lead to abscesses, cysts and, in the worst case, to sepsis.

What can it be when a dead tooth hurts after years?

The death of nerve vessels inside the tooth is also possible due to trauma. A fall or blow to a tooth in childhood can only result in pain years or even decades later.

The mechanism or the trigger for the sudden development of pain has not yet been scientifically clarified.
Patients notice the grayish discoloration of the tooth and complaints such as Pain. Therapeutically, the tooth is treated with a root canal and then provided with a prosthetic crown.

Therapy of a dead tooth

Since a tooth with a dead dental nerve can lead to massive inflammation and usually causes very severe pain in the surrounding tissue, the tooth must be treated with root canals. The following is carried out

• Trepanation (opening the tooth and removing tissue)
• Rinsing and disinfection of the tooth chamber
• Wait a week (is the tooth still causing problems?)
• Root canal filling
• Crowning (for stabilization)

You might also be interested in: Crown after a root canal treatment

Tooth continues to hurt despite root treatment

Does the tooth make despite renewed root canal treatment (the second root canal treatment is called Revision called) pain, surgical intervention is recommended. With the so-called root tip resection, the tooth roots are now treated from below. The gums are cut open and the roots are shortened and sealed. Everything is disinfected beforehand. After complete healing, this tooth can now also be crowned, provided that it is inconspicuous and the person concerned no longer has any complaints.

If even the single or repeated root tip resection is unsuccessful and the tooth continues to cause problems, it may be a better option to have this tooth removed. After the extraction wound has healed, you have to think about a subsequent replacement of the extracted tooth in order to select the best possible individual form of the tooth replacement.

Read more on the topic:

• Revision of a root canal treatment
• Apical resection

Root canal treatment on a dead tooth

A root canal treatment for a dead tooth is a routine procedure, but it is usually more complex than for a tooth that is still alive, as the bacteria and the already metabolized biomass must be completely removed from the inside of the tooth and disinfected. Most of the time only cell debris is left.

For the root canal treatment of the dead tooth, the tooth must first be reamed in order to visit the patient's root canal system. This does not necessarily have to be anesthetized, as the tooth no longer perceives stimuli due to the dead nerve tissue. The individual root canals are then made accessible with hand files or machine files and the entire vascular material is removed. When the ducts are reached, a decaying odor usually comes into play, which signals that bacteria have already started to metabolize the tissue and that unpleasant-smelling gases are produced as breakdown products.

The next step involves a medicated pad and disinfecting irrigation fluids so that the bacteria within the root canal system are all removed. The tooth is then left with the medication for one to two weeks until it is symptom-free. In order to protect the tooth from penetrating food particles and bacteria, it is temporarily given a temporary filling.
Only when the tooth is symptom-free is it provided with a root filling after the canals have been completely expanded and prepared. The root filling can be introduced in a thermally stable or plastic manner, which means that it is liquid or in the form of a rubber stick. Once the root canal has been filled, the tooth is usually healed.

After a period of two to three months, after the tooth has remained symptom-free and inconspicuous, the tooth is crowned and thus completely reintegrated into the dental arch.

Read more on the topic: Root canal treatment process

When should you pull a dead tooth?

A dead tooth should only be extracted if all therapeutic approaches have failed and the tooth causes persistent discomfort.
Contrary to the approaches of many alternative practitioners, who are of the opinion that all dead teeth should be removed immediately, teeth can be completely reintegrated into the dental arch after the treatment and are considered full members.The thesis that dead teeth must be extracted immediately is absolutely unfounded, as successful root canal treatments have been scientifically proven to heal the affected teeth.

The root canal treatment has about a ninety percent chance of success. If the treatment has not been free of symptoms, either a revision, the removal of the old root canal treatment and the reintroduction of a new one, or a root tip resection. During the apicectomy, the apex is surgically cut and, if necessary, the root filling is sealed again from below.
If the apicectomy was not able to alleviate the symptoms either, it must be discussed whether a new apicectomy should be initiated.

If the freedom from symptoms has not been achieved after the second root tip resection, the only remaining option is tooth removal to alleviate the symptoms. Nevertheless, dentists and oral surgeons try everything to preserve a tooth, because a dead tooth does not mean reaching for the pliers at the same time, but can now be prepared using the latest techniques and materials in such a way that it can be preserved in the long term.

Read more on the topic: Tooth extraction

Why should a dead tooth be crowned?

As the blood vessels die, the tooth is no longer optimally supplied with nutrients. It is only supplied by the periodontal membrane, the periodontal tissue, which ensures that the tooth develops a certain brittleness. If the tooth also has a large defect (ie a "hole"), it can break more easily.

To protect against breaking off, a crown is made which fully integrates the tooth into the dental composite. The crowning is particularly desirable in the posterior region, as the teeth have to withstand the greatest amount of chewing force and stress here.
In the anterior region, a crown or a veneer is usually necessary for aesthetic reasons, as non-vital teeth can turn gray over time.

How can you whiten the discolored tooth?

The black discoloration of devitalized teeth is primarily an aesthetic problem for those affected. The discolored tooth no longer fits into the harmonious nuances of the dental arch and is even noticeable from a distance. There are ways to whiten these discolored teeth again. One way to whiten teeth is by whitening. In bleaching, a low concentration of hydrogen peroxide, which is also used to bleach clothes and hair, is used to lighten the tooth enamel. However, large jumps are not possible.

An effective lightening to 2 shades is realistic. If you want to bleach the dark, almost black-colored, devitalized teeth, you can never say exactly whether the resulting color will harmonize with the existing teeth. In addition, bleaching removes moisture from the tooth. This makes the already weakened tooth even more unstable. Therefore, whitening is not recommended on a dead tooth.

Read more on the topic: Whitening

Crowning is a safe way of integrating discolored teeth into the dental arch in a visually harmonious way. On the one hand, the crown restores the flawless aesthetics; on the other hand, the weakened tooth is protected by the crown and is no longer at risk of breakage. Due to the wide range of materials, shapes and colors for crowns nowadays, the perfect look is restored and a layperson cannot tell that it is a crown at all.

Bleaching a dead tooth

Dead teeth darken as iron builds up from the blood vessels, which is why they appear gray. This can also be the case due to an imperfect root filling or residual tissue. These teeth can be whitened by bleaching. Only one tooth can be lightened with a splint, or the bleaching material can be introduced into the inside of the root canal. This enables a maximum of two to three tooth shades to be lightened.

However, the bleaching effect does not last permanently, so it usually has to be refreshed once a year. Private costs of 40-80 euros for the treatment of the tooth can be expected.

Diagnosis - How to tell that the tooth is dead

Due to the loss of its vital parameters, the tooth is now insensitive to a thermal change in the environment. The dentist does a so-called vitality test. He holds a piece of cotton wool that has been cooled with a cold spray to the tooth.

If the patient feels the cold, the tooth is alive, if he does not feel it, he has died. But this test can also be deceptive. In the case of already crowned teeth, this test can turn out negative due to the thick layer and the material of the crown, although the tooth is still vital.

In addition to the test using a cold spray, you can also check the vitality of the tooth nerves using CO² snow or an electrical resistance test.

An x-ray is often taken to confirm the diagnosis. If apical periodontitis is the cause of the loss of vitality, a dark shadow can be seen on the X-ray image below the tip of the root. This is a sign of the prevalent root inflammation.

Often the tooth is also sensitive to knocking and pressure due to the inflammatory processes. For this test, the dentist carefully taps the tooth with a blunt instrument and compares the sensation with the neighboring teeth. Devital teeth are often more sensitive than the others because of the inflammation under the tip of the root. This percussion test can also help the dentist make a diagnosis.

What causes lead to a dead tooth?

Causes for the death of the tooth can be very variable.
If, for example, a caries has progressed so far that the pulp (tooth pulp) is reached, bacteria can inflame the vessels in the pulp. The inflamed blood and nerve vessels die off as a result of the inflammation process and the tip of the root can also become inflamed up to so-called apical periodontitis or tooth root inflammation. Due to the death of the pulp vessels, the dentin is no longer supplied. The tooth loses its vital functions and dies completely.

Another cause of a devitalized tooth can be trauma (Injury) be. A single blow to the tooth or mechanical irritation is often enough to cause the nerve to die. Years later, the trauma can only lead to the death of the nerve and thus the tooth.

You might also be interested in: Pulp necrosis

This often happens without symptoms until the tooth is visually discolored and the person concerned only notices it then. A tooth can also be traumatized by grinding.

Another cause is generalized periodontitis, which, if not adequately treated, can develop into a local root inflammation. These inflammatory processes at the tip of the root can also lead to the death of blood and nerve vessels in the pulp and thus ultimately to the death of the tooth.

How long does it take for the tooth to die?

The duration of a tooth death varies and varies depending on the cause. In the case of acute pulpitis caused by tooth decay, which leads to tooth root inflammation, this can lead to the death of the nerve tissue in a few weeks or months.

In the case of trauma from childhood, there is a possibility that the nerve will only die off decades later and cause discomfort. Furthermore, the tooth can devitalize completely without symptoms, so that the patient does not even notice it until the diagnosis is recognized by a chance finding.

Everyone reacts differently or weakly to inflammatory processes and so the individual reaction and the current state of the immune system are decisive for the speed at which a tooth dies.

What is certain, however, is that a dead tooth nerve cannot be revived. Even a root canal treatment only ensures that the tooth can remain in the dental arch without any symptoms.

Consequences of a dead tooth

If a tooth dies, the dead tissue has to be broken down. This happens as part of an inflammation that can spread quickly without treatment. This creates a risk of a cyst or abscess. When cysts or abscesses form, pus develops in the cavity under the tip of the root. The swelling creates the so-called “thick cheek” and, as a complication, the systemic disease sepsis. The bacteria get into the bloodstream and attack the patient's organs, which is life-threatening.

Is there a connection between a dead tooth and back pain?

In naturopathy, a connection between the “corpse poison” emitted by a dead tooth and diseases of the organism is suspected, including back pain. However, there is no scientific evidence at all, and the mechanism by which the breakdown products of the tooth are supposed to influence the back is not known either. From a medical point of view there is no connection.

What is the connection between a dead tooth and depression?

Just like the connection with other pain or illnesses, depression is also a possible consequence of a dead tooth that emits toxins. Again, there is no scientific study or evidence.

The only thing known is that prolonged periods of pain can trigger mental illnesses such as depression. Toothache, for example from a dead tooth, can also cause long-term complaints if left untreated.

However, there is no medical connection between the "corpse poison" and depression.

What is the "corpse poison" in a dead tooth?

The outdated term “corpse poison” describes substances in a dead tooth that are secreted by the metabolism of bacteria in the dead tissue. The nerve and blood vessels within the root canals have perished due to stimuli such as tooth decay or trauma, and bacteria metabolize these cell debris. This creates the so-called "corpse poison":
Toxins that are released into the organism. These include Thioether compounds, Mercaptans and biogenic amines. These substances have a disrepute not only for causing inflammation, but also for causing systemic diseases.

However, these theses are very controversial. Naturopaths attribute carcinogenic effects to this corpse poison, but this has never been proven in studies.
From a medical point of view, there is also nothing to support this claim, as these toxins occur in many normal metabolic pathways within the body and in many nutrients such as fish or garlic and are simply excreted. Therefore the term “corpse poison” has not been scientifically proven.

It can be said with certainty, however, that dead teeth must be freed from the dead tissue with a root canal treatment, otherwise there is a risk of spreading inflammation and the formation of cysts or abscesses, which as a complication always develop into life-threatening blood poisoning (= sepsis) can.

Read more about this at: Dead body poison in the tooth