How to identify and treat a dead tooth: advice from a dentist

All teeth have a nerve inside of them, and it is perfectly possible to damage this nerve. If there is a lot of damage, or if there is damage over a long time, the tooth can die.

How to identify and treat a dead tooth: advice from a dentist

Before you get too concerned, and to calm your nerves, I want to reassure you that having a dead tooth does not always mean that you need to have that tooth removed, and I will discuss your options later.

  • A dead tooth is a tooth where the nerve inside has died, and this may happen for a number of reasons including dental decay, dental trauma (a break in the tooth) or previous dental work in the tooth such as a crown.
  • Key signs of a dying tooth include pain, swelling, or a change in colour of your tooth.
  • If you are worried that a tooth may be dead, always have it checked out by a dental professional.
  • Even if the tooth is not painful, it is important to have the tooth checked because you may have an infection underneath the tooth which needs treating. Without treatment, you might get a painful abscess in the future.
  • Treatment for a dead tooth can include monitoring and watching the tooth, root canal treatment, or as a worst case scenario removing the tooth.

Having a dead tooth may be a concern to you, but read on because this article will explain how you can tell if your tooth is dead, what causes this to happen, what to do if you think your tooth is dead.

How to tell if a tooth is dead

You may be worried that you have a dead tooth. There are some common signs and symptoms if a tooth is dying or dead, and for more information you should read on.

As a tooth dies some changes occur. The pulp inside the tooth is the part which contains the nerve as well as blood going to the tooth. How your tooth feels will depend on what is happening inside this pulp.

Ultimately, your dentist will need to do some tests including a cold test and an x-ray to be able to confirm that your tooth is dead.

What does a dead tooth feel like?

A tooth that is alive and healthy should not be in pain at all. 

A tooth that is dying will be painful.

But a tooth that is completely dead is unlikely to feel anything at all.

STAGE 1: A DYING TOOTH

Back to that pulp I was talking about earlier. When this part of the tooth becomes infected with bacteria your own body sends lots of cells to try to save the tooth.

This process is called inflammation and happens everywhere in the body to try and protect you. When this inflammation happens inside the pulp it is called pulpitis.

In the end, all the extra cells inside the nerve causes a build up of pressure inside the pulp, and this is what causes the pain. 

This pulpitis is sore -- sometimes to cold, sometimes to hot. Sometimes it can be difficult to even tell. This is good news, because it is only the early stages of a tooth dying. When caught early enough, steps may be taken which could possibly slow down or even the reverse the process.

Image showing how a nerve can be irritated by a filling

Sometimes teeth with large fillings in them become sore as the nerve is irritated by the filling, and sometimes this goes away by itself. This reversible irritation of nerve is also known as pulpitis, and may not need any treatment, other than for it to be checked by a dental professional.

STAGE 2: TOOTH IS UNSAVEABLE

As the nerve containing pulp becomes more infected the nerve might be damaged beyond repair. This is irreversible pulpitis.

Irreversible pulpitis can be incredibly painful to begin with, but often this pain goes away, sometimes within a few days. Do not be fooled, you still need to see your dentist!

STAGE 3: A DEAD TOOTH

A dead tooth no longer has a living nerve in it and so will likely feel different to a living tooth. You might not be able to explain why it feels different, but there are some common feelings in a dead tooth.

A dead tooth is not normally painful, because there is no nerve in the tooth to feel pain. But a dead tooth may have an infection in the bone underneath it. This infection is called an apical periodontitis. This can grow into an abscess if it is not treated.

If you have pain when you bite down, you likely have an infection in the bone at the very tip of the root. This infection can lead to an abscess with pus and swelling, and can mean that the bone around the tooth is sore to touch. Our article about abscesses goes into a  lot of detail about abscesses and how to treat them

A dead tooth may feel loose in the mouth. The tooth can feel loose if you touch it with your finger, or when you bite down. The tooth might feel like it is out of place in the mouth, but without being painful.

What does a dead tooth look like?

A dead tooth can look like a normal tooth to the untrained eye. If there is no pain in the tooth you may not even notice that you have a dead tooth.

However, there are some common signs for a dead tooth that you might notice at home:

  • A dead tooth may have a break in it. This break may be the reason why the tooth is dead. The break may just look like a line through the tooth. But the break might be very obvious and you might have a chunk of your tooth missing.
  • A broken dead tooth might be black inside, especially if the damage was done a long time ago.
  • A dead tooth may be darker than the tooth next door to it. The colour of a dead tooth might be more yellow, more grey, or more black than a living tooth. A change in colour is often one of the first signs of a dead tooth.

Not all discoloured teeth are dead teeth. Teeth naturally yellow and darken with age, and you can find out more in our article about yellow teeth and what causes them. Your tooth might also stain badly from food and drink, as well as smoking. Another common reason for a tooth to change colour is a tooth that has a large metal filling. Sometimes these teeth go darker with age as a small amount of metal seeps out, but this does not necessarily mean that you have a dead tooth.

Steps to take if you are worried you have a dead tooth

If you are worried that you have a dead tooth, it is important that you get advice from a dental professional. If the tooth is not painful, this may not be urgent and could wait a few weeks until an appointment is available. 

It is always best to get a professional check on a suspected dead tooth to confirm whether or not it is in-fact dead. You might even find out that you have been worried about nothing and that the tooth is totally healthy!

What can I do at home?

At home, if you are worried you have a dead tooth and are waiting for an appointment there are some things you could do:

  • Take a picture of the tooth. Try and get a friend to take a picture of the tooth. This way the dentist can see if there are any changes between when you first notice the tooth and when you get to see the dentist.
  • Have a think if you have any reason to have a dead tooth -- have you fallen and knocked the tooth, or have you had a hole in the tooth  for a long time? You can read more about the causes of a dead tooth below.

If your tooth is painful get booked in with your dentist for an emergency appointment so that they can try to alleviate your pain.

Dead Tooth Pain Relief 

Although a dead tooth has no nerve, and so should not be painful, it is possible that you may have some symptoms in the lead up to this stage.

A dying tooth can be very sensitive to extreme temperatures. If this is the case then avoiding hot or cold food and drinks may prevent pain.

A dying tooth, or a dead tooth with infection at the top of the root, can be sore to bite down on. If your tooth is sore to bite down on try to avoid hard or sticky foods, and try to eat on the other side of your mouth.

Some teeth are more sore when you lie down flat, as the blood can flow more easily to your head. Because of this it can be more comfortable lifting your head with a couple of pillows when you go to sleep.

Over the counter painkillers are very good for managing toothache. Paracetamol and ibuprofen are the most common types of painkillers and can be bought in most supermarkets as well as pharmacies. Be careful not to overdose, but these can help manage your pain until you see a dentist. If you have questions about pain relief you can ask your local pharmacist, or read up about it on the NHS website.

What is a dead tooth?

I have already explained that a tooth has a living centre to it -- the pulp -- and that this contains a nerve supply and a blood supply when the tooth is healthy. This soft core sits inside the very hard dentine and enamel of the tooth.

Scientific diagram showing the anatomy of a tooth

Bacteria can get into the pulp through dental decay or through a break in the tooth, for example if you fall over and crack a tooth.

Cutting of the blood supply, for example by falling over and knocking out a tooth is also a big cause of damage to the tooth.

The first signs of irritation in the pulp are because your body sends cells to try and repair the damage. These extra cells cause a build up of pressure inside the pulp, which can make it sensitive to hot or cold. This reversible pulpitis stages does not mean that your tooth is dead, or that it will definitely die.

Ultimately if we don’t treat the irritation in the pulp, it is possible for this living bit of the tooth to die off, so that there is no longer a working nerve in the tooth, and blood will no longer flow to the tooth either.

If the tooth doesn’t manage to repair itself, or the infection spreads beyond just the pulp, you may develop more serious irreversible pulpitis. This simply means that the damage to the nerve cannot be undone, and definitely requires treatment, be that root canal treatment or for the tooth to be removed.

What is a non vital tooth?

When dentists talk about whether a tooth is alive or not, they may talk about the tooth vitality.

Dentists have many ways they can test a tooth to see if the tooth is alive. 

A tooth without a nerve will not sense changes to temperature. This can be tested on the tooth using a very cold bit of cotton wool, for example.

A non-vital tooth is a tooth which doesn’t react to cold stimulation or electric stimulation. In other words, a non-vital tooth is a dead tooth!

Dentists also have specialist electrical pulp testers. These use a very tiny electrical current. When using this on a tooth that is alive, a small but non-painful sensation will be felt by the nerve in the tooth. If the tooth is no longer alive, it will not react to the current and you would feel nothing at all, no matter how high the current is turned up!

Photo of electrical pulp tester
Image Source: Wikimedia Commons

Your dentist will do special tests with cold or electrical stimulation to see if there is any feeling left in the tooth. A healthy tooth will react and feel cold or a sensation through the tooth, without being painful. An exaggerated reaction or no reaction at all can indicate to your dentist that the tooth is dead.

What happens when a tooth nerve dies?

There are a number of reasons why a tooth nerve can die. The reason the tooth dies can also affect what happens when the nerve dies.

A tooth which is dead has no living nerve or blood supply in it. Because of this the tooth will feel different to a healthy, living tooth. 

If your tooth is dead, the nerve to the tooth will no longer be able to feel pain, and so the tooth itself will not be painful.

As the inside of the tooth, the pulp, dies it will change colour. The pulp will no longer be red inside because there will no longer be flowing blood inside the pulp. In fact, if your tooth is broken in half you may see that it is black inside. The whole tooth may change colour to look darker than the teeth next door.

As well as looking darker, a dead tooth may have signs of infection that has spread from the root of the tooth.

Signs of infection of a dead tooth include an abscess with pus coming out. A dead tooth may smell bad because of this pus and infection. This infection may also make it painful when you bite down on the tooth, even though the tooth itself isn’t aching or sore.

A dead tooth may become loose in the mouth. It may move when you touch it or when you bite down on it. This may not even be painful because there is no nerve in the tooth.

Reversible pulpitisIrreversible pulpitisDead tooth
What is happening?Tooth is trying to repair itself in one small area. One small area of pulp is inflamed.Tooth is trying to repair itself. Most of the pulp is inflamed beyond repair.The tooth has previously been damaged. The pulp is completely dead.
CauseSmall amount of decay or gentle knock, a leaking fillingLarge amount of untreated decay, severe knock, dental work, untreated reversible pulpitisLarge amount of untreated decay, severe knock, dental work, untreated pulpitis.
What is happening to the nerve of the tooth?The nerve is irritated and this is painful.The nerve is irritated and this is painful.There is no nerve in the tooth.
Response to vitality testExaggerated response, may have pain after.Exaggerated response with lingering pain afterwards.No response.
TreatmentMonitor, consider temporary filling to help tooth settle.Tooth requires root canal treatment, or extraction.Monitor if not causing any pain, root canal treatment, or extraction.

Why does a tooth die?

A tooth will die when the pulp (the central part of the tooth) has been irritated or damaged. Your body sends extra cells to the pulp when it is irritated.

This irritation may come from bacterial infection, such as through decay or through a broken tooth.

The pulp may also become very irritated due to too much pressure close to the pulp, for example if you have had a lot of dental work on that tooth, or trauma to the tooth that can affect the blood supply.

Tooth Decay

Tooth decay is caused by bacteria. As such, untreated tooth decay may result in these bacteria reaching the nerve of the tooth.

A tooth that has a large cavity, or decay, inside it will normally die in an obvious way.

With tooth decay, the bacteria in the cavity spread through the tooth to the pulp. The bacteria in the pulp can cause infection. To try and remove the bacteria your body sends lots of immune cells to the pulp. These extra cells may help clear the infection without too much bother. 

Photo of severe tooth decay
Image Source: Wikimedia Commons

Unfortunately if there is too much infection with the bacteria, or if there are too many immune cells causing inflammation, the nerve may die. This can be painful as your body tries to fight the bacteria in your tooth.

Dental Trauma

Dental trauma is any sort of event that causes a knock to a tooth. The trauma may cause a wide range of damage to the tooth.

Photo showing badly damaged tooth
Image Source: Wikimedia Commons

The least serious form of dental trauma is concussion -- a simple knock to the tooth with reversible damage to the pulp. More serious dental trauma may cause breaks in the tooth, possibly exposing the nerve. Or your tooth may be knocked out completely.

A tooth that is knocked, but not broken, may die slowly and without and signs or symptoms. The centre of the tooth (the pulp) may lay down lots of reparative dentine in response to trauma. In some circumstances this hard dentine layer can entirely fill up the pulp and the nerve canal in the tooth. If this is the case the pulp is becoming sclerosed, and the nerve is no longer able to fit in the pulp.

Dental trauma may also cut of the blood supply to the pulp of the tooth. When you knock the tooth, it may tip forwards to backwards or may be pushed inwards, or even be knocked out completely. In all of these cases the fragile blood vessels and nerves that enter the pulp via the root at the very top can become damaged. If this cannot be repaired, the tooth can die.

Finally, dental trauma may cause a break in the tooth that allows bacteria to get straight to the pulp of the tooth. How the tooth dies in this case is very similar to tooth decay.

Dental Work

Repeated dental fillings which are close to the pulp, or invasive treatment such as preparing a tooth for a crown, can all irritate the pulp and therefore the nerve of the tooth.

The bigger the filling is, the more likely the pulp is to react to the heat caused during drilling, and even the filling material itself. In some cases the damage may be reversible, as the tooth places the reparative dentine to protect itself.

Photo showing a filling
Image Source: Wikimedia Commons

Sometimes the pulp’s reaction to the filling is exaggerated, causing increased pressure in the pulp, and for the nerve to die. 

Sometimes too much of this dentine can be placed causing sclerosis of the pulp, which means there is no longer space for the nerve to stay and the tooth dies. 

Long term the tooth may die off because of dental work, and no matter how good your dentist is!

How long does it take for a tooth to die?

There is no easy answer for how long it takes for a tooth to die.

Mostly, it depends on what has happened to the tooth to cause it to die.

If you have untreated tooth decay in your tooth, or have broken the tooth so that bacteria can get to the pulp, it could take from a few months to a few years for the tooth to die. And this may not always be painful.

Is it easy to spot a dead tooth? Can it be spotted from a normal x-ray?

A dentist will be able to tell you if you have a dead tooth.

They can do a number of tests but will consider:

  • Appearance
    • A darker or yellow tooth in comparison to other teeth is often a sign of a dead tooth. Large holes, fillings, or fractures may also indicate to the dentist that the tooth could be dead.
  • Pain
    • An absence of pain from the tooth itself can be a sign of a dead tooth. There may, however, be some tenderness in the tooth when biting down, or if the dentist taps on the tooth.
  • Radiographs/x-rays
    • An x-ray can’t directly show that a tooth is dead, but it can give the dentist a number of clues. For example, the space where the nerve is may have closed up (sclerosed), or there may be an area of infection at the top of the tooth which is usually associated with a dead tooth.
  • Cold testing
    • Often a tooth that is dead will not react to cold. The dentist can test individual teeth and compare reactions.
  • Electric pulp testing
    • This sounds more scary than it is. A tiny electrical current is run through the tooth. On a healthy tooth this will not hurt, but merely feel like a buzzing. A dead tooth will not react at all.

Overall, there is not a single way to test for a dead tooth, but the dentist will use lots of different tests to build up a picture. 

How long can a dead tooth stay in your mouth?

If you have a dead tooth and it is not causing you any symptoms, it might be in your mouth for a long time. You may not notice it at all.

You may have recently seen a new dentist who has done some extra tests and told you that a tooth is dead. So what now?

A dead tooth can be left in the mouth without any treatment, although this is not normally advised. If that tooth didn’t cause any problems when it was dying off, that tooth may stay there for many years. Most of these teeth will cause pain at some point.

You may choose to have treatment on your dead tooth. The odds of successful treatment are high, and successful treatment in a dead tooth could allow you to keep that tooth as long as any other tooth in your mouth. 

Are dead teeth harmful to general health?

Dead teeth can harbour bacteria, which your body is unable to remove as there is no blood flow to the teeth.

For healthy people, having an untreated dead tooth in their mouth is not necessarily harmful to their general health. But you may want to consider what impact it may heave, leaving this source of inflammation and infection untreated in your body for a long time.

The worst case scenario is that an abscess forms and you need emergency treatment for that abscess. This type of infection is normally only around the tooth itself, and unlikely to cause any harm to your general health.

Some people may not like the thought of a dead tooth which hasn’t been treated in their mouth. 

A root treated tooth is also not harmful to general health. Recent Netflix documentary Root Cause has alternative views on this, but the evidence for root canal treatment is extensive and you could look at the websites for the American Association of Endodontists and the European Society of Endodontology for more information about this.

That’s all good and well if you are a healthy individual. However some people have weakened immune systems, for example if you are having treatment for cancer, or take immunosuppressants. In this case it is not advised to keep an untreated dead tooth.

Guys and St Thomas Hospital in London explain in this document why dental treatment is important before starting cancer treatment. Not having treatment can complicate your cancer treatment.

The bacteria that can be in your dead tooth can cause infection. And if your immune system is weak for any reason, this could have serious consequences. A dentist will discuss these risks when they give you the options for treating a dead tooth.

How to prevent teeth from dying in the first place

As we have discussed there are a number of ways teeth can die. There are some steps you can take to avoid this happening.

Keep your teeth clean

Keeping your teeth clean will avoid decay and protect fillings that you already have. Brush twice a day, preferably with an electric toothbrush, and with a fluoride containing toothpaste. You should also clean between your teeth every day, for example with floss or interdental brushes. You can read more about this in our article about tooth decay.

Reducing the amount of sugar in your diet will help too. By reducing your risk of decay you are less likely to get bacteria into the pulp of the tooth and cause infection of the pulp. Making your fillings last longer will also reduce the need for the dentist to do drilling, each time creating a bigger filling, which can also irritate the pulp.

Protect your teeth from bumps and falls

Knocking your front teeth can cause damage to the pulp, and in the end may cause it to die. Take simple steps, like avoiding opening bottles or other items with your teeth, to prevent avoidable damage.

If you play contact sports such as rugby or hockey you should wear a gumshield or mouthguard to prevent serious injury to your teeth and gums. Sometimes accidents are unavoidable, but reduce your risk by being careful where you can.

Think twice about dental work

Serious dental work, like crowns, does risk damaging the pulp. You may need a crown to save the tooth, and this is unavoidable. But, for example, if you want crowns on your front teeth to improve the appearance, you should think twice about this. Be aware of the risks, only you will know if it is worth it.

Dead Tooth Treatment

If a tooth is dead, it is important to get professional advice on what treatment is required. 

It is possible that you can choose to keep a dead tooth without having any treatment, especially if there are no symptoms.

However, any tooth that has died is liable to infection. That infection may occur at any point and can result in a sore tooth, and an abscess forming. We discuss the options for this in our article about dental abscesses. For some people, for example those with a lowered immune system, it may not be acceptable to keep a tooth that could potentially cause infection, without having some sort of treatment.

Having treatment for a dead tooth will reduce the risk of an abscess, but it is important to remember that even treated teeth may become re-infected. 

Options for treatment include monitoring the tooth (but accepting the risk that you may get pain at some stage), or you may opt for treatment to keep the tooth. To keep a dead tooth you will normally require root canal therapy. 

If you prefer not to have a lot of treatment, you may choose to have the tooth extracted. After a tooth has been extracted you may choose to leave the gap or to have a fake tooth of some description to fill the gap.

You may already have a dead tooth which has been treated with root canal treatment. This teeth can become darker because they are dead. There is an option to whiten the tooth to improve how it looks.

Tooth extraction

A tooth extraction will remove the tooth, which can act as a source of infection and pain if it is left in the mouth.

To find out what you should expect when having a tooth extraction, have a read through this article dedicated to tooth extraction.

Tooth extraction is irreversible- once the tooth is out, it cannot be placed back into the hole. However there are options to fill the gap, such as a denture, a bridge or an implant.

Root canal treatment

You may be wondering how to save a dying tooth? If your tooth is dying, you can opt for root canal therapy (or root canal treatment). The idea of this is to remove the dead nerve, and fill the gap left behind where bacteria can build up and cause an infection.

There is a lot of information in our article on root canal treatment. Not all teeth can be saved with root treatment, but you can ask your dentist about this option is you want to avoid having a dead tooth removed.

The British Endodontic Society estimates success rates of about 90% for root treated teeth. However some teeth may not survive even with root treatment, and future re-treatment may be necessary.

Dead tooth whitening

A dead tooth, whether or not it has had root canal treatment, will often go darker than other teeth. This can be upsetting, especially if it is a front tooth.

Tooth whitening is an option available to improve how such a tooth looks. This is a cosmetic procedure. As such, in the UK it is unlikely to be available on the NHS and you will likely need to pay privately for this treatment.

Can you whiten a dead tooth?

Yes, you can whiten a dead tooth!

The tooth must have had root treatment first. The bleach can be placed inside the dead tooth to whiten the tooth from the inside as well as outside.

The results are normally quite quick -- anywhere between 48 hours and a couple of weeks, and can last many months or even years.

How to whiten a dead tooth

There are two main techniques for whitening a dead tooth -- but both aim to whiten the tooth from the inside and outside at the same time.

Our in-house dentist Dr Chhaya Chauhan goes into detail about how to whiten a dead tooth in the video below, and in our article about professional whitening.

How to whiten a single dark tooth

You will need to see a dentist for this procedure. It will involve removing the filling to get to the root filling, and possibly removing some of the root filling too.

The dentist will also be able to supply you with whitening trays and bleach to take home, if required.

Are there any alternatives?

If you don’t like how a dead tooth looks, whitening it is a good option for a front tooth as it does not involve much drilling, and it is a fairly simple procedure.

You may be wondering what other options are available, for example if the whitening does not work as well has you had hoped, or if you have had a bad experience with whitening in the past?

You can choose to leave your tooth as it is. The fact that it has changed colour after treatment is normal, and will not affect you. However, you may want to think about having a crown put on the tooth. In most cases your dentist will recommend a crown on the tooth after a root filling anyway in order to protect the tooth. You should ask about this option for your tooth.

FAQ

What is a dead tooth?

A dead tooth is a tooth which has been damaged so that the pulp inside it, including the nerve, is no longer living.

What do you mean by reversible pulpitis?

Reversible pulpitis is irritation to the pulp (the bit of the tooth containing the nerve), which can be repaired so that the tooth survives.

What does a dead tooth look like?

A dead tooth is often a different colour to a healthy tooth, and may have a hole or crack in it.

I have a black tooth, is it dead?

Not all teeth that are black are dead. Teeth may develop with black-ish marks on them, and teeth with metal fillings can stain so that the look black. In these cases the teeth may be perfectly healthy but look black.

I have a painful tooth, is it dead?

Dead teeth cannot feel pain. However a tooth that is dying can be very painful. You may also get pain from an abscess underneath a dead tooth.

How can a dentist tell if my tooth is dead?

A dentist will use their experience and a series of tests including hot and cold, electric pulp testing, and xrays, to see if your tooth is dead.

Why is my tooth dead?

A tooth may die because of:

  • Tooth decay spreading to the pulp.
  • Severe trauma to the tooth, for example falling over.
  • Lots of dental work in the tooth.

What treatment can be done on a dead tooth?

A dead tooth could be treated with a root canal treatment to keep it in the mouth. You may also choose to have it extracted. Once the tooth has a root canal filling it will normally have a crown, or you may have it whitened to improve the appearance.

Do I have to have treatment on a dead tooth?

If the tooth is not painful you may choose to leave the tooth in the mouth without treatment, although this is normally not advised due to the high risk of future pain and infection.

How can I improve the way my dead tooth looks?

You can improve the way a dead tooth looks by having dead tooth whitening, or with a crown.

About Dr. Gemma Wheeler

Gemma qualified from Cardiff University School of Dentistry in 2015. She went on to complete her Foundation Training and a further two years in the Armed Forces, primarily based around Wiltshire. She now works in mixed NHS and Private practice in South Wales.

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