Pulp necrosis can be defined as the death of the pulp, the pulp internal part of the tooth where the nerves of the tooth are housed, this pulp death can occur in two ways depending on the location

  • Total: when the pulp dies in its entirety
  • Partial: when only one of the parts of the pulp dies

Mainly the death of the pulp is a consequence of a previous pulpitis (pulp inflammation), but it can also occur after trauma when the pulp dies or is destroyed before an inflammatory reaction develops, as a result of which what specialists call an ischemic infarction that ends in a necrotic, dry and gangrenous pulp.

Acute pulpitis as well as degenerative states, depending on some intrinsic factors, can progress rapidly or slowly towards pulp death.

Specifically there are two types of necrosis:

  • By coagulation: the soluble part the tissue becomes totally solid material. Caseification is a type of coagulation necrosis in which the tissue is transformed into a mass with a consistent texture.
  • By liquefaction: the tissue becomes liquid, the pulp is trapped between rigid walls, which causes the tissue pressure to increase dramatically, leading to irreversible pulpitis and subsequent liquefaction necrosis. When the exudate produced can drain somewhere in the oral cavity or because of the caries itself, the pulp can be kept more intact for a longer time.

Regarding the necessary treatment, the type of necrosis is not significant to the choice of one treatment or another, this means that in both cases root canal treatment should be performed regardless of the type of necrosis that is occurring.

Many patients have the following question when they are told about the need for root canal treatment, endodontics. The question arises as to why perform some type of treatment if there is absence of pain.

Often after several episodes of sharp and intense pain, it goes away. But this is not the consequence of an improvement in the state of the nerve, but rather of a worsening, as pulp necrosis has occurred.

Come this moment the risk to our oral health is much greater since dead tissue can cause infections of a greater nature. This is why patients should not be trusted when the pain stops and they should go to the dentist to check the status of the tooth, our dentist will perform the relevant tests to check the vitality of the piece and the true state in which it is found, to perform endodontics. It is important not to wait for an infection to appear in the tooth as it can have consequences on the bone structure, putting the support of the tooth at risk. If we allow the infection to proliferate, an antibiotic regimen should be administered. Recovery in these cases is much slower, without the antibiotic regimen, root canal treatment will not be possible.

It is important that despite the pain in teeth with some symptoms or signs such as those that we have explained previously, we should not overlook going to the dental clinic in order to carry out a clinical study with vitality tests and a radiographic study , which can confirm the pulp status of the piece in question. And it is our dentist who establishes the diagnosis and prognosis.


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