Pulp Necrosis (Dead Tooth)

Pain can change as the pulp deteriorates. An earlier severe toothache may become more constant during irreversible pulpitis, while later disease can present with discolouration and infection around the root.

Pulp necrosis develops as dental infection progresses and the pulp loses vitality. A dead pulp does not remove the source of infection; the tooth still needs definitive dental treatment.

Pulp disease can move from temperature-triggered pain to more constant pain and then to loss of pulp vitality. Infection may subsequently involve the tissues at the root tip, producing apical periodontitis or an abscess.

A dead tooth becomes urgent when infection spreads beyond the local area or creates signs of airway involvement. Marked trismus, difficulty swallowing, drooling, limited tongue movement and a swollen or firm floor of the mouth are red flags.

Assessment combines the history and physical examination with the appearance of the tooth and signs of local infection. When disease is moderate, severe or systemic, blood tests can help assess inflammation and infection.

Definitive treatment removes the infected source through endodontic therapy or extraction, with drainage when an abscess requires it. Antibiotics on their own do not replace source control and may delay proper care.

The procedure changes according to whether the tooth can be retained with endodontic therapy or removed, and whether an abscess needs drainage. These clinical findings determine the treatment route.

Infection can produce apical periodontitis, an abscess and spread beyond the mouth. Airway compromise, swallowing difficulty, drooling or a swollen floor of the mouth require urgent hospital admission and airway management.

Definitive treatment of the dental source is the key preventive step once pulp vitality has been lost. Do not rely on antibiotics as a substitute for endodontic therapy, drainage or extraction.