What Is a Necrotic Tooth?

A necrotic tooth is a tooth whose nerve (pulp) has died. This occurs when bacteria or trauma permanently damage the blood supply and nerve tissue inside the tooth. Once the nerve dies, it can no longer heal, and bacteria are able to multiply inside the root canal system.

Although the pain from an inflamed nerve may disappear after the nerve dies, the problem has not gone away. In fact, the infection often continues to spread into the bone surrounding the tooth and may eventually lead to a dental abscess.

With prompt treatment, many teeth with a necrotic pulp can still be successfully saved.

What Causes a Tooth Nerve to Die?

A tooth may become necrotic for several reasons, including:

• Deep tooth decay (cavities)
• Untreated irreversible pulpitis
• A cracked or fractured tooth
• Trauma or injury to the tooth
• Large or failing fillings
• Repeated dental procedures on the same tooth
• Severe tooth wear from grinding or clenching

Once the nerve has died, treatment is necessary to remove the bacteria from inside the tooth.

Signs and Symptoms

A necrotic tooth may cause:

• A tooth that no longer responds to cold
• Pain when biting or chewing
• Swelling of the gums near the tooth
• A pimple or bump on the gums (gum boil)
• Bad taste or drainage in the mouth
• Tooth discoloration or darkening
• Facial swelling if the infection progresses

Interestingly, some necrotic teeth cause very little pain. Others become extremely painful once the infection spreads beyond the tooth.

How Is a Necrotic Tooth Diagnosed?

Determining whether a tooth’s nerve is alive or has died requires a comprehensive examination.

During your visit, Dr. Omeltschenko may evaluate:

• Digital X-rays
• Clinical photographs
• Cold testing
• Bite testing
• The condition of existing fillings or crowns
• Signs of infection around the root
• Gum health

These findings help determine whether the tooth can be predictably restored and what treatment is recommended.

What Happens If It’s Left Untreated?

A dead tooth nerve will not heal on its own.

Without treatment, bacteria continue to multiply inside the tooth and may spread into the surrounding bone.

Possible complications include:

• Dental abscess
• Progressive bone loss
• Facial swelling
• Increasing pain
• Spread of infection
• Tooth loss
• More extensive treatment

Treating the tooth before significant infection develops often improves the long-term prognosis.

Possible Treatment Options

Treatment depends on whether the tooth can be predictably restored.

Possible treatment options include:

• Root Canal Therapy – Removes the dead nerve tissue and bacteria from inside the tooth, disinfects the canals, and seals the tooth to preserve it whenever possible.

• Dental Crown – Because many teeth requiring root canal therapy have lost significant tooth structure, a crown is often recommended afterward to strengthen and protect the tooth.

• Tooth Extraction – If the tooth cannot be predictably restored because of extensive decay, fracture, or bone loss, extraction may be the best long-term solution. Replacement options such as a dental implant or bridge can then be discussed.

Whenever possible, our goal is to preserve your natural tooth while providing treatment designed for long-term success.