Do all dead teeth fall out?

A tooth looks solid, but inside it is alive. The pulp at its center holds blood vessels and nerves that keep the tooth healthy and sensitive. A tooth is called "dead" or "non-vital" when that pulp dies because its blood supply has been cut off. The two most common causes are deep tooth decay that reaches the pulp and an injury to the tooth, such as a blow to the mouth. Once the pulp dies, the tooth can't heal itself and becomes more vulnerable to infection.

A dead tooth is often painless, and you may not notice it without a dental exam. Some people do notice signs such as:

• the tooth turning gray, yellow or darker than the teeth around it
• pain or tenderness, especially when biting
• swelling of the gum near the tooth, or a small pimple-like bump on the gum
• a bad taste or bad breath that doesn't go away

Left untreated, a dead tooth can lead to a dental abscess, the spread of infection into nearby tissue and bone, and eventually loss of the tooth. Treatment such as root canal therapy can remove the dead pulp, clear the infection and, in many cases, save the tooth.

Will a dead tooth always fall out?

No. A dead tooth won't always fall out on its own. Even though the nerve and blood supply inside it have died, the outer structure of the tooth is still there and stays anchored in the gum and jawbone. A dead tooth can stay in place for months or years.

That doesn't make it harmless. Because a dead tooth no longer has a blood supply, it can't fight off bacteria. Without treatment it can lead to:

• a dental abscess, a pocket of infection at the root of the tooth
• spread of the infection to surrounding tissue
• loss of jawbone around the tooth
• a tooth that becomes brittle and breaks
• problems for the teeth next to it

If you think you may have a dead tooth, see a dentist for an exam and an X-ray, even if it doesn't hurt.

How can a dead tooth be treated?

The right treatment depends on how much of the tooth is left and on the health of the gum and bone around it. At Dentist on Madison in Midtown Manhattan, Dr. Avner will examine the tooth, take X-rays and explain your options.

Root canal treatment. When the tooth structure is largely intact, root canal treatment is usually the way to save it. The dentist removes the dead pulp, cleans and disinfects the inside of the tooth, then fills and seals it to prevent new infection. A tooth treated this way is often covered with a dental crown afterward to strengthen and protect it. Learn more about root canal treatment at our office.

Extraction and replacement. When a tooth is too damaged to save, it may need to be removed. Read about tooth extraction. The missing tooth can then be replaced with a dental implant topped with a crown or, when the teeth on either side need crowns anyway or more than one tooth is missing, a dental bridge.

Discoloration. A tooth that has turned dark after root canal treatment doesn't respond to ordinary whitening. Ask your dentist whether internal whitening, a crown or a veneer would suit it.

Whatever the treatment, early care gives the best chance of keeping your natural tooth and avoiding more serious problems. Keeping your own tooth, when that is possible, also preserves the bone around it and avoids the need to replace it later.

When to see a dentist

Call a dentist soon if a tooth has changed color, hurts when you bite, or if your gum is swollen near a tooth. Call right away, or go to an emergency room after hours, if you have facial swelling, fever or swelling that is spreading. At Dentist on Madison, we see dental emergencies during office hours. Call (212) 227-4600.

Frequently asked questions

Is a dead tooth an emergency?

A dead tooth that doesn't hurt still needs a dental visit soon, but it's not usually an emergency. It becomes urgent if you have severe pain, swelling of the face or gum, fever or a bad taste from pus, because these can be signs of an abscess.

How long can a dead tooth stay in the mouth?

A dead tooth can stay in place for months or even years. The longer it goes untreated, though, the higher the chance of infection, bone loss around the root and a tooth that becomes too weak to save.

Can a dead tooth come back to life?

Once the pulp has died, it doesn't heal. After an injury, though, a tooth can be sensitive or temporarily discolored while the pulp recovers. That's why a dentist may monitor an injured tooth with follow-up tests and X-rays before recommending treatment.

Does root canal treatment hurt?

Root canal treatment is done with local anesthesia, and for most people it feels similar to having a filling. The tooth may be tender for a few days afterward. Treatment usually relieves the pain that an infected tooth was causing.

How does a dentist know a tooth is dead?

A dentist looks at the color of the tooth, checks the gum around it, taps on the tooth and takes X-rays to look for changes around the root. Pulp tests, such as touching the tooth with something cold, show whether the nerve still responds. The results together tell the dentist whether the pulp is healthy, inflamed or no longer alive.

Can I leave a dead tooth that doesn't hurt?

It's not a good idea. A dead tooth can carry an infection without any pain, and the infection can damage the bone around the root before you notice anything. A checkup and X-ray will show whether the tooth needs treatment now, while there are still more options for saving it.

*This article is general information, not a diagnosis or medical advice. A dentist needs to examine the tooth to recommend treatment.*

Sources

• American Dental Association, MouthHealthy: Root canals
• American Dental Association, MouthHealthy: Dental emergencies