Got A Dead Tooth?

Updated: Oct 15

So you think you got a dead tooth or perhaps it's not quite there yet and its a dying tooth but is there something you should do about it? What's the worst that can happen? This is a guide for everything that you need to know about dead teeth.


Table of contents:



What is a dead tooth?

You may not realize it but your tooth is actually alive when it is healthy but an unhealthy tooth can die. Your tooth is able to stay alive because there is/are canals that connect your body to your tooth. The canal contains the nerve of the tooth and also the blood supply, which supplies nutrients to keep it alive.


Typically after a root canal procedure, your tooth is considered dead because the process of removing the nerve will also sever the blood supply. Once there are no more nutrients going to the tooth, it will no longer be alive. Dentists call a no longer alive tooth, non-vital and a tooth that is still living is called vital.


Aside from needing a root canal, there are other causes for tooth death such as previous trauma, tooth decay, or even a large filling that is close to the nerve.


To summarize, a tooth is considered dead when it has its blood supply cut off or the nerve dies which results in the blood supply also being severed.


Signs and Symptoms

You can definitely tell that your tooth is dead because it will look and feel different from all your other teeth. Au contraire, perhaps you can't tell because dead teeth are usually painless so they mostly go unnoticed for years. Nonetheless, here are some signs that you may have an expired or expiring tooth.


What it looks like

A tooth that has recently died or is in the process of dying, will not look any different from a healthy tooth. It is only after the tooth has died for a few years that it starts to change colors. The color of dead teeth will either be grey or black.


There are also rare situations where a dying tooth could look red or pink in color as well. Usually when it swells up with blood, which is what gives it that red color. These situations are a result of an immediate injury or accident.


What it smells like

Fortunately a non-vital tooth does not smell at all because most people don't even know that their tooth has already died. If you are having a smell come from the deceased tooth, it is actually an indication of a gum problem and not a tooth problem.


What it feels like

A tooth that is no longer alive actually does not have any sensation at all because the nerve is dead. If the nerve is not functioning anymore, it won't be able to feel any sensations. What this means is that the tooth will not feel sensitivity to cold or hot. It is the same as if you put a human who is alive in the Arctic, they would feel cold but if you put a dead person there, they won't feel it at all. Once again, that tooth won't feel any sensations at all!




Diagnosis

Only your dentist can give you a definitive diagnosis that your tooth is indeed dead. You may have suspicions that it is no longer alive but it is not confirmed until your dentist performs a vitality test and a dental x-ray.


Vitality test

This is a diagnostic test that will confirm whether or not your tooth is still living. It is also known as a cold test because your dentist will put a cold cotton ball on your tooth to see if it can feel the cold.

  • If it can feel the cold then it is vital.

  • If it can't feel the cold then it is non-vital.

  • If it can feel the cold but the sensation lingers for more than 10 seconds then it is a dying tooth. This means that the tooth will be dead within the next few days to weeks.


Alternatively there is also an electric pulp test, which is a machine that sends small jolts of electricity to your tooth and measures at what electrical level the tooth feels it. Dead teeth won't feel the electrical jolts even at the max voltage.


X-ray

The last diagnostic tool that your dentist can use to detect a non-vital tooth is with a dental x-ray. There are two clinical presentations that tell us the tooth is no longer vital.

  • Infection at the root tip. Sometimes dead teeth will have an infection at the tip of the root. Interestingly, it won't always show up on the xray. What it looks like on the x-ray is a big dark circle.

Infection at the root tip
  • Constricted canal. Teeth that have died will sometimes have a constricted canal. The canal will slowly shrink over time until it is almost impossible to see. What it looks like on the x-ray is a very small black line that goes all the way to the tip of the root. A normal tooth will have a very wide black line.

Constricted canal on the right front tooth
Constricted canal on the right front tooth



What causes a dead tooth?

There are multiple ways for your tooth to die but the three most common are due to trauma, tooth decay, and large fillings that are close to the nerve.


Previous Trauma

If your tooth sustains a traumatic blow to it, it may die due to the sheer force of the impact. The most common sources of trauma stem from sports injuries such as basketball, football, soccer, and hockey.


Children are also prone to injuring their front teeth just from everyday activities such as playing around. Their hand eye coordination aren't as developed so they tend to trip, fall, and bump into things. In fact, according to this study, nearly 50% of children will sustain some type of injury to their teeth.


Tooth Decay

A small cavity won't kill the tooth but if it is left untreated, it may grow large enough to reach the nerve of the tooth. The tooth decay will eat through the nerve and cause the tooth to die. Once that happens, the tooth would require root canal treatment.


This is why it is important to treat small cavities right when you catch them so that you can avoid situations such as these. Treatment will be more conservative and it'll be less expensive as well!


Large tooth filling that is close to the nerve

There are instances where the tooth can still die even if the cavity never reaches the nerve. A large cavity filling that is near the nerve but not into it, can still cause the tooth to die sometimes.


This is because the nerve may require a certain amount of buffer space away from foreign objects such as a filling. If a foreign object is too close to it, it may get irritated and then eventually die. This doesn't happen to everyone but it can happen to some people because everyone is different.



How do you treat it?

The only way to treat a dead tooth is by completing a root canal on it to finish the job by removing the entire dead nerve in the tooth. We understand that it is already dead but you still have to finish killing the nerve by removing it. You don't want to walk around everyday life with dead organic matter in your body.


After the root canal treatment is completed, you can leave the cleaned out non-vital tooth in your mouth for as long as you want. That is how long it can stay in your mouth unless something happens to it.


  • The above two x-rays show a before and after of a non-vital tooth that has completed root canal treatment.


I've had a dead tooth for years, can I leave it alone?

The vast majority of people have the dead tooth for years and most likely never even noticed it until their dentist pointed it out to them. The main reason they've never noticed is due to the condition being mostly painless. Since it never bothered them, they never paid attention to it nor thought of seeking treatment for it. Therefore, a dead tooth can stay for as long in the mouth until you notice it and decide to do something about it.


Whether you should get a root canal for your dead tooth would depend on how early your dentist is able to catch it and if it is still possible to even do it.

  • If the tooth has been dead for a long time, sometimes the root canal can close off by itself thus preventing your dentist from even doing the procedure.

  • If you catch it early, the root canal will still be open thus allowing you to do the procedure.


Even if it doesn't hurt, we would still recommend having it treated because a dying tooth will become a cosmetic concern in the future once it changes color. The tooth color can turn grey or even black sometimes. If you've had the root canal completed, it'll give you the option to do internal teeth whitening, which is different from external teeth whitening. That we'll explain later in the article.


Can I bring it back to life?

Unfortunately you cannot heal a dying tooth because once it is on its way out, it will complete its journey to the afterlife. There is no saving a dying tooth naturally because even your dentist can't do it. Fortunately for you, these teeth don't fall out of your mouth once they're dead so you don't have to worry about a cosmetic emergency.




Cosmetic treatment options

Regardless of whether or not you get the root canal on the tooth, it will start to discolor over time. The color will often be much darker than the adjacent teeth and may look like a grey tooth. The best way to cosmetically treat the tooth is by covering over it with a dental crown or a dental veneer. The porcelain will help to mask the color and match the adjacent teeth.


Dead teeth can become very discolored and that makes it a cosmetic challenge to cover up the color of it. It may even take your dentist a couple of tries to get the color masking right.



How to whiten a dead tooth

Traditional teeth whitening may not help very much with a tooth in this condition since the discoloration is not from external stains. The discoloration is coming from intrinsic stains, which means it is stained from the inside out. A more effective way to whiten this tooth would be to do internal whitening or internal bleaching.


Internal teeth whitening requires the tooth to have had a root canal because you are literally placing the whitening gel inside of the pulp or nerve of the tooth. The gel is left there for about 1-2 weeks and may be repeated an extra session if necessary. This process will whiten the tooth from the inside outwards. This is needed because the external teeth whitening cannot reach that deep into the inner parts of the tooth.




Prevention

Preventing your tooth from dying may be inevitable at times because accidents do happen such as trauma from playing sports. Nonetheless, it would be prudent to wear a sports guard to protect your teeth from potential trauma.


You should also make sure that you brush and floss twice a day so that you don't get cavities because large cavities that reach the nerve can kill the tooth nerve. Therefore if you keep your teeth clean and cavity free, the chances of your tooth dying will be minimized!


Hopefully that helps explain everything that you need to know about your deceased tooth. This article is brought to you by your favorite dentist in long island city.


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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!