Necrotic Pulp: Symptoms, Causes, Diagnosis, Treatments

Necrotic pulp is actually a dental pulp within a tooth that has turned necrotic. This may be painful and may cause severe toothache in the affected person. This current article will revolve around this topic where we will know about the necrotic pulp, the symptoms, diagnosis and treatments for the condition.

Necrotic Pulp

What Does Necrotic Pulp Mean? An Overview on the topic!

Our teeth have three layers namely the enamel, the dentin and the pulp. The blood vessels and nerve fibers are located in the pulp of the tooth. In usual terms a dead tooth pulp means a dead or non-vital tooth.

So, a dead or non vital tooth pulp that has no blood supply and no longer has any living tissue in it, is known as a necrotic pulp. When there occurs a necrotic pulp in a person, the root canal and the pulp chamber inside the affected tooth becomes a potential site for the bacterial colonization open to the inside of the body.

Usually necrotic pulp is followed by pain, swelling and difficulties in chewing food on the affected tooth. There may be other symptoms which may require professional treatments to get rid of. There may be various causes that may lead to necrotic pulp.

In our following arrays of the article we will be taking a look on the causes, diagnosis and treatment procedures available for necrotic pulp.

Symptoms of Necrotic Pulp:

Following are the symptoms of necrotic pulp.

  • Pain and Discomfort: One of the most common symptoms of necrotic pulp is the tooth pulp becomes tender and may be painful and also cause discomfort while chewing. However, it is also possible that in some cases, the person may not have pain or discomfort for years after being affected by the necrotic pulp.
  • Darkening of Tooth: It usually happens that in necrotic pulp, while degeneration of the tooth’s pulp; the dark by products may leach in to its hard tissues and this in turn may cause it to sometimes darken the affected tooth. Mostly this is observed in the front teeth like the incisors and the canine teeth.
  • Gum Boils or Fistulous Tracts: One more symptom of necrotic pulp may be “Gum boils” or “Fistulous tracts”. These are actually pimple-like lesions associated with necrotic pulp which literally drains for pus.
  • Acute tooth Abscess: In some instances, the bacteria residing inside a necrotic tooth become active and can form an acute tooth abscess. This may cause pain, swelling etc and at times may be quite severe. At times, the affected tooth may get elevated.

Causes of Necrotic Pulp:

Usually necrotic pulps are the end results of the process of pulp tissue degeneration. Necrotic pulp is actually a non vital tooth that has sustained the conditions from which it cannot recover. These conditions may include various types of tooth problems which finally results in the pulp tissue necrosis causing the non-vital or dead tooth.

Some conditions causing necrotic pulp include:

Diagnosis for Necrotic Pulp:

Let us talk about the diagnosis for necrotic pulp in this section.

  • Usually the diagnosis for necrotic pulp is endodontic diagnosis, just like in case of irreversible pulpitis condition. In case the above mentioned symptoms of necrotic pulp are noticed an endodontic examination must be undergone for the proper diagnosis of the condition.
  • An endodontic examination generally include a general comprehensive history and multiple radiographic angles, mostly using digital X-rays, Alpharetta, DEXIX Digital Radiography etc. taken from the buccal, mesial and distal angles.
  • Here, percussion, mobility, palpation and probing are required to be recorded for all the teeth and the offending teeth is required to be tested to cold and heat. By doing this, diagnosis for necrotic pulp can be made easier. Though the condition of irreversible pulpitis show some marked signs and symptoms with the hot and cold application; necrotic pulp condition usually may or may not show any symptoms here. However, a lesion of endodontic origin may be observed with a radiograph. And, in case the dead or non vital or necrotic pulp shows any symptom then it may include serious pain while chewing, palpation sensitivity, lack of response to thermal testing etc.

Treatments for Necrotic Pulp:

Below we have mentioned some of the treatment procedures available for treating the necrotic pulp.

Usually treating a necrotic pulp involves the following steps.

  • Removal of caries, old filings etc. and if necessary, the temporary build-ups
  • Access preparation
  • Using antiseptic for disinfecting the operative field and rubber dam
  • Filling up the access cavity with a biocompatible antiseptic irrigant, like sodium hypochlorite. Here a thin endodontic file is very carefully moved to a level that is around 1-2 mm short of the radiographic apex
  • Then, the working length is decided by means of a radiograph.
  • Then the canal cleaning begins with the help of thin instruments so as to avoid pushing necrotic, infected material via the apical foramen.
  • Next, using copious amount of irrigation solution, cleaning and shaping of the root canal is done.
  • After cleaning and shaping of the root canal, the canal is dried and filled with a calcium hydroxide paste.
  • The root canal can be filled while the next doctor visit in case there are no symptoms, no exudates and any fistula has healed. However, the treatment is to be continued if the symptoms or fistula or exudates are present.


Apexification is a medical procedure that is carried out when the root is not completely developed. After a proper cleaning of the root canal, the calcium hydroxide is left for a long time so as to give the root a chance to continue its development. In this process, the intracanal medicament is usually changed after 30 days and then it is left for at least a period of 6 months for the radiograph check-up to be done. Generally during this period, the canal is cleaned once more and again filled with calcium hydroxide for more 6 months. Then again after 6 months a check up is done for if there is a healing and a closure of the root canal by this time. Usually the procedure gets desired results.

Know About the Procedure of Root filling/Root Canal for Necrotic Pulp

This is an important procedure involved in the treatment procedure for the necrotic pulp. It is essential to clean the canal, remove bacteria and their products which can cause more of bacterial growth. After cleaning, it is essential to go for root canal filling as the canals cannot be left empty. Again, coronal filings may leak and cause infection in the empty and cleaned root canal. So, it is a pre-requisite to seal the root canal with a root filling for protecting the periapical tissues. There are a number of root filling techniques which can be followed by the dentist.

Is Antibiotic Treatment Appropriate for Necrotic Pulp?

Antibiotics are known to aid the body in eliminating infection that the body’s immune system is unable to cope with on its own. An endodontic treatment aids in reducing the bacteria and the cause of the infection within the tooth that is feeding the periapical lesion to allow the body to eliminate any infection outside the root canal system. However, antibiotic administration does not serve any good to the patient of necrotic pulp where there is the absence of periapical lesions that are larger than apical PDL widening, swelling, etc or that are within the canal or where there is continual pain after debridement of the canal system. This is so because antibiotics are carried by the circulatory system to the area of infection and a necrotic pulp is no longer connected to the circulatory system. So, oral antibiotics serve no benefit to the patients within the teeth and only helpful for the periapical lesions. Moreover, overdose of antibiotics may cause more of the issues.


Above, we discussed about some of the causes, symptoms, diagnosis and treatment procedures for necrotic pulp. It is essential for you to consult a professional in dentistry in case you experience any of the symptoms which may be associated with the necrotic pulp conditions and take the best possible treatments for the dead or non vital tooth.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:May 3, 2022

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