Is a Pulpless Tooth Healthy Because It Is Comfortable?

The old idea ran somewhat as follows:

Ease = comfort = health.

Disease = discomfort = lack of health.

We know now that this idea is a half-truth. Probably all tissues in perfect health are comfortable. But many tissues may be in advanced stages of some diseases with no recognizable signs of discomfort. Some tissues not only may be diseased themselves but may be the seats of continuously active infection without giving a single recognizable sign of local discomfort. The results of the infection may be visible only in the breaking-down of other organs.

There are many pulpless teeth, formerly putrescent, which are comfortable, so far as local reaction goes. Radiographs of some show radiolucent areas or osteitis; some have fistulas; some have no radiographic evidence of periapical pathology or have increased density. Some patients with radiolucent areas and fistulas seem to be well and happy and vigorous. Other patients, without a discernible sign of periapical pathology, exhibit signs of serious or advanced systemic breakdown. In many such cases the teeth are not regarded as foci of the breaking infection because they never cause pain, they have been treated, the root canals are filled, and there is no periapical radiolucency or osteitis.

Yet patients with such systemic breaks, sometimes manifested in diseases generally regarded as incurable, such as some heart lesions, frequently improve greatly in health upon the removal of the teeth and curettement of the periapical region. Cultures from that region often demonstrate the presence of infections. The patient’s recovery is often materially aided by the employment of vaccines made from the periapical infection.

The periapical infection is not necessarily that of a pus-producing organism. Alone, it may not be effective in breaking down the health of the body, but its presence for a long period in the body fluids may materially hasten the onset of the degenerative diseases. Or, when the resistance power of the body has been sufficiently reduced by some overload, it may administer the last, fatal kick.

Comfort about a pulpless tooth may indicate a state of health. On the other hand, it may mean a lack of local reaction and that a periapical infection is discharging organisms and products into the body to become effective elsewhere.

Pulpless teeth are different things under different conditions. In the mouths of the healthy and vigorous they are doubtless permissible, but only so long as that person is without overloads. In the mouths of the sick they are possible foci of very serious infections, and the patient’s prognosis will be much more favorable if they are removed.