Teeth Wanted: Dead or Alive

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MUSCLES:  
​ ' What's this "Dead-or-Alive"?  In the last & past blogs
  we discussed the importance of the tooth to the bone 
  --and the bone to the tooth.  WHY does a tooth "die-off"?
  And is the tooth just as important "Dead" as it is "Alive"? '   

 Dr Skerpan:   Absolutely it IS!!!   If the tooth is
 savable & intact enough, in most instances it is
 advisable to retain it with "endo-dontic" treat-
 ment.  But let's first review the makeup of the 
 pulp, and some common reasons WHY the pulp
 "dies-off".  The pulp is made up of soft-structures
 --namely the blood-vessels, nerves, odontoblasts
 (or "cells" that produce the layer of dentin) and
 connective-tissue.  The causes of "pulp-death"
 would be anything  that "damages" or "stops" the
 proper functioning of the pulp's content---i.e.,
 mostly the  blood-vessels & nerves.  A tooth ulti-
 mately needs "endo-dontic" treatment because
 of "pulp-death".

The PULP is made up of soft-structures---blood-vessels, nerves, odontoblasts & connective-tissue.

"Pulp-death" most commonly occurs when the pulp is affected or injured so greatly
that the pulp's content can not be repaired back to a normal & proper vital function.
As we have seen before, this internal "dead-pulp" becomes infected and becomes
the "nidus" of the infection or abscess at the root's apex in the bone.

MUSCLES:  ' And what can affect or injure the pulp to the "point of no-return"? '

Dr Skerpan:
​ The pulp gets to it's "end-point" most commonly from deep decay (cavity) & fillings,
 cracks & fractures or some physical trauma.  Anything that would compromise 
 the pulp's soft-structures will do it!  The traumatic factor can occur from the TOP 
 crown-of-the-tooth OR even from the BOTTOM apex-of-the-root!

X-ray of a DEEP CAVITY intruding into the PULP-chamber.

X-ray of DEEP FILLINGS intruding onto the PULP-chambers---Premolar APEX shows an ABSCESS in the bone resulting from "pulp-death".

Deep-DECAY & CRACKED-off TOOTH causing traumatic injury & "pulp-death" within the PULP-chamber.

FRACTURE down thru' the crown-of-the-TOOTH to the PULP-chamber---with or without pain!

Physical traumas to the pulp are many--and many do not involve any pain at all! 
One kind of trauma may come from chronic (long-time) severe wear of the enamel
& dentin approaching the pulp.  This may be caused by incorrect tooth-brushing
techniques as discussed previously---habits like "grinding" the teeth &/or incorrect
bite-forces---abrasive or acidic foods or objects---and even accelerated wear with
dry-mouth.  Another kind of physical trauma can be acutely (abruptly) or chronical-
ly formed fractures in any level of the tooth's hard-structure in the TOP-"crown" 
&/or root. These fractures can occur fully, partially & at any angle!  Also with acute
traumas like a sudden hit to the tooth or mouth, the tooth can be "jarred" enough
in it's bone-socket for the surrounding "perio-dontal structures" to become injured.
If the blood-vessels & nerves at the root's apex are damaged, they may "die-off" 
from the Bottom-Upward into the root-canals & pulp-chamber. 

FRACTURES---& INCORRECT tooth-brushing technique with severe wear of enamel & dentin at the gum-edges!

SEVERE WEAR from INCORRECT bite-forces, "grinding" & dry-mouth---& NON-compliance with the mouth-guard

FRACTURES may occur ANYwhere within the tooth's "crown" or roots.

Physical trauma also may be caused by too much
bone-loss and/or mobility during advanced and
severe perio-dontal conditions (i.e., loss of the 
tooth's surrounding supportive structures).  The  
"perio-dontal structures" & bone can be destroyed
around the tooth so that the damage & bacteria can
get to the root's apex. Then the blood-vessels and
nerves "die-off" from the Bottom-Upward into the
canals & pulp-chamber.  Physical trauma at the
root's apex may also occur from medical conditions
affecting the body's metabolism--(i.e., diabetes,
thyroid, osteoporosis or even some medications)---
or from conditions affecting the body's immunity.  
In such instances, the tooth's blood-supply is com-
promised from the compromised bone-metabolism.
The pulp's nerves and blood-vessels "die-off" as the
outside bone can no longer supply the pulp's needs.
​​

Teeth with severe "perio-dontal" bone-loss---and an abscess at each root's apex.

MUSCLES:  ' So there are several reasons WHY the pulp "dies-off"---namely
                       deep decay & deep fillings, cracks & fractures and physical traumas.
                       The pulp can "die-off" from the TOP crown-of-the-tooth to the
                       BOTTOM apex-of-the-tooth---OR it can "die-off" from the BOTTOM
                       to TOP (i.e., from the apex into the root-canals & pulp-chamber).
                       So we know WHY the tooth can die--so that's it?  WHY does the tooth
                       still have a chance if it is dead? '

Dr Skerpan:
There are only two choices for most teeth at this point--doomed to be extracted OR
possibly "rescued" with "endo-dontic" treatment.  If the tooth is a good candidate 
for this latter treatment (and if it is the best treatment choice for the patient), endo-
dontics offers a "one-last-ditch-chance" for the tooth to remain and function in it's
original position!  The actual tooth IS as important "Dead" as it is "Alive" for the
stable health of mouth & body!  Even an implant will never function exactly as the
natural tooth.  We will cover WHY a tooth with "endo-dontic" treatment still can 
successfully exist & function.  That will be the topic of our next dental blog.

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' There's HOPE for a tooth with a dead-pulp! Stay-tuned for ENDO-DONTICS to the "RESCUE" in our next Dental-Blog! '

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THE very dog-gone END!

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