Dead Teeth - Granulomas

Dead teeth are a result of granulomas and can be extremely harmful if not properly treated. Similar to periodontal disease, we are dealing with highly aggressive bacteria here, which lead to the decay of tissues inside the tooth, specifically the dental pulp or nerve.

The process begins when bacteria reach the inside of the tooth through a cavity or tooth decay, triggering an immune response. Teeth are hard structures, and the swelling that always occurs in response to an infection cannot expand, resulting in compression of the blood vessels and “suffocation” of the tooth, accelerating the death of the nerve. Once the dental nerve dies throughout the root canal, bacteria reach the bone in the lower or upper jaw. Here, an immune response called a granuloma or chronic periapical periodontitis can develop. The bacteria do not freely pass through the bone they reached through the tooth; instead, a so-called “front” is formed. On one side, bacteria penetrate deeper into the bone with their secretions, while on the other side, the immune response attempts to contain it. Since the influx of bacteria from inside the tooth is continuous, and they actually have a good hiding place and rear base, the immune system cannot heal the granuloma. Eventually, an untreated tooth will inevitably be lost. As long as it is still present, the bone progressively disappears. If periodontal disease is also present, the processes can merge, resulting in the tooth losing its bone support. Since the bacteria involved in both processes are very similar, the impact on the body is also similar.

Such teeth are extremely harmful to the body, so the examination and treatment should be approached accordingly.

It is possible to infer whether you have such a tooth present in your mouth. It should be noted that many oral conditions do not manifest as painful sensations or discomfort. Approximately 80% of granulomas are discovered as part of routine examinations.

The most common warning sign of this type of condition is undefined or nonspecific pain that does not occur continuously. You often complain of having caught a cold in your jaw, feeling a strange sensation for several days after sailing, hiking, and similar activities. This is a clear warning that there may be a granuloma in the jawbone and that urgent action is required.

Granulomas pose a significant risk to overall health.

It is much better to perform granuloma treatment procedures when the body is in good condition and before severe symptoms such as pain, swelling, or tooth mobility occur. At that time, the chances of successful treatment are increased by 20-25%, and the long-term prognosis for tooth retention in the mouth is good. Of course, this applies while considering and adhering to all modern guidelines for root canal treatment. The mandatory use of an operating microscope, proper isolation of the tooth to ensure clean working conditions, bioactive fillings, and sufficient time for the procedure are essential. Such procedures are not typically performed under time pressure. Only after a one-year follow-up X-ray evaluation can we assess whether the granuloma has healed. Only then can we consider the treatment of the tooth as successful. If treatment is not successful, additional surgical procedures may be necessary, or we may discuss the extraction of such a tooth.

Today, there are great possibilities for the proper management of dead teeth, using the latest materials and technologies, along with the importance of a well-trained therapist. Properly managed and radiographically monitored dead teeth are much better than implants.

The problem lies in teeth that have not been optimally treated.

There are many such teeth in the mouth worldwide. It is important to emphasize that this is not due to the negligence or lack of knowledge of dentists but rather because advanced technology, materials, and knowledge in this field were not available in the past.

If the tooth is well

treated, and the root canal system is thoroughly cleaned, it can be as good as a regular tooth that still has the dental nerve.

But what about teeth that are not fully treated?

Such teeth are a severe problem and need to be extracted. Treated dead teeth should be regularly monitored with X-rays. If the X-ray shows that the bone has healed, then that tooth is definitely harmless to your body. If the bone has not healed, we have two options. The first is a so-called microscopic apicoectomy, in which we use a microscope to remove the unhealed granuloma from the body by also removing the lower part of the root. The second option is tooth extraction.