What to do if there is pain in a dead tooth

Causes of pain

There are many reasons why a dead tooth may begin to cause pain. Most of them are associated either with the lack of adequate treatment and care, or with the development of the inflammatory process. The most common reasons are:

Incomplete nerve removal. If the nerves were not completely removed, the tooth will hurt in case of the slightest inflammation.
Poorly cleaned channel. After the nerve is removed, the dead tooth is filled, but if the canal was poorly or incompletely cleaned, microscopic particles remain under the filling material. Over time, they cause inflammation and, as a result, pain.
Poor quality filling. When filling, the material must be inserted into the canal completely, to the very end. If part of the canal is not sealed, pathogenic microflora begins to develop there. A variant of this reason can be considered the use of low-quality filling materials. They quickly collapse, causing the channel to open.
Inflammatory processes in the gums or periosteum. Inflammation that develops next to a dead tooth begins to spread to nearby tissues, causing pain.

Whatever the reason, if a dead tooth starts to hurt, you need to contact a dentist. Delay can lead not only to the destruction of the crown, but also to the rapid spread of inflammation.

Why can a tooth hurt if the nerve has been removed a long time ago?

In medical practice, there are cases when a tooth that was pulpless a month, or even a year ago, suddenly begins to hurt. At first, it may be a barely noticeable discomfort, a reaction to hot or cold. However, soon the unpleasant sensations develop into acute pain, in addition, it often comes to swelling, suppuration and tumors. An unambiguous answer to the question “why does a tooth that has been healed for a long time begin to hurt?” difficult - doctors currently cite several of the most common and obvious reasons:

Incomplete depulpation
. In other words, if for some reason the nerve was not completely removed, sooner or later it will definitely make itself felt. The process of pulp removal is very complex, requiring maximum precision and care from the doctor. In this case, experience also plays an important role - a young specialist who is thoroughly familiar with the theory is unlikely to be able to cope with this task better than a dentist seasoned by many years of medical practice. If the nerve is not completely removed, over time you will inevitably have to deal with pain and a variety of complications. By the way, if the patient has a pronounced reaction of the tooth to cold or hot, most likely it is the nerve that has not been completely removed.
Poor quality filling after depulpation.
This reason is also quite common in medical practice. For a better understanding of the situation, let us explain: the root canal of a tooth has a thickness of 0.5 to 1 mm, in an expanded form (after processing with special tools) - up to 2 mm. The shape and bends are individual for each individual channel - they can be straight, with bends, with creases. It is not always possible to see this on an x-ray, so the doctor has to work “blindly”, by touch. It is not surprising that in some cases part of the canal remains unfilled. And it is in this part that bacteria accumulate over time, causing inflammation and leading to pain. Also, the filling itself may not lie tightly, allowing access to pathogenic microorganisms.
Increased pressure on the tooth
. The tooth does not just stand in the jaw bone - it is attached to it by numerous threads of connective tissue. If during the filling process the doctor installs a filling that is too high, then the chewing load on this tooth will increase significantly, which, accordingly, will increase the load on the ligaments. Over time, the increased pressure will turn into a constant aching pain, especially evident when pressed.
Infection
. If we assume that the nerve has been completely removed and all the canals have been thoroughly cleaned and securely sealed, there is only one option left - the activity of pathogenic bacteria that entered the root canals and then into the jaw tissue during the treatment of caries or pulpitis.
Insufficient hygiene
. After high-quality depulpation, the patient needs high-quality regular oral hygiene. Even under the most reliable filling, bacteria can accumulate over time if you do not brush your teeth in a timely manner. Some patients believe that dental plaque does not accumulate on the filling material and is not afraid of tartar. In fact, this is not so - bacteria have an equally destructive effect on both tooth enamel and artificial fillings. The infection can get to the root of the tooth and from the gums - this is especially true for people suffering from periodontal diseases.
In fact, one of the neighboring “living” teeth hurts
.

Naturally, it takes time for bacteria to accumulate in an unfilled canal or for an infection to make itself felt. It is likely that a tooth can get sick in a year or after 5 years - it all depends on the degree of neglect of the problem, as well as on the individual characteristics of the body (people with strong immunity tolerate inflammation much easier, so they may not notice alarming manifestations for longer).

In any of the above cases, the tooth will have to be re-treated - the filling will have to be removed, the canals will have to be cleaned and filled again. In addition, a number of additional disinfection measures will have to be carried out.

Symptoms

Most often, painful sensations occur during chewing or eating hot or cold food. Some patients complain of almost constant, aching or throbbing pain.

The inflammatory process can develop rapidly. In this case, the pain is usually sharp and severe. May be accompanied by swelling of the gums and swelling of the face. Sometimes the inflammation lasts for years, and since the patient does not experience severe pain, he delays the visit to the dentist, aggravating the situation.

Treatment of a dead tooth in dentistry

The treatment method for pain in a tooth with a removed nerve depends on the reasons that caused this condition. The dentist will conduct an examination and, if necessary, prescribe an x-ray examination.

If the cause is unsatisfactory treatment, the filling material is removed, preparation is carried out again, and the canals are inspected with medications placed in them. Then, when the condition returns to normal, the tooth is refilled.
If the roots are curved, it may be necessary to remove the part that prevents the canals from being cleaned and sealed.
The cyst or granuloma must be surgically removed along with the pathologically changed tissues around it.
If there is inflammation of the gums, complex treatment is prescribed. This includes professional teeth cleaning with stone removal, placing medications in periodontal pockets, and taking systemic medications.
If indicated, physiotherapy procedures are prescribed that have a therapeutic effect on hard tissues.

Remember: by delaying a visit to the dentist, hoping that the pain will go away on its own, you increase the likelihood of serious complications, the treatment of which will be lengthy and possibly expensive.

What to do if a dead tooth hurts

At the first appearance of pain, you should contact your dentist. Since in most cases pain is a consequence of the inflammatory process, the doctor must carry out a diagnosis.

It is imperative to assess the condition of the gums, diagnose (or exclude) diseases such as periodontal disease, periodontitis, etc. Gum disease is difficult to treat, and timely diagnosis will help to prescribe the right treatment in time.

After diagnosis, the doctor prescribes treatment aimed at eliminating the causes of pain:

If inflammation is detected, anti-inflammatory drugs or antibiotics may be prescribed.
The old filling is removed, the canals are cleaned, and the filling is performed again.
The darkened crown of the dead tooth is additionally whitened to restore the aesthetics of the smile.

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A specific treatment plan is prescribed individually, based on the results of the examination and the general condition of the patient’s teeth and gums. Sometimes pain in a dead tooth is a consequence of a whole range of dental problems.

Why can a tooth hurt immediately after nerve removal?

It also happens that immediately after the end of the anesthesia (and the procedure for removing nerves is invariably accompanied by the use of local anesthetics), the patient begins to experience acute pain in the dead tooth. There may be several reasons for this:

The filling material got from the root of the tooth onto the soft gum tissue . This situation can occur if the material is fed into the root canals under very high pressure. In addition, this often occurs due to incorrect measurement of the channel length. To avoid this problem, it is necessary to take pictures before and after depulpation, and if defects are detected, immediately remove the filling, remove excess paste and reseal the canals.
Remains of dental instruments in the canal . The needles for widening the canals and removing nerves are very thin. Even though modern instruments are made from high-quality materials, there is a small chance that a small piece of needle will remain in the canal, causing discomfort and pain.
Damage to the tooth root . During the process of cleaning canals and removing nerves, there is a possibility of drilling through the root of the tooth, resulting in an open cavity leading directly into the jawbone (which, by the way, can also be damaged due to drilling too deep).
The body's reaction to filling material . Or simply an allergy. Anyone can encounter this, especially if the patient has not previously had to deal with dental intervention. In this case, it is necessary to urgently remove the filling and repeat the procedure using a different material.

All of the above causes of tooth pain after nerve removal are pathological and require urgent medical intervention.

It is important to understand that immediately after treatment, a tooth with a removed nerve may hurt for some time for a number of reasons:

Depulpation is a process of violating the integrity of nerve tissue, which cannot be completely painless. After the local anesthesia wears off, the patient still feels discomfort and aching pain for some time, which can be relieved with toothache tablets.
A reaction to cold and hot things in the first couple of days after nerve removal is normal. Due to the violation of the integrity of the tooth tissue, its sensitivity also increases, which goes away after complete healing.

In order for the recovery period to pass quickly and painlessly, it is necessary to strictly follow the recommendations of the attending physician - do not drink or eat for 2 hours after the operation, observe the rules of hygiene, take anti-inflammatory and painkillers.

When should you see a doctor?

Dentists themselves recommend not delaying a visit to the clinic if the slightest alarming symptoms occur:

Acute throbbing pain in the first hours after depulpation.
The presence of edema, a swollen cheek or gum, the formation of an abscess under a tooth without a nerve.
Manifestation of tooth reaction to cold and hot long after dental intervention.
The pain after the operation does not subside, but on the contrary, it becomes stronger.
An increase in body temperature (indicates the presence of an inflammatory process).
Pain when pressing on a tooth or chewing.

If you contact an experienced doctor in a timely manner, any problems can be solved as soon as possible.

Prevention

If you have dead teeth, care must be taken to preserve them. A crown that does not receive nutrients is fragile. Over time, it can deteriorate and tooth mobility appears. Prevention of diseases in such diseases is very important.

It is imperative to ensure proper daily oral hygiene. Teeth should be brushed with a suitable toothpaste; the brush should not have very hard bristles. After eating, you need to rinse your mouth with special compounds. This will help get rid of food debris and minimize the risk of developing plaque, tartar, and the proliferation of pathogenic microorganisms.

It is important to undergo regular examinations by the dentist, and at the first appearance of pain or signs of disease, immediately go to see a doctor for diagnosis and treatment.

How to relieve pain?

The process of treating a damaged tooth is very complex and time-consuming. It often takes several visits to the doctor to completely eliminate the cause of the pain. At the same time, in order to somewhat reduce pain, it is quite acceptable to use painkillers, especially considering the fact that most of them also have an anti-inflammatory effect:

Ibuprofen.
Aertal.
Ketanov.
Nimesil.
Nise.
Paracetamol (may help with moderate pain).

In addition, you can numb an open tooth using special lidocaine-based sprays.

Don’t forget: pain relief is just a means to eliminate discomfort, but unfortunately, no pill, even the strongest and highest quality, can cope with the source of the disease.

Low quality filling material

Today, almost all modern clinics use exclusively composite light fillings. However, just a few years ago, you could walk out of the dentist's office with a metal amalgam in your tooth or a regular cement filling. If you still have such “old” fillings, then there is a high probability that the tooth tissues hurt precisely because of this material. Over time, such compositions may lose their properties, crack, and dry out. Sometimes a filling, having greater hardness than tooth enamel, can destroy the crown. Even keeping a filling in place for a long time does not guarantee the health of this organ and a positive result of treatment.

Allergic reaction

The inflammatory process in tooth tissues, as is known, can be provoked by both an infectious factor and an allergic one. Tooth tissue can sometimes produce this effect in response to medications or interaction with a filling. Although composite light fillings are characterized by minimal allergic properties, individual reactions of human tissues sometimes give such a result.

This problem can be solved quite simply: the filling with the harmful allergen is removed, and a composite with a different chemical composition is installed in its place. For the future, it is advisable for you to remember which particular filling caused a negative reaction in your body, so that the next time you visit another dentist, you can warn him about this feature.

Installing a temporary filling

A certain method of treatment, when a temporary filling is installed, involves placing a medicinal substance at the bottom of the carious cavity, which strengthens and nourishes thinned dentin tissue. Or it could be a drug that destroys the nerve tissue of the tooth. Its effect often produces a painful reaction from the pulp chamber, as a result the filling seems to hurt. Therefore, you should not perceive such discomfort as a treatment error. At the appointed time, go to your dentist, who will remove the temporary filling and install a permanent photopolymer.

If the pain becomes unbearable, you need to take a good dose of analgesics. As a last resort, it is allowed to open a temporary filling at home, remove the medicine from the carious cavity and cover the hole with a temporary tampon. A visit to your dentist within 24 hours is required.

In order to never find yourself in a situation of repeated treatment, you need to choose your dentist wisely. Pay attention to the reviews of your friends, the level of qualifications of the specialist and the general experience of medical practice. For example, the LeaderStom network of clinics takes the issue of personnel selection very seriously: all dentists have the most prestigious professional titles and regalia, gained through successful work experience. This gives an almost 100% guarantee of high-quality, competent dental therapy.

How long does a tooth live without pulp?

This period varies greatly. In some patients, the tooth is destroyed within a year, and in others it can last for another ten years. What's the difference? Here are the factors that affect the condition of the tooth after depulpation:

the degree of initial destruction of the crown of the tooth;
pulp removal technique, quality of root canal filling;
the method by which the tooth was restored after removal of the nerve (filling/inlay/crown);
caring for the tooth after treatment, performing the necessary hygiene procedures.

After the tooth is depulped, treatment procedures are required that will improve its vitality. First of all, this is filling. Empty root canals are filled with special material. Complete and high-quality removal of the entire pulp, as well as hermetically filling the canals with filling material over the entire length, reduces the risk of inflammation of the tissues surrounding the tooth and the appearance of a cyst.

Depending on the degree of tooth decay and the specific clinical situation, the doctor may suggest restoring the tooth with either a filling, a ceramic inlay, or an artificial crown. An inlay and a crown are the optimal methods for restoring “dead” teeth, because they cover the tooth from above and fit hermetically to the tooth, thereby reducing the contact of the internal environment of the tooth with bacteria in the oral cavity, moisture and air, and protecting the tooth from chips and cracks. In addition, it is comfortable for the patient and has an aesthetic appearance.

Possible complications of ignoring pain

The sensations that may occur in a pulpless tooth clearly indicate the presence of pathology, which must be eliminated as quickly as possible. Otherwise, infection will lead to quite serious consequences:

complete destruction and/or loss of the tooth;
acute or chronic gingivitis (gum disease);
development of periodontitis (inflammation of the tissue surrounding the root, bone tissue of the alveoli and gums);
chronic inflammation of the gums;
the appearance of a cyst.

Ignoring the inflammatory process and delaying contact with the dentist can cause the development of systemic infections, which will spread throughout the body through the bloodstream from the periosteum.

What teeth are called dead?

The concept of “dead” is rather common, but in medicine such teeth are called pulpless (without pulp - loose fibrous tissue penetrated by nerve endings, lymphatic and blood vessels).

If living teeth are those in which there is a nerve that provides nutrition and growth, then dead teeth practically cease to receive nutrients. But, even being separated from the nervous and circulatory systems, they continue to remain a component of the dentofacial apparatus and affect the state of other units in the series.