Is it DEAD or ALIVE?

So you hit your front tooth.  On the concrete when you fell?  When you were tackled in the play that won the game?  Quite possibly when your head hit the steering wheel when someone ran the stop sign.  Jumping off the bed?  Playing tag in the house?  You didn’t think anything about it.  Your tooth was sore for a while. Perhaps not. It’s turning greyish in color but still, no pain. You didn’t break it or maybe you did. But what the heck?  It doesn’t hurt.  And besides that, you say to yourself, “Everyone knows me by my chipped tooth.  It’s apart of me, my character.”

Now fast forward weeks.  Months.  Years.  Even a decade or so.  And now you’re thinking that something is going on with your front tooth.  You’re asking yourself.  Should I go to the dentist?  I don’t have insurance.  I don’t have any money.  I can’t take off from work.  I think I should go.  But I’m afraid of the Dentist.   Should you go?  Yes, you should.  Now.  And when you first hit your tooth.

There are several reasons why you should go after first receiving blunt trauma to your mouth area.  With such trauma, although the back teeth can be easily affected, the front teeth usually are the most susceptible to such trauma.  Your front teeth are the closest to the opening of your mouth.  They have one root or leg on them and therefore, less stable in the mouth.

Often when a tooth is the recipient of trauma it may undergo some damage.  The tooth may break or fracture.  The tooth may even get knocked out partially or completely from it’s socket, it’s home base. And sometimes, a lot of the times, neither of the above happens but the nerve is still damaged in the tooth.

incisor9The part of the tooth you see when you look in your mouth is called the crown.  Underneath the gum tissue is the root or leg of the tooth.  The root of the tooth sits in bone.  Inside the tooth, extending from the crown to the root is the nerve or pulp tissue.  The nerve is what keeps the tooth alive.  The nerve extends out of the apex or the end of the tooth and connects with the rest of the nerves in the body.  Please realize that all the nerves in your body are connected to your brain, even those in your teeth.

Blunt trauma and even minor blows to the teeth can damage the nerve.  If the tooth breaks close to the nerve or at the nerve, it can cause damage to the nerve immediately or eventually some time later.  Even if this is not the case, the nerve can become damaged at the apex of the tooth or the end of the tooth.

If the nerve is damaged in any manner, a clean up process will start in the mouth. The bacteria that lives in everyone’s mouth, regardless of how clean your mouth is or not, will travel to the tooth to clean up the damaged nerve that is dying or is already dead.  The bacteria will enter the inside of the tooth from the crown, apex or both.  They will enter from the crown if the tooth, filling or if your “artificial” crown is broken or has a leakage.  When I mention an “artificial” crown, I am making reference to a porcelain, silver metal or gold metal crown that is made in a dental lab.  The bacteria can also enter from the end of the tooth because there is a natural opening already present at the end of the tooth.

Once the bacteria start the clean up process, it may take weeks, months or years before you have any symptoms.  Often, the dentist will be able to detect the dying or dead nerve before you have any symptoms.  There are diagnostic tests and radiographs that we as Dentists can utilize to detect any potential issues with your tooth.  There are a few things that should not be ignored if you notice them going on in your mouth.  Such things are a tooth turning “grey” or “dark”.  A tooth that feels loose or wiggly as if you can move it.  Discomfort or pain when eating, drinking, biting and even pain from out of nowhere.  A pus bump or swelling on the front or back gum tissue of the tooth.  This pus bump or swelling is called an abscess.  It is the result of the pressure building up around the tooth in an effort to push the pus out from the bone.  Remember, Mother Nature is very smart and protective.  She is trying to rid the mouth of infection before it gets to your brain or other vital organs.  And yes, a untreated tooth infection can kill you.

Once  you have a tooth infection that is a result of a dying or dead nerve, there are only one of two treatment options.  A root canal or extraction (commonly referred to as “pulling out”) of the the tooth.  If there’s enough tooth structure and the bone is healthy enough, it is always best to try to save the tooth by doing a root canal.  Many people will choose an extraction of the tooth for various reasons.  I’m not an advocate of extracting teeth that can be saved but sometimes it must be done if the patient is unable or unwilling to get a root canal.  The goal at this point is to save the person’s life.  Regardless how valuable and important it is to our overall well being, there are many options available to replace a tooth.

I will repeat it again.  Once your tooth has been diagnosed as needing a root canal, there is only one or two treatment choices.  Only one or two.  Not three or four and a maybe.  Only one or two.  They are to either to get a root canal or get a tooth extraction.  And please note, taking antibiotics over and over, each time the tooth gives you a problem or causes pain is not the indicated treatment of the infection.  It will not “cure” the infection.  It is a band aid, a temporary fix, a delay to a potentially serious or fatal situation if the infection is not properly treated by a Dentist.  And sometimes, if you wait too long to get the root canal, the only option may be to get an extraction because the untreated infection has destroyed too much bone around the tooth.  In this case, an extraction is your only option.

So, is it DEAD or ALIVE?  If the tooth needs a root canal, it is dying or it is already dead.  It was once alive but no longer.  But don’t fret, although will now be considered completely “dead”, getting a  root canal allows you to save the tooth, treat the infection and keep it for years to come.  You will still be able to function, speak or chew with this tooth.  If you choose extraction, well, the tooth is no longer there.

Always visit your dentist as soon as possible after receiving a blow to your teeth.  And visit your dentist for regular checkups.  As soon as you experience any pain or symptoms, go to the dentist.   Don’t put off the inevitable.  It is in fact, a matter of life or death.

Dr. Malaika Simone Thomas is a licensed dentist with over twelve years of clinical experience.  She is the author of the blog MyToothSense, A Common Sense Approach to Oral Health Care.  Visit us online at

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