What is pulp necrosis?
The term pulp necrosis describes the death of the blood and nerve vessels within the tooth pulp, the pulp that supplies the tooth with nutrients. The tooth is therefore devitalized and is no longer supplied by the body systems, which is why it no longer feels any stimuli and does not react to cold, heat or pain. Pulp necrosis is irreversible and can only be treated by root canal treatment. The causes and the forms are multiple. But does the diagnosis have an impact on the prognosis?
Causes
The causes of pulp necrosis are variable. If the tooth is bacterially affected by a progressive caries, an infected pulp necrosis develops. The bacteria pass through the tooth’s hard tissue until they reach the pulp and attack the vessels, which in turn attack and bite them.
The dead tissue is metabolized and inflammation can occur. This process used to be known as cadaveric poison in the tooth. This form of pulp necrosis can also be caused by a deepened gum pocket.
The deepened pocket indicates a widened periodontal gap. Through this one can get to the root tip and the canal system because the gums are not so tightly attached to the tooth root. The second, also irreversible form of the disease is sterile pulp necrosis.
Here, it is not the bacteria that are the cause, but traumas and accidents. Furthermore, the forces during nightly grinding can be so strong that the pulp of individual teeth is irritated and the vessels within the pulp die. Accidents usually result in the sterile form of pulp necrosis.
A blow to the tooth irritates it and the nerve vessels can die. The most common example in the dental practice is the trauma of the front teeth. By falling forward, the patient always falls directly onto the front teeth due to the position of the upper teeth, which are the first to suffer from pulp necrosis.
It is remarkable that a fall in childhood, which has remained without consequences for a long time, can lead to complaints of pulp necrosis decades later. However, it is not scientifically clear why this is the case. Even the knocking out of a complete tooth in toto can lead to subsequent necrosis after a retransplantation, since the nerve vessels have been separated from the restoration by the knocking out.
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