A tooth is considered dead when it can no longer sense hot/cold usually due to infection or trauma but you can't diagnose it at home on your own. A healthy tooth on the other hand can feel hot/cold and will be sensitive to extreme temperatures.
Table of contents:
Symptoms
Once the tooth has died the nerve and blood supply will stop functioning. The combination of both of these occurrences will result in a couple of unique signs and symptoms.
Signs of a dead tooth:
Discoloration. Non-vital teeth will lose access to the body's blood supply, which means they will stop receiving nutrients. This causes the tooth to slowly discolor or darken over time and begin to look grey.
Severe toothache. When the tooth nerve is dying it may cause severe pain. However once it is completely dead, it will actually stop hurting. The intense toothache is your tooth's final message for your body.
Unable to feel hot or cold. Dead teeth will have a non-functioning nerve which renders it unable to detect temperatures. Hot and cold drinks will not bother it the slightest.
Gum boil. A tooth which has died may sometimes form a pimple on the gums (gum boil). It may look harmless but that pimple is actually an abscess and it is a tell-tale sign of an active infection.
What it looks like on an x-ray
A dead tooth can present itself in two different ways on an x-ray.
Constricted canal. The tooth's nerve canal looks constricted or smaller than the adjacent teeth on x-rays. In extreme cases the entire canal can be obliterated.
Periapical pathology. There is a halo or radiolucent ring around the root tip on the x-ray.
Canal constriction
The tooth nerve on the x-ray can start constricting where the diameter of the canal will be smaller than the adjacent teeth. If left untreated for an extended period of time, the canal can completely disappear and become obliterated. The canal shrinkage is due to an inflammatory response from the body to a dying nerve.
Periapical radiolucency
Non-vital teeth will sometimes form an abscess at the apex of the root. This will show up as a radiolucent halo or dark area around the root tip. In due time, it may even form a pimple on the gums once the abscess grows large enough.
Radiopaque means that the object is solid while radiolucent means that it is not solid. Radiolucency in the jaw bone indicates that the bone is becoming less solid. This is consistent with an abscess because the infection is eating away at the bone. In essence the jaw is becoming like swiss cheese with holes in it.
Diagnosis
The clinical appearance, discoloration, and x-ray are signs that your dentist use to test a tooth for vitality. They don't test every single tooth but only the suspicious ones based on those three criteria.
Tests for a definitive diagnosis of a necrotic tooth:
Cold test
Electric pulp test
Cold test with endo ice
The cold test is performed with ENDO ICE, which is a product that comes in a metal can. It sprays out cold air that you can use on a cotton pellet. The cotton is then placed on the tooth to test if it is alive or dead.
Endo ice test results:
Normal healthy tooth - will feel the cold and it should linger for a couple of seconds.
Tooth with dying nerve - will feel the cold but it lingers for a long time, even up to 1 min.
Dead tooth - unable to feel the cold.
Electric pulp test
The electric pulp test is a device which sends an electric current to the tooth. You can increase the intensity and record when the tooth feels it.
Healthy teeth should feel the electric stimulation at some point.
Dead teeth will not feel any electric stimulation even at the max output.
Causes
There can be many reasons for the tooth's nerve to die.
Trauma. Sports injuries such as an elbow to the face or accidents when you fall face first to the ground. All of these induce blunt force trauma to your mouth and may cause the tooth to become necrotic.
Tooth decay. Untreated cavities will progress through each subsequent stage of tooth decay. Once it reaches the pulp, it will eventually die and become infected.
Large filling. Large dental restorations that are close to the tooth nerve can eventually kill it. Your pulp requires a certain amount of distance from foreign objects. If the filling is too close to it, it will become irritated and potentially die after a while.
Infection. A severe dental infection could invade the pulp and kill it.
Biting hard foods. Biting into something hard the wrong way can cause it to die. It is equivalent to sustaining trauma except this situation is due to eating.
Treatment
It is important to treat a tooth that has died or is in the process of dying as promptly as possible. Sometimes it is accompanied by excruciating pain or can develop an infection.
Root canal. A dead nerve will need to be removed from the tooth so that it doesn't develop an infection. The procedure to extract it while leaving the tooth intact is called a root canal. If the tooth was dying, it will be completely dead afterwards.
Extraction. If the infection is too severe to treat or the root canal has failed, the last option would be a tooth extraction. This procedure removes the entire tooth along with its nerve from your mouth permanently.
Cosmetic treatment
After the non-vital tooth nerve and all of its infection has been dealt with, you do need to address the cosmetics. Dead teeth are often grey and discolored which gives it an unsightly appearance.
Options for improving the aesthetics:
Crown. The discoloration can be masked with a ceramic crown. You can change the color to match the adjacent teeth.
Veneer. If the discoloration isn't that severe, a more conservative option would be a veneer. Less tooth structure is removed using this method.
Teeth whitening. In the beginning stages of discoloration, external teeth whitening may be able to change the color of it. You can try strips and professional treatments.
Internal bleaching. The latter stages of discoloration begins from the inside out. That means you need to bleach it internally which is different from the traditional whitening that you're used to. Your dentist will literally place peroxide inside of the tooth's pulp chamber to whiten it from the inside out.
Prevention
It may be impossible to prevent your tooth from dying because a lot of the situations are out of your control. However there are ways that you can reduce the chances of it occurring.
Practice good oral hygiene. Brush your teeth for two minutes twice a day. Try to floss before going to bed.
Dental check ups. Getting your teeth checked by a dentist every 6 months can catch problems while they're starting.
Wear a mouthguard. If you play sports it would be prudent to wear a mouth guard to protect your teeth. Hockey players are missing a lot of teeth because physical contact can result in severe oral trauma.
Minimize sugar intake. Try your best to decrease the intake of sugar and other acidic foods. These all increase the chances of getting a cavity.
Drink enough water. Most water is fluoridated in the US and drinking enough of it throughout the day will supply ample fluoride to prevent cavities. It also washes away plaque and food debris from your teeth when you drink it.
Frequently Asked Questions (FAQs)
Can you heal a dead tooth naturally?
Unfortunately it is impossible to heal a dead tooth and bring it back to life. As a matter of fact, you can't bring anything that has died back to life and that includes all forms of living organisms. You can't revive your loved ones, your pets, or any type of animal. Your tooth is no exception to the rule.
Once it has died it will permanently stay that way. Therefore there are no home remedies which can naturally treat it. Your only option would be to seek out a dentist to have the nerve removed with a root canal.
What if my tooth has been dead for many years?
If your tooth has been dead for many years, we still recommend treating it with a root canal and a crown. You never know if it'll develop an infection in the future so it is a good idea to take out the nerve. From a holistic point of view, it doesn't make a lot of sense to keep a dead body part like your nerve still in your body.
Even if you don't want to do the root canal, you should still consider putting a crown on it to mask the unsightly discoloration. These non-vital teeth often present severely darkened or grey looking and they stand out like a sore thumb when you smile.
Will it fall out?
It should not fall out on its own because it is a nerve condition and it does not affect the periodontium. It is the periodontium which supports the tooth and keeps it from being mobile. However that is not to say that it can't be afflicted with gum disease.
How long does it take to die?
It is not possible to predict when your tooth will die because it can take weeks, months, or even years if you're lucky. Your dentist will need to test its vitality at every dental check up. Once it is no longer alive it will stop responding to the vitality tests.
Takeaway
Your teeth are alive and that is why they can feel changes in temperature. Since they are alive it also means that they can die and become non-vital. If that happens you should seek treatment promptly to prevent it from developing an infection.
If you're in the Long Island City area, our dentists can help diagnosis your dead tooth for you during the dental consultation appointment.
