An exposed nerve in a tooth signals a serious dental emergency, resulting in intense, throbbing pain. This condition occurs when the dental pulp—the innermost soft tissue containing blood vessels, connective tissue, and nerves—becomes compromised. Exposure means the protective layers of enamel and dentin have been breached. Immediate, professional dental care is necessary to address the pain and prevent a severe infection.
Immediate Steps for Pain Relief
The acute, sharp pain from an exposed nerve demands immediate action while waiting for a dental appointment. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can reduce inflammation and provide systemic relief from the throbbing sensation. A cold compress applied externally to the cheek for fifteen-minute intervals can also help by constricting blood vessels and temporarily numbing the area.
Warm salt water rinses are a simple, effective measure to cleanse the area and reduce local irritation. Mixing a teaspoon of salt into warm water and gently swishing it around the affected tooth helps wash away debris and soothe inflamed tissue. Topical application of substances containing eugenol, such as clove oil, offers direct, localized pain relief. Eugenol acts as a temporary anesthetic and mild antiseptic when dabbed carefully onto the painful spot.
It is advisable to create a temporary barrier to shield the exposed area from the oral environment. Dental wax, sugar-free gum, or an over-the-counter temporary dental cement kit can be used to cover a visible hole or fracture. Protecting the site minimizes irritation from air, temperature changes, and food particles, which commonly trigger severe nerve pain. Also, avoid chewing on the affected side and consuming extremely hot, cold, or sugary foods and drinks, as these stimuli instantly exacerbate the pain.
What Happens When the Pulp is Exposed?
The tooth is constructed in layers, with the outermost enamel protecting the dentin, a hard yet porous layer that surrounds the central dental pulp. Dentin contains microscopic channels called dentinal tubules that extend to the pulp, housing fluid and nerve fibers. When the enamel and dentin are lost, external stimuli like cold air or pressure cause rapid fluid movement within these tubules, activating the nerve endings and resulting in characteristic sharp sensitivity.
A breach that reaches the pulp chamber introduces oral bacteria directly to the sterile pulp tissue, leading to inflammation known as pulpitis. Mild inflammation that allows the pulp to recover is reversible pulpitis. However, an exposed nerve typically signals irreversible pulpitis, where the tissue is damaged beyond repair. This irreversible state leads to necrosis, or tissue death, within the pulp chamber.
If left untreated, the bacterial infection will spread beyond the tooth’s root tip into the jawbone, resulting in a periapical abscess. This abscess is a pocket of pus that causes swelling and intense pressure, which can erode the surrounding bone tissue. The infection poses a risk not only to the tooth but also to the patient’s overall health, requiring urgent intervention to eliminate the source of the bacteria.
Professional Treatment Options
The definitive treatment for an exposed nerve depends on the extent of the damage and the health of the remaining pulp tissue.
Pulp Capping
When exposure is minimal, typically due to trauma or an accident during decay removal, a conservative procedure called pulp capping may be attempted. Direct pulp capping involves placing a biocompatible material, such as Mineral Trioxide Aggregate (MTA) or calcium hydroxide, directly over the small exposure site. This material seals the opening and stimulates the underlying pulp cells to form a protective layer of reparative dentin, preserving the tooth’s vitality.
Indirect Pulp Capping
Indirect pulp capping is used when deep decay is removed and the pulp is nearly, but not yet, exposed. A thin layer of affected dentin is intentionally left in place, and a bioactive material is placed over it to encourage natural dentin regeneration. The goal of any capping procedure is to maintain a healthy, living pulp, thus avoiding the need for more extensive treatment.
Root Canal Therapy
When the pulp is irreversibly damaged or necrotic, root canal therapy is the standard solution to save the tooth. This endodontic procedure involves administering local anesthesia and isolating the tooth with a dental dam to maintain a sterile field. The dentist or specialist creates an access opening in the crown to reach the infected pulp chamber and root canals. Specialized instruments are used to meticulously remove all infected pulp tissue, clean, and shape the narrow canals using disinfecting solutions.
Once the entire root canal system is cleaned, the empty space is filled and sealed with gutta-percha, a rubber-like material, combined with an adhesive sealer to prevent bacterial re-entry. Since a tooth that has undergone root canal therapy is structurally weaker, it nearly always requires a full coverage crown. This crown is placed over the treated tooth to restore its original shape, strength, and function, ensuring it can withstand normal chewing forces.
Extraction
Extraction, or tooth removal, becomes necessary when the tooth is deemed non-restorable due to severe structural damage, such as a fracture extending deep below the gum line. This option is also considered if the infection is widespread and cannot be resolved through root canal treatment. Extraction eliminates the source of the infection and pain, though the missing tooth must be replaced with a bridge or implant to prevent adjacent teeth from shifting and to preserve jawbone density.
Long-Term Care and Prevention
Preserving a tooth after pulp exposure treatment requires a commitment to diligent oral hygiene and protective measures. Regular brushing twice daily with a fluoride toothpaste and daily flossing are essential to prevent new decay from forming, particularly around the margins of fillings or crowns. Routine dental examinations allow the dentist to monitor the health of the treated tooth and check for any signs of recurrent infection or structural compromise.
A tooth that has undergone root canal therapy is susceptible to fracture, making a permanent crown necessary for long-term survival. The crown encases the entire tooth structure, providing the reinforcement needed to withstand chewing forces. To prevent future pulp exposure from trauma, individuals in contact sports should always wear a professionally fitted athletic mouthguard.
For those who clench or grind their teeth (bruxism), a custom-made occlusal guard should be worn at night. This appliance creates a protective barrier between the upper and lower teeth, dispersing grinding forces and preventing excessive wear that thins the enamel and dentin. Avoiding habits like chewing on ice, pens, or hard candy also reduces the risk of sudden cracks and fractures that could expose the pulp.