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Necrotic Tooth: Causes, Symptoms, and Treatments
Dental necrosis is a serious condition that affects the living part of the tooth, the pulp. Without treatment, it can lead to local and general infectious complications. Discover how to recognize a necrotic tooth, what its causes are, and the therapeutic options to treat it.
What Exactly is a Necrotic Tooth?
Dental necrosis is defined as the death of the pulp cells, the soft tissue located in the heart of the tooth. The pulp contains the nerves and blood vessels that ensure the tooth's vitality.
When the pulp is destroyed by bacteria or trauma, it is no longer supplied with blood or nerves. The tooth is then irreversibly non-vital; this is called necrosis. Over time, the tooth changes color, turning gray or black.
Necrosis can be partial, affecting only a part of the pulp, or total. It can affect any tooth, most often following a deep cavity or a shock.
What are the Symptoms of a Necrotic Tooth?
The signs of a necrotic tooth are not always obvious. They generally include:
- A history of intense but brief pain, often following a severe toothache or trauma.
- A tooth that changes color, becoming darker.
- Reduced sensitivity to hot and cold.
- Sometimes, swelling of the gum near the affected tooth.
- In advanced stages, a dental abscess with pain, swelling, and fever.
Between painful episodes, the tooth may seem "quiet" for several months or years, giving the illusion of being healed. However, the infection is progressing silently.
Only an examination by a dentist, with vitality tests and an X-ray, can diagnose necrosis. A necrotic tooth no longer responds to stimuli (hot, cold, electric).
What Causes Dental Necrosis?
Three main causes can lead to pulp necrosis:
- Deep Dental Cavity: Carcinogenic bacteria penetrate the enamel and dentin to infect the pulp, causing pulpitis and then necrosis.
- Dental Trauma: A violent shock (accident, fall, blow) can sever the blood vessels that supply the pulp. Deprived of oxygen, the pulp cells die.
- Periodontal Infection: In patients with severe periodontal disease, bacteria from periodontal pockets can reach the pulp through the root apex and cause it to necrose.
Some invasive dental treatments (deep fillings, crown placement, aggressive whitening) also weaken the pulp and promote necrosis.
How is a Necrotic Tooth Treated?
Once the pulp is necrotic, the only treatment is a root canal treatment. It aims to remove the infected pulp and fill the pulp space to prevent further bacterial contamination. Here are the main steps:
- Local anesthesia of the tooth.
- Creating an access cavity in the tooth to reach the pulp.
- Removing the necrotic pulp using fine endodontic files.
- Cleaning and shaping the root canals.
- Filling the canals with a sealing material (gutta-percha).
- Placing a temporary, then permanent, filling or crown.
The treatment allows the tooth to be saved, but it will be more brittle. That is why it is often necessary to place a dental crown or onlay afterward to strengthen the treated tooth. In the most severe cases, extraction may be unavoidable.
What is the Cost of Treating a Necrotic Tooth?
The cost of endodontic treatment varies depending on the tooth:
- Molar: $1,000 - $2,000+
- Premolar: $800 - $1,800+
- Incisor or Canine: $700 - $1,500+
These treatments are typically covered as a major service by dental insurance, often at 50% after a deductible, up to the plan's annual maximum.
To this cost, you must add that of the prosthetic restoration (e.g., a crown: about $1,000 - $2,500), which will also have its own insurance coverage terms. In total, the complete treatment of a necrotic tooth can range from $1,500 to over $4,000, depending on the tooth and the required restoration.
Conclusion
Dental necrosis is a common and serious condition that does not heal on its own. Untreated, it evolves into potentially severe infectious complications.
Regular check-ups with a dentist are essential for early detection and management. Although lengthy and costly, endodontic treatment often allows for the long-term preservation of the tooth.
Prevention of necrosis involves good daily oral hygiene, annual check-ups, and prompt treatment of any cavities or dental trauma. Don't wait for pain to consult!
Frequently Asked Questions About Necrotic Teeth
Does a necrotic tooth always hurt?
No, the pain is not constant. It often occurs at the beginning, during the pulpitis stage, and then disappears when the pulp is completely necrotic. The tooth then seems "healed," but the infection is progressing silently.
What happens if a necrotic tooth is not treated?
The infection can spread to the bone around the root and form an abscess or granuloma. Ultimately, the tooth will be lost, and the infection may spread systemically (cellulitis, sepsis).
Can a necrotic tooth be brought back to life?
No, once the pulp is destroyed, it cannot regenerate. The only treatment is a root canal, which aims to remove the infected pulp and seal the canals. The tooth is no longer alive, but it remains functional.
What are the possible complications of a necrotic tooth?
Dental abscess, granuloma, cyst, cellulitis, sinusitis, sepsis... An untreated necrotic tooth exposes you to sometimes very serious local and general infections. Hence the importance of regular dental follow-ups.