Tooth Pulp

What is tooth pulp?

Tooth pulp is the innermost layer of your tooth. It contains nerves, blood vessels, specialized cells and connective tissues, which provide nutrients for your tooth. In simple terms, dental pulp is what keeps your tooth alive.

The outer layers of your tooth — dentin and enamel — protect the pulp of your tooth. But your dental pulp can become exposed due to cavities, cracks or chronic teeth grinding (bruxism). If this happens, you might need a procedure to fix the issue.

What does tooth pulp do?

Your tooth pulp serves many purposes, including:

• Protection against bacteria. The immune cells in your dental pulp help detect and fight against invading germs.
• Sensory function. The nerves in your dental pulp detect changes in temperature and pressure. The resulting discomfort lets you know something is wrong.
• Dentin formation. Your dental pulp makes dentin (the middle layer of your tooth). Dentin supports your enamel (the hard, outer layer) and protects your tooth pulp.
• Nutrient production. Your tooth pulp makes proteins — such as albumin and fibrinogen — to keep your dentin healthy.
• Moisture. The blood vessels in dental pulp help keep your tooth moisturized. This reduces brittleness and keeps your tooth strong and healthy.

What happens if the pulp of a tooth is exposed?

Cavities, cracks and other traumas can expose your tooth pulp. Exposed pulp makes your tooth vulnerable to infection. Left untreated, this infection can spread to other areas of your mouth and body.

Here’s how it happens:

• When your tooth pulp becomes exposed, bacteria from your mouth invade the pulp.
• This results in an inflamed tooth pulp.
• Inflammation results in a toothache.
• As infection worsens, your tooth pulp may die.
• The infection may also spread to other areas of your mouth and jaw.

Left untreated, an exposed tooth pulp can lead to life-threatening conditions, including:

• Oral sepsis.
• Brain abscess.
• Meningitis.
• Purulent sinusitis.
• Orbital cellulitis.
• Cavernous sinus thrombosis.

What is tooth pulp made of?

Your tooth pulp is a jelly-like mass of connective tissue that contains:

• Nerves.
• Blood vessels.
• Odontoblasts.
• Fibroblasts.
• Histiocytes.
• Macrophages.
• Mast cells.
• Plasma cells.

The pulp itself fits within the hollowed-out spaces inside your tooth (pulp cavity). Your pulp cavity has three main parts:

• Pulp chamber: The main upper portion, contained in the crown of your tooth.
• Pulp horns: Extensions of the pulp chamber that curl up toward the chewing surface of your tooth.
• Radicular canals: Extensions of the pulp chamber that travel down the length of the roots, all the way to the apex (tip).

What does tooth pulp look like?

Your tooth pulp is reddish-pink in color, and it takes on a miniature shape of the tooth itself.

What are common conditions and disorders that affect tooth pulp?

A few different conditions can affect your tooth pulp, including:

• Pulpitis.
• Pulp necrosis.
• Dental pulp calcification.

Pulpitis

Pulpitis is inflammation of your tooth pulp. It happens when irritants (like bacteria) get past your dentin and invade your pulp. Symptoms often include discomfort or lingering pain.

Pulpitis may be reversible or irreversible. Reversible pulpitis refers to mild inflammation that improves with treatment. Irreversible pulpitis refers to severe inflammation that doesn’t improve with treatment. Irreversible pulpitis can result in pulp necrosis (pulp death).

Pulp necrosis

Pulp necrosis refers to death of your tooth pulp. Once your dental pulp dies, you may stop feeling pain or discomfort.

Left untreated, pulp necrosis can result in a dental abscess (a collection of pus inside your tooth and in the surrounding tissues). This type of infection can spread to other areas of your mouth and body.

Dental pulp calcification

Some people develop areas of calcification in their dental pulp. The most common reasons for this include natural aging and trauma to the tooth.

Less commonly, some health conditions can increase your risk for dental pulp calcification, including:

• Kidney disease.
• Heart disease.
• Paget’s disease of the bone.
• Hyperparathyroidism.
• Dentin dysplasia, a genetic disorder affecting the teeth.
• Gout.
• Dentinogenesis imperfecta, a tooth development disorder.

In many cases, dental pulp calcification doesn’t require treatment. But if the calcified tooth becomes infected, you might need root canal treatment to save it.

How do dentists check the health of tooth pulp?

Dentists use a combination of tests to check the health of your tooth pulp. These tests may include:

• Pulp testing.
• Dental X-rays.

Pulp testing

A dental pulp test uses cold temperature to check the health of your tooth pulp. During this test, your dentist will apply a cold substance to different areas of your mouth. They’ll ask you to rate your pain level on a scale from 1 to 10. They’ll also measure how long it takes for you to feel the initial discomfort as well as how long it takes for the discomfort to go away.

Dental X-rays

In addition to performing a pulp test, your dentist will also take X-rays of your teeth. Dental X-rays can show your dentist whether the infection has spread to other areas.

What are common tooth pulp treatments?

Procedures used in the treatment of tooth pulp conditions include:

• Pulpotomy.
• Pulpectomy.
• Root canal therapy.

While many general dentists perform these procedures, they may refer you to an endodontist instead. An endodontist is a specialist who focuses on saving natural teeth.

Pulpotomy

A pulpotomy is a procedure performed on a tooth that’s still alive. (In other words, you still have feeling in the tooth and the pulp hasn’t died yet.)

During this procedure, a dentist or endodontist removes the unhealthy tissue that’s in the crown of your tooth (the part that sits above your gum line). They’ll leave the pulp inside your tooth roots. Your dentist will place a medicated filling to protect the tooth and reduce the risk of re-infection.

Dentists perform most pulpotomies on primary (baby) teeth. But sometimes a pulpotomy can save a permanent (adult) tooth.

Pulpectomy

A pulpectomy involves removing the pulp from all parts of your tooth, including the roots. Next, your dentist will clean and sterilize the pulp cavities, including your pulp chamber and root canals. Finally, they’ll fill your pulp chamber and root canals with a material that gets reabsorbed by your body.

Dentists usually perform pulpectomies on primary (baby) teeth. In adults, a pulpectomy is the first step of root canal therapy.

Root canal therapy

Root canal therapy is similar to a pulpectomy. Both procedures involve removing the tooth pulp. But during a root canal, your dentist or endodontist also cleans, shapes and fills the canals. In most cases, they’ll also place a dental crown to protect your tooth.

What if tooth pulp treatment doesn’t save my tooth?

Dentists use pulpotomy, pulpectomy and root canal therapy to save natural teeth from infection. But if there’s too much decay or damage, your dentist may need to pull the tooth. If you need a tooth extraction, your dentist will talk with you about replacement options, such as a dental bridge or dental implant.

How can I keep my tooth pulp healthy?

Practicing good oral hygiene is the best way to keep your teeth healthy:

• Brush your teeth at least twice a day using a soft-bristled toothbrush and fluoride toothpaste.
• Clean between your teeth once a day using traditional dental floss, dental picks or interproximal brushes.
• Visit your dentist regularly for checkups and cleanings.
• Wear a mouth guard at night if you clench or grind your teeth.
• Drink plenty of water.

Does tooth pulp grow back?

In its natural state, tooth pulp doesn’t regenerate. In other words, if your dentist removes the dental pulp during root canal therapy, it won’t grow back. Instead, they fill the empty space inside your tooth with a dental filling material.

Currently, scientists are studying ways to regrow tooth pulp using dental pulp stem cells. If successful, dentists will be able to regrow new pulp for an infected tooth.

Can a tooth live without pulp?

A tooth dies whenever it loses blood supply. This can happen naturally (due to infection) or during a root canal procedure when your dentists removes the pulp.

A tooth can’t live without pulp — but it can still function just the same.

A note from Cleveland Clinic

Dental pulp is what makes a tooth alive. It contains nerves, blood vessels and lots of regenerative cells that keep your tooth healthy. Sometimes your tooth pulp can become infected due to cavities or other damage. Prompt treatment can eliminate bacteria and prevent infection from spreading. To reduce your risk of tooth pulp conditions, visit your dentist regularly and practice good oral hygiene at home.