Etiologies, risk factors and outcomes of dental pulp necrosis


  • Maha Ali Abdulwahab North Jeddah Specialist Dental Center, King Abdullah Medical Complex, Jeddah, Saudi Arabia
  • Musab Saeed Alqahtani College of Dentistry, Vision Colleges, Riyadh, Saudi Arabia
  • Abeer Assaf Alshammari Dental Department, Ministry of Health, Dammam, Saudi Arabia
  • Suzan Essam Jiffri General Dentist, Safaa Albarad Dental Clinic, Jeddah, Saudi Arabia
  • Abdulrahman Mohammed Alasim College of Dentistry, King Saud University, Riyadh, Saudi Arabia
  • Fahad Majed Alsharidah College of Dentistry, King Saud University, Riyadh, Saudi Arabia
  • Naif Ibrahim Alqunfuthi College of Dentistry, Jazan University, Jazan, Saudi Arabia
  • Batoul Abdulmalek Alnamnakani College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
  • Raghad Saeed Alshahrani College of Dentistry, King Khalid University, Abha, Saudi Arabia
  • Norah Abdullah Alshahrani College of Dentistry, King Khalid University, Abha, Saudi Arabia
  • Rian Naser Aljohani Dental Department, Dr Erfan & Bagedo General Hospital, Jeddah, Saudi Arabia
  • Meshall Abdul-Lattif Almintakh Dental Department, Khulais General Hospital, Khulais, Saudi Arabia



Dental pulp necrosis, Pulpitis, Dental trauma, Dental infection


Dental pulp necrosis is referred to the situation in which the teeth biologically die due to bacterial infection or without bacterial infection. Dental pulp necrosis can be due to a chronic progression of pulpitis, in which the tissue of soft pulp in the tooth dies due to several causes such as trauma or severe bacterial infection. Untreated cavities, multiple invasive treatments for the tooth, and pathological ischemia for dental pulp are among the most common causes for the necrosis process. Usually, the first symptom of dental pulp necrosis is the irritant pain in the tooth only or the surrounding area because of the inflammation. The grade of pain ranges from mild, moderate, to severe pain according to the size of the damage, followed by swelling and discomfort in chewing due to the pressure on the nerve root at the base of the tooth. We aim to review the different etiologies, risk factors, correlations, and clinical outcomes associated with pulp necrosis. To our knowledge, this article is going to be the first comprehensive review of dental pulp necrosis.


López-Marcos JF. Aetiology, classification and pathogenesis of pulp and periapical disease. Med Oral Patol Oral Cir Bucal. 2004;9(1):58-62.

Koç S, Del Fabbro M. Does the Etiology of Pulp Necrosis Affect Regenerative Endodontic Treatment Outcomes? A Systematic Review and Meta-analyses. J Evid Based Dent Pract. 2020;20(1):101400.

Mejàre IA, Axelsson S, Davidson T, et al. Diagnosis of the condition of the dental pulp: a systematic review. Int Endod J. 2012;45(7):597-613.

Leston JM. Functional anatomy of the trigeminal nerve. Neurochirurgie. 2009;55(2):99-112.

Tripathi M, Sadashiva N, Gupta A. Please spare my teeth! Dental procedures and trigeminal neuralgia. Surg Neurol Int. 2020;11:455.

Yu C, Abbott PV. An overview of the dental pulp: its functions and responses to injury. Aust Dent J. 2007;52(1):S4-16.

Petersson K, Söderström C, Kiani-Anaraki M, Lévy G. Evaluation of the ability of thermal and electrical tests to register pulp vitality. Endod Dent Traumatol. 1999;15(3):127-31.

Kahler B, Rossi-Fedele G, Chugal N, Lin LM. An Evidence-based Review of the Efficacy of Treatment Approaches for Immature Permanent Teeth with Pulp Necrosis. J Endod. 2017;43(7):1052-7.

Larsen T, Fiehn NE. Dental biofilm infections-an update. Apmis. 2017;125(4):376-84.

Johnson BT, Mayo JA, Jeansonne BG. beta-Hemolytic Streptococci and other beta-hemolytic organisms in apical periodontitis and severe marginal periodontitis. Endod Dent Traumatol. 1999;15(3):102-8.

Feng Z, Li Q, Meng R, Yi B, Xu Q. METTL3 regulates alternative splicing of MyD88 upon the lipopolysaccharide-induced inflammatory response in human dental pulp cells. J Cell Mol Med. 2018;22(5):2558-68.

Dabuleanu M. Pulpitis (reversible/irreversible). J Can Dent Assoc. 2013;79:d90.

Aldrigui JM, Cadioli IC, Mendes FM, Antunes JL, Wanderley MT. Predictive factors for pulp necrosis in traumatized primary incisors: a longitudinal study. Int J Paediatr Dent. 2013;23(6):460-9.

Lima SM, Grisi DC, Kogawa EM. Diabetes mellitus and inflammatory pulpal and periapical disease: a review. Int Endod J. 2013;46(8):700-09.

Omi M, Hata M, Nakamura N. Transplantation of dental pulp stem cells suppressed inflammation in sciatic nerves by promoting macrophage polarization towards anti-inflammation phenotypes and ameliorated diabetic polyneuropathy. J Diabetes Investig. 2016;7(4):485-96.

Ricucci D, Loghin S, Siqueira JF, Jr. Correlation between clinical and histologic pulp diagnoses. J Endod. 2014;40(12):1932-9.

Reddy LV, Bhattacharjee R, Misch E, Sokoya M, Ducic Y. Dental Injuries and Management. Facial Plast Surg. 2019;35(6):607-13.

Mensch K, Nagy G, Nagy Á, Bródy A. Characteristics, diagnosis and treatment of the most common bacterial diseases of the oral cavity. Orv Hetil. 2019;160(19):739-46.

Kim JL, Park JH, Han SB, Cho IY, Jang KM. Allogeneic Blood Transfusion Is a Significant Risk Factor for Surgical-Site Infection Following Total Hip and Knee Arthroplasty: A Meta-Analysis. J Arthroplasty. 2017;32(1):320-5.

Abbott PV, Yu C. A clinical classification of the status of the pulp and the root canal system. Aust Dent J. 2007;52(1):S17-31.

Jacobsen I. Criteria for diagnosis of pulp necrosis in traumatized permanent incisors. Scand J Dent Res. 1980;88(4):306-12.

Mishra S, D SS, Bhusari C. Assessing Inflammatory Status of Pulp in Irreversible Pulpitis Cases with Pulse oximeter and Dental Hemogram. J Clin Pediatr Dent. 2019;43(5):314-9.

Demirturk Kocasarac H, Geha H, Gaalaas LR, Nixdorf DR. MRI for Dental Applications. Dent Clin North Am. 2018;62(3):467-80.

Bjørndal L, Simon S, Tomson PL, Duncan HF. Management of deep caries and the exposed pulp. Int Endod J. 2019;52(7):949-73.




How to Cite

Abdulwahab, M. A., Alqahtani, M. S., Alshammari, A. A., Jiffri, S. E., Alasim, A. M., Alsharidah, F. M., Alqunfuthi, N. I., Alnamnakani, B. A., Alshahrani, R. S., Alshahrani, N. A., Aljohani, R. N., & Almintakh, M. A.-L. (2021). Etiologies, risk factors and outcomes of dental pulp necrosis. International Journal Of Community Medicine And Public Health, 9(1), 348–352.



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