Pulp Necrosis

Pulp necrosis is when the pulp tissue inside of your tooth dies. It’s usually caused by an infection that develops when bacteria enter the pulp through a cavity or crack. Brushing twice a day, flossing regularly and routine dental visits can help prevent an infection or treat it before it causes necrosis.


What is pulp necrosis?

Pulp necrosis occurs when the innermost tissue of your tooth (the pulp) dies. Pulp tissue is underneath the hard tooth enamel and extends down into the roots. It consists of blood vessels, nerves and other types of cells that help keep your teeth healthy.


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How does pulp necrosis develop?

When you have a cavity or a crack in your tooth, bacteria can get into the pulp and cause inflammation (pulpitis). Your teeth have some ability to recover from pulpitis on their own. But if left untreated, pulpitis will eventually lead to pulp necrosis. The stages include:

  1. Reversible pulpitis: The tooth can heal on its own if a dentist repairs and seals it.
  2. Irreversible pulpitis: The inflammation progresses and the tooth can’t heal on its own.
  3. Pulp necrosis: The pulp tissue dies.

The infection can also spread beyond the pulp into your jaw, neck and chest if not treated. These conditions can be very serious.

How common is pulp necrosis?

Pulp necrosis is a common condition, but it isn’t known exactly how often it occurs. The frequency of root canal procedures may provide a rough estimate, as root canals are often performed to treat pulp necrosis. The American Association of Endodontists estimates there are 15 million root canal procedures done each year.


Symptoms and Causes

What are the symptoms of pulp necrosis?

The main symptoms of pulpitis and pulp necrosis are a toothache and sensitivity. The type of pain and sensitivity you feel may vary based on the stage:

  • Reversible pulpitis: You may have a short, sharp pain with cold or sweets, but it goes away quickly. Usually, you’re not sensitive to heat.
  • Irreversible pulpitis: This can be a low-grade ache, throbbing or sharp pain that lasts 30 seconds or more after exposure to heat, cold or sweets.
  • Pulp necrosis: If the nerve dies, you may not have any sensitivity to heat, cold or sweets. You may feel pain when your dentist taps your tooth.

What causes pulp necrosis?

The most common cause is a cavity. Most people will develop a cavity at some point in their lives. If not detected and repaired, it can allow bacteria to enter the pulp. Other causes include:

  • Cracked tooth: A crack in your tooth can be a route for bacteria to enter the pulp.
  • Dental procedures: Multiple or unsuccessful dental procedures can make a tooth more susceptible to pulp necrosis.
  • Trauma: An injury to your tooth can expose the pulp. It can also affect blood supply to the pulp, causing tissue death.
  • Worn tooth enamel: This can be a result of aggressive brushing or grinding your teeth. The worn areas can allow bacteria to enter your tooth.


Diagnosis and Tests

How is pulp necrosis diagnosed?

If your dentist suspects an infected pulp, they’ll likely refer you to an endodontist. This is a dentist who specializes in treating tooth problems that affect the pulp. Dentists and endodontists use these tests to diagnose pulp necrosis:

  • Electric pulp testing: In this test, an instrument delivers a small electrical pulse to your tooth. If you can feel the stimulation, your pulp is alive. In pulp necrosis, you won’t feel the electrical pulse.
  • Heat or cold test: This involves touching your teeth with a hot or cold substance. Your dentist may also ask about the sensitivities you’ve experienced while eating or drinking.
  • Tooth tapping: Your dentist will assess your response to gentle tapping on your tooth with an instrument.
  • X-rays: Dental X-rays allow your dentist to see the structure of your teeth and jaw. The images may show defects in the tooth or infected pulp.

Management and Treatment

How is pulp necrosis treated?

Once the pulp tissue dies, your dentist must remove it. This will prevent the infection from spreading and causing further damage. Options for treatment include:

  • Root canal: General dentists and endodontists perform root canals. They remove the pulp, clean out the root, then fill and seal the empty root canal. After your tooth has had a few weeks to heal, your dentist will usually cap your tooth with a crown.
  • Tooth removal: This is the extraction of your tooth. Talk to your dentist about your options for replacing the tooth with a dental implant or dental bridge.

Your dentist or endodontist may also prescribe antibiotics to help prevent the infection from spreading, especially if you have to wait for the procedure. But this isn’t a primary treatment.

What are the possible complications of pulp necrosis?

Complications occur when the infection in the pulp spreads. If it reaches the tip of the root, it can cause a pocket of pus (abscess) that can be very painful.

Other complications include:

  • Ludwig’s angina, an infection in the soft tissues under your tongue and in your neck.
  • Mediastinitis, an infection in the space around the organs in your chest.
  • Osteomyelitis of the jaw, an infection of the jaw bone.


How can I prevent pulp necrosis?

You can prevent cavities and keep your teeth healthy by:

  • Brushing your teeth two times a day.
  • Flossing every day.
  • Seeing your dentist for routine cleanings and checkups.
  • Reporting any new dental symptoms, such as pain and sensitivity, right away.
  • Using a night guard to protect your teeth if you grind your teeth in your sleep.

Outlook / Prognosis

What is the outlook for pulp necrosis?

With prompt diagnosis and treatment, your outlook is good.

If the infection spreads to your jaw, neck or chest, it can be serious. In the past, such conditions were life-threatening, but antibiotic therapy and improved imaging and surgical techniques have improved the prognosis.

Living With

When should I talk to my dentist?

If you experience any tooth pain or your teeth become sensitive to heat, cold or sweets, talk to a dentist right away. Early detection and treatment of pulpitis and pulp necrosis can help prevent the infection from spreading and reduce your risk of complications.

A note from Cleveland Clinic

In pulp necrosis, the pulp tissue inside of your tooth dies. Treatment options include a root canal or removal of your tooth. Prompt treatment is essential because the infection that causes pulp necrosis can spread to surrounding areas. Taking care of your teeth is the best way to prevent this condition. Brush and floss your teeth regularly, schedule routine dental appointments and tell your dentist about any new symptoms right away.

Medically Reviewed

Last reviewed on 07/18/2022.

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