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What to Expect if You Have a Dead Tooth

Posted on April 14, 2021

What is a Dead Tooth?

Our tooth is composed of three layers:

  1. Enamel: This is an extremely hard outer layer, takes 2.5 years for the decay process to go through the enamel to the next layer.
  2. Dentin: This is the next layer under the enamel, which comprises the biggest part of the crown of the tooth. It is organic and much softer than enamel. Takes only 6 months for the decay process to go from the outer edge of the dentin to the third layer (the heart of the tooth) the pulp.
  3. Pulp (chamber): This is a chamber in the center of the tooth covered by the dentin and the enamel. It is the living part of the tooth comprised of an artery, vein, and nerve. If the sanctity of this chamber is broached by decay or trauma the blood flow is impaired. The lack of blood leads to necrosis (tissue death inside the tooth). At this time if bacteria are present infection will occur with the formation of gases trapped inside the chamber. This leads to pain, swelling, and abscess formation.

So if there is any decay or a traumatic accident that violates the pulp the tooth will die.

What Causes a Dead Tooth?

  1. Tooth decay: This is a process where bacteria that always live in our mouth (ie Streptococcus Mutans) works on food debris (simple sugars, sucrose) to form an acid that eats away at the enamel of the tooth. The decay then goes quickly through the dentin and into the pulp, where blood supply is impaired, necrosis occurs which leads to infection and tooth death.
  2. Trauma: If a tooth breaks (fractured) and the crack exposes the pulp, the pulp will, in turn, lose its blood supply, necrose and die.

Signs and Symptoms of a Dead Tooth

  • Pain
    • Unsolicited
    • Upon lying down
    • Percussion, chewing or biting
    • Application of Heat
  • Bad taste or smell which usually signifies an infection
  • Swelling in gum at apex of tooth
  • discoloration of tooth, usually darker

Treatment Options for a Dead Tooth

Root canal therapy

This is a conservative treatment where our endodontist, Dr. Steven Lipner, with the aid of a microscope, skillfully removes the infected pulp tissue, sterilizes the pulp chamber all the way to the tip of the roots, and then fills the chamber with an inert sterile material called gutta perche (which prevents further infections from recurring). Usually following root canal therapy one of our cosmetic dentists will place a core and a beautiful porcelain crown over the tooth to ensure its strength, longevity, cosmetic, and function. This is the best option when we are faced with a dead tooth.


On occasion, the tooth is so broken, so infected that we cannot save it with root canal therapy. As dentists, we have a very diseased, infected area, with a badly broken tooth and a patient in pain. The tooth must come out. So we gently elevate the tooth out of the mouth.

Sometimes we place an implant (false root) right at this time, other times we place bone graft material or simply leave the space alone. If the tooth is important we think two steps ahead and plan with you, the patient, how space will be restored in the future.

Pain Management

  1. Antibiotics
  2. Analgesic medications (Tylenol alternating with Advil)
  3. Avoid hot foods
  4. Avoid hard foods
  5. Keep head elevated when sleeping
  6. Call 209 NYC Dental ASAP as we are open seven days a week for emergency dental treatment

Dead Tooth Prevention

  • Home care, brushing 2x daily, nightly flossing, non-abrasive fluoride toothpaste
  • A diet that is very low in sugar
  • Regular checkups at the dental office
  • Completion of all necessary work, including fillings, crowns, and Invisalign orthodontics. This stops decay and aligns our teeth. So that if trauma occurs, it is dispersed evenly throughout the mouth thus preventing fracture of a single tooth.
  • Mouthguards- prevents weakening teeth from grinding (bruxism), decreases chances of traumatic injury during sports.

Book an Appointment with 209 NYC Dental

At our office, 209 NYC Dental, we are a multispeciality office. We have Dr. Lipner, our specialist who uses a microscope to do root canals. Additionally, we have Dr. Wang, our board-certified surgeon and implantologist. Our team of dedicated cosmetic dentists is here to help you. Consultations are complimentary. If you exhibit any of the signs of a dead tooth, do not hesitate, make an appointment today. Whether your tooth is dead or not you will leave with a smile.


About Dr. Steven Kafko

Guided by the belief that being a highly skilled specialist in a narrow field is better than being ordinary in everything Dr. Kafko has grown 209 NYC Dental into one of the leading NYC multi-specialty dental practices that it is today. Having extensive cross-specialty training with decades of experience, and strive to provide his patients with the most appropriate dental care Dr. Kafko succeeded in becoming an excellent diagnostic dentist. His skills to triage the most comprehensive dental treatment that a patient may require are highly appreciated by patients and his colleagues.

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