The pulp is the tissue that maintains the vitality of the tooth, and is located immediately under the dentin, in the pulp chamber and in the root canals.

The activity of the tooth is thus maintained, as it reacts to a range of stimuli that may damage it.

There are also extensions of the pulp chamber at the dentine level responsible for taking up information.

This tissue gives the alarm signal in the event of trauma to the tooth, which may be of a different nature:

• mechanical – tooth abrasion or other trauma resulting in a reduction in the thickness of the enamel or dentine favors the appearance of sensitivity by approaching the pulp chamber.

• thermal – foods and liquids of extreme temperatures, too cold or too hot, can generate dentine sensitivity reactions. If there is already a dental lesion, the tooth will react to smaller and smaller stimuli.

• bacterial – dental caries is a lesion with less substance of the dental units that has a bacterial etiology. Through acid attack, they demineralize the enamel and dentin and progress faster or slower, depending on oral factors, towards the depth of the tooth. Once in the vicinity of the dental pulp, caries causes sensitivity.

The tooth, in the early stages of trauma, reacts by developing sensitivity.

Establishing treatment at this stage eliminates the risk of complications and creates the conditions for a good healing in time.

However, if these factors, which damage the pulp, are not eliminated, dental necrosis, loss of dental sensitivity, i.e. death of the pulp, can occur.

This can be quantified radiologically by an apical lesion around the root. This sign does not always occur.

When pulp mortification is suspected and radiological examination is inconclusive for diagnosis, vitality tests applied to the tooth will be negative.

Pulp necrosis is a condition that occurs when the pulp (soft) tissue inside the tooth dies. This can be caused by various factors including tooth decay, trauma or medical conditions such as diabetes or coeliac disease. Symptoms of pulp necrosis include spontaneous or pressure pain, sensitivity to extreme temperatures and changes in the color of the affected tooth.

Tooth necrosis may be the result of previously untreated pulpitis, trauma or contamination following endodontic treatment.

This means that the dental pulp, the nerve, is infected and the vitality tests are negative.

The vitality tests can be thermal or electrical, but whichever method is chosen, the result is the same, negative.

Bacteria and toxins migrate through the root canals and cause a periapical inflammatory reaction. Over time, untreated, the tooth becomes sensitive to chewing, sometimes even contact with an antagonist unit causing significant pain.

Diagnosis

Early diagnosis and appropriate treatment are essential for maintaining dental health and preventing further complications. In this article, we present the main aspects of pulp necrosis diagnosis and treatment, including characteristic signs and symptoms, diagnostic methods and available therapeutic options.

The diagnosis of pulp necrosis is based on history, clinical examination and dental radiographs.

In some cases, a biopsy may also be required. The history may reveal information about the patient’s medical and dental history and current symptoms.

Clinical examination may reveal physical signs of pulp necrosis, such as advanced dental caries or a periapical abscess. Dental radiographs can be used to visualize the internal structure of the tooth and identify any abnormalities.

Treatment

The clinical approach in this case is to remove the mortified pulp tissue, a procedure called pulpectomy.

This is carried out by endodontic treatment, which is designed to completely eliminate the pathogens that caused the inflammation and maintain it.

By penetrating the pulp chamber and canals, the contaminated tissue will be removed, the remaining empty space is irrigated abundantly with antiseptic substances and then filled with gutta-percha cones and cement.

If the clinical examination shows that the loss of dental hard tissue is considerable, a replacement crown may be applied.

If the carious lesion or trauma also affects the root and it is no longer possible to opt for solutions that preserve the hard tissues, the last option in this case is to extract the dental unit in question and prosthetically treat the edentulous space.

Pulp necrosis is a common condition in dental practice, which can have multiple causes.

Treatment of pulp necrosis may involve removal of dead pulp tissue by dental extraction or endodontic treatment. In the case of endodontic treatment, an opening will be made in the crown of the tooth to allow access to the dead pulp tissue. This will be removed with special instruments and the root canal will be cleaned and filled with a filling material.

If necessary, the tooth will be restored with an inlay, onlay or dental crown to restore function and aesthetics.

Conclusion:

Early diagnosis and proper treatment of pulp necrosis is essential to maintain dental health and prevent further complications. Patients should follow rigorous oral hygiene and visit the dentist regularly to detect any dental problems in the early stages.

By understanding risk factors and adopting a healthy lifestyle, patients can reduce the risk of developing pulp necrosis and other dental conditions.