Pulp necrosis: when the tissue inside a tooth dies

Pulp necrosis means that the soft tissue inside a tooth has died. This tissue, called the pulp, contains nerves and blood vessels. Deep tooth decay can lead to pulp damage, but decay and pulp necrosis are different conditions.

An affected tooth needs dental assessment even if it is not painful. If the root canal becomes infected, the infection can spread into the tissues around the root.

What causes pulp necrosis?

Severe inflammation of the pulp can progress to tissue death. Deep decay, a crack or an injury may damage the pulp or its blood supply. The tooth can sometimes look fairly intact from the outside, particularly after an injury.

This is not a diagnosis you can make from the colour of a tooth or the size of a cavity. Your dentist will consider its history, test the tooth and examine the gums and surrounding area. X-rays can help assess the roots and supporting bone, alongside the clinical findings.

Does a tooth with dead pulp always hurt?

No. Pain may lessen or disappear as the pulp dies, but that does not mean the tooth has recovered. Some affected teeth have few symptoms until the tissues around the root become inflamed or an abscess develops.

Possible signs include pain when biting, swelling, a bad taste, drainage from the gum or a change in tooth colour. Each can have other causes. Do not wait for severe pain before arranging an assessment of a damaged or discoloured tooth.

When to seek urgent care

An infection associated with a tooth can spread and become serious. Seek urgent dental advice for swelling, fever, pus, worsening pain or feeling unwell. Contact NHS 111 if you cannot access urgent dental care.

Call 999 or go to A&E if swelling affects breathing, swallowing or speaking, involves the eye or vision, or causes marked difficulty opening the mouth. Pain relief should not delay assessment of these symptoms.

How is it treated?

For a tooth with infected dead pulp that can be saved, root canal treatment removes the affected tissue, cleans the canals and seals them. The tooth then needs a suitable restoration. A filling or crown repairs and protects the remaining tooth; it does not replace treatment of an infected root canal.

If the tooth cannot be restored or its supporting tissues are too damaged, extraction may be appropriate. Your dentist should explain the options, likely outcome and costs. If a tooth is removed, discuss whether and how to replace it, taking account of its position, your bite and your preferences.

Antibiotics do not remove dead pulp and are not a substitute for dental treatment. They may be needed for selected infections that are spreading or causing systemic illness, as assessed by a clinician.

What might treatment cost?

The fee depends on the tooth and the treatment needed. The following are specific listed services, not a complete estimate for every affected tooth:

• Root canal treatment for an incisor without a microscope, including treatment, treatment X-rays and a core build-up: £450.
• The same incisor treatment with a microscope, including the core build-up: £550.
• Extraction of an incisor or canine, teeth 1–3 in a quadrant: £140.

The two root canal prices are alternative treatment options, and each includes the build-up. Crowns and onlays, if needed, are priced separately. Other tooth types and retreatment have different fees. Ask for a written estimate and see our dental treatment fees and oral surgery fees.

For instalments, read the current finance terms. Eligibility and approval conditions apply.

Reducing the risk of further problems

Brush twice daily with fluoride toothpaste, clean between your teeth and limit how often you have sugary foods and drinks. Attend dental reviews at the interval recommended for you and arrange care for decay, cracks or injuries promptly. These measures support oral health but cannot prevent every cause of pulp damage.

Contact us to arrange an assessment. If you have urgent symptoms, use the urgent care routes above.