Tooth poisoning — devitalization or extirpation

Toothache often means infection or damage to the pulp. Treatment of tooth pulp consists in its removal. Until recently, the method of devitalization, that is, the so-called poisoning of the pulp of the tooth, was used. Today, an alternative method is increasingly used - extirpation. Both methods are aimed at achieving the same result - removing pain and preventing further infections. How do they differ and which one to choose?

What is tooth poisoning?

“Devitalization” is the process of killing the pulp of the tooth — the soft tissue inside the tooth that contains nerves and blood vessels. It is often called “poisoning” of the tooth, although this is a confusing term because it has nothing to do with poisoning in the traditional sense. Devitalization is performed when the pulp is damaged or infected and unable to heal on its own. The goal is to prevent pain and infection by removing the pulp.

A devitalized tooth is dead because it lacks the pulp that supplies blood and nerves, but it can still perform its function as long as it is properly maintained.

When is tooth poisoning carried out?

Devitalization is necessary in the case of:

Deep caries, which has reached the pulp, causing infection and inflammation — requires root canal treatment.
Cracks or fractures of the tooth, which allows bacteria to access the pulp.
Injury to the tooth, such as a strong blow that damages the pulp, even without breaking the tooth.
Pulp necrosis caused by illness or injury, which increases the risk of infection.

These situations can cause pain, sensitivity, darkening of the tooth, swelling and pain in the gums. If left untreated, they can lead to more serious problems, such as an abscess.

What does the tooth poisoning procedure look like?

The devitalization procedure takes place in several stages:

Anesthesia — administration of local anesthesia in the area of the treated tooth to minimize pain.
Access to the pulp — making a hole in the tooth, usually from the inside in the case of the front tooth or from above in the case of the molars.
Pulp removal — removal of pulp with endodontic files and thorough rinsing of canals with antibacterial fluids.
Filling the channel — tight filling of the canal with gutta-percha to prevent re-infection.
Tooth restoration — closing the hole with a permanent filling or, if the tooth is weakened, installing a crown.

The procedure usually requires several visits. After it, discomfort or sensitivity may occur, which subside within a few days. Follow-ups are recommended to make sure the infection has been removed and the tooth is healing properly.

Why does a tooth hurt after poisoning?

Pain after devitalization can result from inflammation of the tissues around the root of the tooth. Too high a filling or crown can cause excessive pressure and pain. If the pain is severe, lasts more than a few days, or worsens, you should consult a dentist who can adjust the filling or take further treatment.

How long does tooth poisoning last?

The duration of treatment depends on the degree of complication of the case. Simple root canal treatment can be carried out in one or two visits, lasting from 30 minutes to several hours. For teeth with multiple canals or a strong infection, more visits may be needed.

What helps with pain after tooth poisoning?

To relieve pain after devitalization, you can apply:

Over-the-counter pain relievers, such as ibuprofen or paracetamol, according to the dosage recommendations.
Ice packs on the outside of the face at the site of pain (wrapped in a towel so as not to damage the skin).
Avoiding hard, crunchy and hot foods, especially in the first days after the procedure.
Taking care of oral hygiene — gentle brushing and flossing to prevent infections.

If the pain is severe or does not go away, you should consult a dentist.

Does tooth poisoning harm?

Teeth after devitalization are weaker and more prone to cracks, since the treatment consists in hollowing out the tooth. Devitalization is carried out with pastes containing paraformaldehyde, which deadens and mummifies the pulp. Paraformaldehyde is a highly reactive and potentially harmful substance — animal studies have shown that it can penetrate the lymph nodes, liver, kidneys, lungs and brain.

Because of this, it is necessary to use tight temporary dressings to prevent paraformaldehyde from entering other tissues. Despite the potential risks, devitalization has been used for many years and in most cases proceeds without serious side effects. However, patients should be aware of the possible risks, and the decision on treatment should be made after considering other options.

Tooth poisoning — alternative: extirpation

Extirpation is a procedure that involves the complete removal of pulp from the chamber and root canals of the tooth, without the use of pharmacological agents. The pulp is removed mechanically by means of pulppers, which rotate in the channel to exfoliate it.

Devitalization has been used more frequently in the past, but is now being replaced by extirpation, which is the preferred method of root canal treatment. Extirpation allows you to preserve living tissues around the canal and apical periodontium.

Devitalization is associated with the risk of complications such as paraformaldehyde entering other tissues, while extirpation, although it carries the risk of leaving residues of pulp and bacteria, is considered a safe and effective method.

Content author

Dr. Wojciech Gącienica-Ciułacz

Dentist/Dental implantologist

Dr. Wojciech Gącienica-Ciułacz is a dentist for whom dentistry is a true vocation. In his practice, he stands out for his extraordinary ability to listen carefully to patients, thanks to which he is able to precisely adjust the treatment plan to the individual needs and expectations of each person. His approach is based on the deep conviction that effective dental therapy must take into account not only the medical aspect, but also the comfort and well-being of the patient.