The tooth and the pulp
If your dentist tells you there is an inflammation or an infection in a tooth, it means the pulp of the tooth has been damaged.

Signs of damage to the pulp can be:

• Heightened sensitivity to heat or cold
• Pain and swelling
• Pain when chewing
• Fistulas that drain pus into the mouth
• In some cases, no symptoms at all

Let us take a closer look at a tooth to understand how the pulp can become damaged.

Every tooth consists of a crown and a root. Teeth further back in the mouth often have two or three roots while teeth in the front normally have one root. The crown of the tooth is covered by a hard shell called enamel. Under the enamel is a softer substance called dentine. At the core of the tooth is a chamber extending into the root through a narrow canal. Inside this chamber is the pulp. Every root canal ends with an opening towards the surrounding bone.

The pulp consists of soft tissue connected to blood vessels and nerves. The blood vessels supply the tooth with nutrition and help with the defence against infections. The nerve in the pulp is part of a complicated network of nerves in the jaw and face. This nerve network ensures, amongst other functions, we can use the mouth for chewing.

A tooth will do best with a pulp that is alive, but if the pulp dies, the tooth can often be saved by the right treatment.

Reasons for pulp damage

Leaky fillings: Old fillings (composite or amalgam) can develop gaps allowing food and bacteria to seep into and down and damage the pulp.

Receding gums: The gum can occasionally recede and expose a part of the root of the tooth. The enamel that normally protects the tooth is not present here and the pulp can get damaged.

Tooth grinding (bruxism): Many people grind their teeth during night without knowing it. This can also damage the pulp.

Caries: Dental cavities are, probably, the most common reason for pulp damage. Caries irritates the pulp and causes swelling. Inflammation (pulpitis) is the body’s response to a trauma like a caries lesion. It makes the tissue more sensitive and swollen. However, since the pulp cannot expand as normal tissue, the pain is more often worsens. The tooth becomes sensitive to hot/cold. The closer the caries is to the pulp, the bigger the risk of the pulp dying. At this stage there is sometimes a possibility to treat the tooth without a root canal (root filling). We will then remove all or most of the caries, seal the cavity and wait, usually several months, before doing the final filling. The pulp can actually build new dentine beneath the caries. We always recommend this treatment when possible in order to do as little treatment as possible and to save as much pulp tissue as possible.

Inflammation becomes bacterial infection.
If untreated the pulp eventually becomes infected with bacteria (osteitis) from the caries lesion. The sensitivity becomes reduced or totally absent. You might think the tooth does not need any treatment, but the truth is that the infection will not go away by itself, and antibiotics will not help. The reason the sensitivity has disappeared is that the nerves in the tooth are dead. If pain exists at this stage, it is because of the surrounding bone (usually tender on biting) swollenness, and fistulas that can drain pus in the mouth.

The only way to treat this tooth is with a root canal treatment or to remove the tooth.

Shooting pain can be a sign of damage to the pulp (inflammation).

If your dentist does not find an obvious reason for the pain, the tooth will be observed for a while.

Sometimes it can be helpful to apply a protective substance such as fluoride on the tooth. Certain toothpastes claim to plug the small canals on the root surface. While there are limited proven results, it is not harmful to try these products; for example, Sensodyne or Zendium.

If the symptoms are not severe and the dentist does not find anything during the examination, it is recommended to wait and check for any changes in the tooth’s condition. In certain instances, the reason will reveal itself later, but often this is just an irritation that will diminish over time. However, if the pain worsens, please contact your dentist.

A root canal treatment will eliminate the shooting pain but a modern approach is to keep the pulp alive as long as possible. If the pain becomes too severe, a root canal treatment is a sure way of saving the tooth.

Previously, one was forced to have an infected tooth taken out. Today, treatments to save the tooth are available. The appropriate treatment will depend on the extent of the damage. Modern root canal treatment is painless.