Rotten tooth nerve in children and adults causes and final treatment

A tooth nerve infection (pulp necrosis) is one of the most painful dental problems, affecting both children and adults. This issue isn’t just a temporary pain—it’s a sign that tooth decay has reached a severe stage, which can affect other teeth or even overall health if left untreated.In this Dalily Medical article, we will explain what a tooth nerve infection is, why it happens in both children and adults, and the best treatment methods, including medications and surgical options. We’ll also cover the symptoms you should watch for, the potential risks if left untreated, and essential tips to keep your teeth—and your child’s teeth—strong and healthy at all times.

What is an infected tooth nerve?

The tooth nerve (pulp) is the innermost part of the tooth, containing nerves and blood vessels responsible for nourishing the tooth and sensing pain. When deep decay or a tooth fracture occurs, bacteria can enter the pulp, causing severe inflammation and infection. Over time, the nerve may become necrotic (die) if not treated promptly.

Can a child’s tooth nerve become infected without decay?
Yes. Sometimes, dental trauma or a small fracture can cause the nerve to become infected even if there’s no visible decay.

Can an infected baby tooth affect permanent teeth?
Yes, especially if the pulp infection reaches the root of a primary tooth. This can damage the developing permanent tooth beneath it, affecting its proper growth.

Is pain always a sign of pulp infection in adults?
No. Sometimes the nerve may be infected but the pain decreases or disappears once the nerve dies. That’s why dental exams and X-rays are essential.

Is root canal treatment painful for children or adults?
With local anesthesia, pain is minimal. Most patients feel pressure but not severe pain. Post-treatment discomfort is usually managed with prescribed painkillers.

Can the tooth nerve get infected again after treatment?
In some cases, relapse can occur if the tooth wasn’t treated properly or if there’s a persistent infection. Follow-up with a dentist is crucial.

Can antibiotics alone heal an infected nerve in adults?
No. Antibiotics may temporarily reduce infection, but the definitive treatment is root canal therapy or surgery, depending on the tooth’s condition.

Can an infected nerve cause facial or neck swelling?
Yes. If the infection spreads, it may cause swelling in the cheek or face and sometimes difficulty opening the mouth or swallowing, requiring urgent medical attention.

Can pulp infection be prevented in children and adults?
Yes, the best preventive measures include:

Brushing teeth twice daily.
Visiting the dentist every six months.
Reducing sugary foods and soft drinks.
Treating cavities early before they reach the pulp.

Types of infected tooth nerves in children:

Reversible Pulpitis

The nerve is inflamed but can still heal.
Symptoms: mild pain or sensitivity to hot/cold foods or drinks.
Treatment: remove decay and place a filling, or use fluoride to strengthen the tooth.

Irreversible Pulpitis

The nerve is severely damaged and cannot recover.
Symptoms: severe, persistent pain, strong sensitivity, sometimes gum swelling.
Treatment: root canal therapy or tooth extraction if damage is extensive.

Necrotic Pulp with Abscess

The nerve is dead, and infection or abscess has formed.
Symptoms: severe pain, cheek swelling, bad breath, fever.
Treatment: root canal therapy or extraction in severe cases.

Types of infected tooth nerves in adults:

Reversible Pulpitis

Same as in children; mild, temporary pain.
Treatment: remove decay and fill the tooth before the infection reaches the pulp.

Irreversible Pulpitis

Nerve is completely damaged; pain is severe and continuous.
Symptoms: persistent pain, strong sensitivity, mild swelling or small abscess.
Treatment: root canal therapy and internal filling.

Necrotic Pulp with Abscess

Nerve is dead, with a large abscess possibly reaching bone or face.
Treatment: root canal cleaning, sometimes antibiotics or extraction if advanced.

Causes of infected tooth nerves in children:

Severe decay: poor oral hygiene and high sugar intake lead to pulp infection.
Trauma or dental injuries: falls or blows can damage the nerve even without visible decay.
Tooth wear from acids: frequent acidic drinks weaken enamel, making the pulp vulnerable.
Poor nutrition: calcium or vitamin D deficiency weakens teeth, increasing susceptibility.

Causes in adults:

Deep cavities: untreated cavities reach the pulp, causing painful infection.
Cracks or fractures: small fractures allow bacteria to infect the pulp.
Old or faulty fillings: gaps under fillings can let bacteria reach the nerve.
Gum disease or chronic inflammation: infection may spread to the pulp.
Poor oral hygiene: lack of brushing or flossing allows bacterial buildup.

Symptoms of an infected tooth nerve

In children:

Severe tooth pain, especially at night or while eating.
Strong sensitivity to hot or cold.
Swelling or redness in gums or face.
Bad taste or smell in the mouth.
Difficulty chewing or eating on one side.
Fever or general fatigue in severe cases.

In adults:

Persistent or intermittent pain, worse when eating or drinking.
Sensitivity to pressure or pain while chewing.
Gum or cheek swelling/redness.
Bad breath or unpleasant taste.
Sometimes fever.
Tooth discoloration (darkening due to nerve death).

Stages of tooth nerve infection in children and adults

Early Decay

Superficial enamel decay, often symptom-free.
Children: small black/brown spot, mild sensitivity.
Adults: mild pain or slight sensitivity to hot/cold.

Deep Decay

Decay reaches dentin (beneath enamel).
Children: intermittent pain, sensitivity, slight gum swelling.
Adults: noticeable pain while eating, occasional bad breath.

Pulpitis

Bacteria reach the pulp, causing inflammation.
Children: frequent complaints, refusal to eat on affected side, mild fever.
Adults: severe pain, difficulty chewing, slight swelling.

Necrosis & Infection

Nerve dies and infection develops, often forming an abscess.
Children: obvious facial or gum swelling, bad breath, fever, fatigue.
Adults: severe continuous pain, darkened tooth, cheek swelling, foul taste.

Advanced Infection

Infection spreads to surrounding tissues or bone if untreated.
Children: facial swelling, high fever, extreme fatigue—emergency case.
Adults: large abscess, difficulty opening mouth or swallowing, potential severe complications.

Risks of an infected tooth nerve

In children:

Infection spreading to mouth or face.
Damage to permanent teeth.
Difficulty eating, affecting nutrition and growth.
Chronic bad breath.
Fever and fatigue.
Speech or jaw movement problems.

In adults:

Abscess or pus formation—severe pain and facial/neck swelling.
Infection spreading to bone or bloodstream—very dangerous.
Permanent tooth loss.
Infection of neighboring teeth.
Difficulty chewing and digestive issues.
Bad breath and tooth discoloration.

Important note:
An infected tooth nerve is not just a simple toothache—it’s a warning of a serious internal infection. See a dentist immediately if there is severe pain, swelling, or bad breath in you or your child.

Diagnosing an Infected Tooth Nerve in Children and Adults

Diagnosing an infected tooth nerve is the most important step before starting treatment. The dentist must determine whether the nerve is still alive and treatable or if it’s dead and requires a root canal or extraction. Diagnosis differs slightly between children and adults.

1. Diagnosing Infected Tooth Nerve in Children

Visual Examination

The dentist checks the tooth for signs of decay, swelling, or color changes.
A darkened tooth or a small abscess in the gums is a strong indicator of nerve infection.

Parental Interview
The dentist asks parents questions to assess the stage of infection:

How long has the child complained of pain?
Does the pain wake the child at night?
Any swelling or bad breath?
Does the child avoid chewing on one side?

Thermal or Stimulus Testing

Cold air or cotton with a cold substance may be applied to check nerve response.
- Severe pain → nerve is inflamed but alive.
- No sensation → nerve is likely dead.

X-rays (Radiographs)

Essential to show:
- Whether decay has reached the nerve.
- Presence of an abscess under the root.
- Effect on jawbone or developing permanent teeth.

Observation of Child’s Behavior

Young children may not describe pain clearly, so dentists observe reactions like fear, crying, or pulling away during the exam.

2. Diagnosing Infected Tooth Nerve in Adults

Clinical Examination

Dentist inspects the tooth and gums for deep decay, discoloration, or visible abscess.

Thermal Testing

Cold or hot substances determine pulp health:
- Severe pain → inflamed nerve.
- No sensation → nerve dead or necrotic.

Percussion Test

Gentle tapping on the tooth:
- Pain indicates inflammation or abscess under the root.

Electric Pulp Test

A small device sends weak electric current to measure nerve response.
No response → dead or severely infected nerve.

X-rays

Reveal the extent of decay, root condition, abscess, or bone loss.
Multiple angles may be taken to assess infection spread.

Medical History Review

Chronic conditions like diabetes or immune deficiencies affect infection spread and healing.

Surgical Treatment of Infected Tooth Nerve

1. Children

Children mostly have primary (baby) teeth. Surgery is considered if:

Medications or standard root canal (pulp therapy) fail.
Infection threatens permanent tooth development.

Surgical Options:

Drainage of Abscess
- Small incision to drain pus, relieve pain, and allow antibiotics to work.
Pulpotomy or Pulpectomy
- Pulpotomy: Removes only the infected part of the pulp, preserving the healthy nerve.
- Pulpectomy: Removes the entire necrotic nerve, cleans canals, and fills them with child-safe material.
- Goal: Preserve the tooth until the permanent tooth erupts.
Tooth Extraction
- Last resort if the tooth is completely dead or infection reached the root.
- A space maintainer may be used to keep room for the permanent tooth.

2. Adults

Surgical treatment in adults focuses on saving the natural tooth whenever possible.

Surgical Options:

Root Canal Retreatment
- For previously treated teeth where infection recurs.
- Dentist reopens the tooth, cleans the canals, and refills them.
Apicoectomy (Root-End Surgery)
- Performed if infection persists at the tip of the root.
- Small incision in the gum, removal of the infected root tip, and filling to prevent recurrence.
Tooth Extraction
- Used when the tooth and nerve are irreparably damaged.
- Post-extraction replacement options include dental implants or bridges.

Post-Surgical Care

Rest and avoid chewing on the treated side for the first 24 hours.
Use cold compresses to reduce swelling.
Take antibiotics and painkillers as prescribed.
Rinse mouth with warm saltwater after the first day.
Return to the dentist if swelling, bleeding, or severe pain occurs.

Tips for Managing Infected Tooth Nerve

For Children

See a dentist immediately
- Early treatment prevents infection from spreading and protects permanent teeth.
Avoid chewing on the affected tooth
- Eat on the healthy side to prevent further inflammation.
Maintain daily oral hygiene
- Brush twice a day with a child-friendly toothpaste.
- Rinse with warm saltwater or mild mouthwash if allowed.
Avoid sugary foods and sodas
- Sugars feed bacteria that worsen decay and inflammation.
Apply cold compresses for swelling
- Do not use heat, which may worsen swelling.
Follow prescribed medications
- Complete the antibiotic or painkiller course even if pain subsides.
Ensure adequate rest
- Rest helps the body fight infection and reduces pain.

For Adults

Do not delay dental visit
- Pain may decrease as the nerve dies, but infection continues and spreads.
Follow dentist’s treatment plan
- Take antibiotics and painkillers on schedule.
Avoid home remedies on the tooth
- Cloves or aspirin may burn the gums and worsen inflammation.
Eat soft foods at moderate temperatures
- Avoid very hot or cold foods.
Maintain daily oral hygiene
- Brush twice a day with fluoride toothpaste and floss to remove debris.
Use cold compresses for swelling
- Apply externally for 10 minutes, then take a break.
Post-treatment follow-up is essential
- Revisit the dentist one week after root canal or surgery to confirm healing.
Monitor other teeth
- Treat minor cavities early to prevent pulp infection.

General Advice:

Avoid home remedies like garlic or cloves directly on the tooth—they may do more harm than good.
Brush gently twice a day with fluoride toothpaste.
Visit the dentist every six months to prevent serious problems.