What is Pulp Necrosis? Symptoms, Diagnosis, and How to Treat It

Did you know your teeth are alive? It’s true, thanks in part to tooth pulp, the innermost layer of the tooth which contains living tissue, nerves, and blood vessels. However, teeth are subject to death, a condition referred to as pulp necrosis, which can occur when exposed to dental infection, tooth decay, trauma, or other harm. This can lead to several dental issues and cumbersome symptoms like severe tooth pain, tooth discoloration, infection, and loss of sensation to hot, cold, or pressure over time. Fortunately, this condition can be properly managed by dental professionals to prevent serious complications. In this article we reveal important facts you need to know about pulp necrosis, including the causes, symptoms, and treatment options.

What is Pulp Necrosis?

What is pulp necrosis? Pulp necrosis can be explained as tooth pulp death. Pulp tissue is the centermost layer of the tooth, which is surrounded by dentin and tooth enamel. The pulp is responsible for keeping the tooth alive, as it contains the tooth's nerves, blood vessels, and connective tissue. Severe untreated dental pulp infection or trauma are common causes of pulp necrosis. This leads to serious dental issues if untreated, including jawbone loss, tooth loss, dental abscess formation, and systemic infection.

Types of Pulp Necrosis

Common types of pulp necrosis include:

Acute pulp necrosis: Classified based on speed, this type occurs quickly, typically after severe trauma or a rapidly spreading infection. Pain and tooth sensitivity are often extreme and intermittent. As the pulp dies, symptoms may completely disappear. Common treatment options include immediate root canal therapy or tooth extraction. Prompt evaluation and treatment from a dentist is key to better health outcomes and preventing life-threatening issues.
Chronic pulp necrosis: Also distinguished based on speed, this type develops more slowly than acute pulp necrosis and is commonly caused by slow-acting decay or trauma. This condition may be asymptomatic or trigger a dull or lingering pain. Over time the tooth may appear darker in color. Root canal therapy or tooth extraction are common treatment options for chronic pulp necrosis. Serious health consequences including cysts, bone loss, and life-threatening infection can develop without prompt dental treatment.
Localized pulp necrosis: Categorized based on the extent of the condition, only part of the dental pulp is dead, while other portions remain alive. Some areas of the tooth may trigger symptoms when stimulated, while other areas may be unresponsive. A pulpotomy may be recommended as treatment, which removes infected pulp from within the crown of the tooth and leaves the healthy pulp within the root intact. There are high tooth survival success rates with early treatment and proper management.
Generalized pulp necrosis: This type involves the death of the entire dental pulp. Teeth are usually asymptomatic, and do not respond to stimuli including cold, heat, or other tests performed by dental professionals such as electric pulp tests (EPT). Successful outcomes are possible with root canal therapy when treated early.

Causes of Pulp Necrosis

There are various causes of pulp necrosis. The most common causes include tooth trauma, untreated cavities, and bacterial infection. These factors can lead to blood supply disruption, particularly by triggering prolonged inflammation that can result in pulp death. As inflammation progresses over time, the initial stage of infection goes from reversible pulpitis to irreversible pulpitis, which ultimately leads to pulp necrosis.

Symptoms of Pulp Necrosis

It is important to monitor for symptoms of pulp necrosis, which include:

Tooth pain: Severe intermittent pain or lingering pain may be present and then suddenly stop as pulp tissue dies.
Sensitivity to temperature: Teeth in early stages of pulp necrosis are often sensitive to hot and cold temperatures. Once the pulp dies the tooth generally lacks temperature sensitivity.
Tooth discoloration: Teeth often become darker in color, sometimes grey, yellow, brown, or black, as the nerves, blood vessels, and connective tissue die.
Infected tooth: Pulp necrosis is often related to tooth infection, which may also be present with gum swelling, bad odor or taste in the mouth, and dental abscess.
Pressure Sensitivity: Teeth may hurt when tapped, biting, or chewing.

How is Pulp Necrosis Diagnosed?

Diagnosing pulp necrosis requires a professional evaluation by a dentist. A tooth infection diagnosis may also be confirmed and help guide treatment options. To identify necrosis of pulp, dental exams involving X-rays and thermal sensitivity tests are performed. A thorough review of you and your family’s medical and dental history will occur. Your dentist will check for signs and symptoms such as pain upon tapping, response to hot, cold, or electric pulp tests, tooth discoloration, decay, infection, tooth abscesses, gum swelling, sinus tracts, bone loss, and other abnormalities. In general, necrotic pulp will not respond to heat, cold, or electric stimuli. Dental X-rays may show discoloration or abnormalities near the affected tooth root and surrounding bone.

Pulp Necrosis Treatment Options

Treatment for pulp necrosis is personalized to each individual based on their exact situation and dental needs. Dental treatments for necrotic pulp focus on removing any existing infection, preventing further damage, and saving the affected tooth when possible. Root canal therapy is a common pulp necrosis treatment that is performed to save the tooth by removing the dead tissue and sealing it with a biocompatible material (gutta-percha) to protect against further harm. Teeth are often restored with a dental crown after root canal treatment to enhance protection and promote long-term success. For children with developing teeth and healthy immature roots, a pulpotomy procedure may be recommended to remove damaged pulp tissue. If a tooth is deemed unsavable by your dentist, tooth extraction with replacement is often recommended. Replacement options can include a dental bridge, implant, or denture. Early treatment is critical for successful treatment outcomes.

Root Canal Therapy vs. Tooth Extraction for Pulp Necrosis

Pulp Necrosis Treatment Option	Pros	Cons
Root Canal Therapy	Saves natural tooth Maintains natural bite, alignment, function, and appearance Avoids jawbone loss Removes infected/damaged pulp tissue High treatment success rate	Higher initial cost Typically requires additional procedures (i.e., dental crown) Potential for future retreatment or extraction if the tooth does not heal Multiple treatment visits are often required to complete
Tooth Extraction	Removes infected/damaged pulp tissue Immediate symptom relief Lower initial cost Initial procedure done in a single visit	Requires tooth replacement (i.e., dental implant, bridge, denture) to prevent complications like teeth shifting Jawbone loss over time unless a dental implant is placed

Preventing Pulp Necrosis: Tips for Maintaining Oral Health

Preventing pulp necrosis involves maintaining several important lifestyle habits. Excellent oral hygiene is key to cavity prevention and protecting against other serious dental issues. It is imperative to brush twice daily and floss daily to remove harmful bacterial plaque that contributes to decay and infection. Routine dental check-ups must also be maintained for early detection of problems and professional treatments that help keep teeth healthy. An important tip for avoiding tooth trauma is to use protective gear like custom-fit mouthguards and face shields when participating in sports or other high-contact activities. Other protective habits include avoiding using teeth to bite into hard objects or open packages, and limiting consumption of sugary and acidic foods and beverages that promote bacterial decay. If you experience any traumatic injury or troubling dental signs or symptoms, you should contact your dental professional for evaluation right away.

Living with Pulp Necrosis: What to Do Next

Living with pulp necrosis requires immediate dental treatment. Early intervention allows dentists to help diagnose, treat, and prevent the condition and associated issues like tooth infection before they worsen. Dental care after pulp necrosis diagnosis often involves tooth treatment options such as root canal therapy or tooth extraction, based on severity and other factors. If treatment is not performed promptly, long-term complications can occur, including chronic pain, permanent tooth loss, severe infection (i.e., dental abscesses), and even life-threatening systemic health risks (i.e., Ludwig's angina).

When Should You See a Dentist About Pulp Necrosis?

Seeing a dentist for pulp necrosis should be immediate, as this is a dental emergency. Although pain may go away over time as the pulp dies, infection remains and requires prompt treatment. Watch out for concerning signs and symptoms such as severe tooth pain, visible discoloration, and abscess symptoms and signs (i.e., fever, pimple on gums, gum swelling, bad taste/mouth odor). Contact our team of dental experts at Great Lakes Family Dental Group promptly if you are experiencing signs or symptoms of pulp necrosis.

Frequently Asked Questions

What is pulp necrosis?

Pulp necrosis refers to the death of dental pulp. The dental pulp is the innermost layer of the tooth, which houses the tooth’s nerves and blood vessels. Pulp necrosis is commonly caused by untreated dental issues, such as tooth decay, trauma, or infection. Pulp necrosis should be managed by a dental professional as early as possible to avoid serious health consequences.

What happens if pulp necrosis is left untreated?

Untreated pulp necrosis can lead to extremely dangerous health consequences. Without treatment, infection can spread from the tooth to other areas of the body, causing life-threatening systemic health risks, including severe cellulitis involving the neck and floor of the mouth (Ludwig's angina), jawbone infection (osteomyelitis), or heart problems (endocarditis). Patients with untreated pulp necrosis may also experience serious symptoms and signs, including dental abscesses, altered taste, difficulty chewing or speaking, tooth discoloration, prolonged pain, facial swelling, jawbone loss, tooth loss, or fever. Immediate treatment is necessary to prevent permanent damage and protect your overall health.

What does necrotic pulp look like?

Necrotic pulp can trigger signs that are visible within the mouth. Most commonly, teeth change to a darker color (i.e., grey, yellow, brown, or black). The gums near the affected tooth may also appear red or swollen with the presence of a gum pimple, known as a dental abscess.

What is the color of pulp necrosis?

Pulp necrosis often leads to tooth discoloration due to the breakdown of nerves and blood vessels within the dental pulp. The teeth commonly turn dark grey, yellow, brown, or black in color over time. Tooth color changes are often accompanied by other signs and symptoms, such as persistent bad taste or smell, lack of sensation to pressure or hot or cold items, dental abscess, and tooth mobility.

Is pulp necrosis a dental emergency?

Yes, pulp necrosis is a serious dental emergency that requires prompt evaluation and treatment to prevent serious complications. Although intense pain may disappear as the tooth’s nerves die, the tooth infection remains until treated by a dental professional. If left untreated, bacteria can spread and lead to systemic health complications. If you suspect pulp necrosis, contact your dentist for an emergency appointment right away.