How to spot the signs of a dead tooth

What is a dead tooth?

A dead tooth, also called a non-vital tooth or pulpless tooth, is a tooth that's no longer receiving a fresh supply of blood. Cosmetic dentist Dr Sam Jethwa explains how a tooth can die:

"Our teeth are made up of three layers; the enamel on the outside, the dentin on the inside, and in the middle the pulp. The pulp, a rich source of nerves and blood vessels, keeps a tooth alive and healthy. When these blood vessels and nerves die, then the tooth dies as well."

The three layers

According to Dr Jethwa, there are three reasons that can cause these vessels and nerves to die; physical trauma and damage - usually from an injury or sometimes even the process of having a filling - or from tooth decay.

Tooth decay tends to be the result of poor higiene dental or a diet that's high in sugar. This prevents bacteria from building up, infecting the pulp, and cutting off its blood flow.

You can often identify a dying or dead tooth by the way it looks. This is because the tooth becomes discoloured, turning grey or black in appearance. This discolouration will continue to grow more obvious as the tooth continues to decay and the nerve dies.

Other signs of a dead tooth include:

• Toothache - this can be constant or happen at certain times, such as when the tooth comes into contact with hot or cold things.

• Tooth sensitivity or a loss of sensation.

• Swelling around the gum.

• An abscess - a swollen, pus-filled bump.

• Mal aliento - sometimes a little bad breath is normal, especially morning breath, but it can be a sign of a dental problem.

"It is possible to save a tooth that is dying, but time is of the essence," says Dr Jethwa. "For the tooth to be saved, you need an early diagnosis."

Can a dead tooth be saved?

This means you should visit a dental professional as soon as you notice the signs of a dead tooth. According to Dr Jethwa, your dentist may have materials that can be placed inside the tooth to regenerate the tooth tissue around the nerve and avoid root canal treatment.

He also explains the other treatment options:

Una root canal is a procedure that drills into a tooth to remove the dead pulp and replace it with a man-made substance. It's then sealed to prevent further infection.

The third treatment option is extraction - the total removal of the dead tooth if it's too damaged to repair. It's your choice if you then want to fill in this gap with an implant, denture, or bridge.

The cost is one consideration - NHS dentists have fixed priced treatment plans but costs at private dentists can vary depending on the pratice, and the type and size of the replacement. The Oral Health Foundation recommends getting a written estimate and treatment plan before starting any dental treatment, to avoid any financial surprises¹.

Can you whiten a dead tooth?

"If the damage has already affected the tooth enamel and caused discolouration and brittleness, then an ultra-thin veneer could be an ideal way to hide the discoloration and protect the tooth from further damage," says Dr Jethwa.

However, this depends on how early the problem is identified. Your dentist will advise on the dental care options available to you, both in terms of your dental health and wellbeing, and also your cosmetic options.

1. Oral Health Foundation: Bridges and partial dentures.