Can Invisalign Cause a Tooth to Die

Thinking about Invisalign? You’re probably focused on the end goal—a straighter, more confident smile. And rightfully so! But like any orthodontic treatment, Invisalign comes with a few risks. One you might not have heard of? The possibility of a tooth "dying" during treatment.

Sounds dramatic, right? But before you panic, let’s break it down.

A tooth dies when the nerve inside it, known as the pulp, is damaged or loses its blood supply. This can happen for a few reasons: 

• Severe tooth decay

• Untreated cavities or infection

• Trauma (the most common cause)

A dental abscess forms when bacteria multiply inside the tooth. If an infection reaches the nerve, it’s crucial to address the symptoms early to prevent tooth loss.

Here’s the kicker: trauma isn’t always obvious. Maybe you took a hit to the mouth as a kid or bit down on something hard years ago. At the time, your tooth seemed fine, so you never gave it another thought. But fast forward 10 or 20 years, and that same tooth might suddenly turn grey or become sensitive. Why? Because trauma can silently weaken the nerve over time. 

That’s exactly what happened to one Invisalign patient who shared their story on Reddit. A teenage accident left them with undetected dental trauma. Fast-forward a decade, and mid-Invisalign treatment, one of their teeth started turning grey. Yikes.

Short answer? No, Invisalign itself doesn’t kill teeth. There are situations where a dying tooth might appear during or after treatment, but the cause isn't because of Invisalign. The way it moves your teeth can speed up a process that was already in motion. If a tooth had previous trauma—especially one that went unnoticed—the shifting and pressure from aligners can push it over the edge.

In this patient’s case, pre-treatment X-rays didn’t show anything concerning. But once Invisalign got things moving, the trauma became obvious. Their tooth had already started calcifying (a fancy way of saying the root canal was slowly closing up). Once that process begins, it’s only a matter of time before the tooth loses vitality.

Not always. Even with X-rays, it’s tough to catch early tooth root damage. That’s why being upfront with your dentist and orthodontist about any past dental trauma is key—even if it happened years ago.

This patient didn’t realize their old injury could still cause problems. Had they known, they might have flagged it to their provider beforehand. Hindsight is 20/20, but now you know!

Spotting a dying or dead tooth early can make all the difference in preserving your dental health and preventing delays in aligner treatment. Here are some common symptoms to watch for:

•  Pain when chewing, biting, or lying down:  This can feel like a dull ache or sharp, localized pain. It may come and go or intensify over time, especially when pressure is applied.

•  Sensitivity to heat: A dying tooth often becomes hypersensitive to warm or hot foods and drinks. Unlike normal sensitivity that fades quickly, this discomfort tends to linger.

•  Unpleasant taste or odor: A persistent bad taste in your mouth or foul breath could signal infection in the tooth's pulp or surrounding tissue. This is often a red flag that bacteria are present and the tooth may be decaying internally.

•  Swelling in the gum near the tip of the tooth:  Swelling or tenderness near the base of the affected tooth can indicate an abscess. You might also notice a pimple-like bump (called a fistula), which can drain pus.

•  Tooth discoloration: A dead tooth may appear darker—yellow, gray, or even black—compared to surrounding teeth. This happens as the blood supply cuts off and the tissue inside the tooth begins to break down.

If you notice any of these symptoms during clear aligner or Invisalign treatment—or at any time—contact your dentist or orthodontist promptly. The sooner you get it checked out, the better your chances of protecting your smile and keeping your treatment on track.

First things first: a dead tooth isn’t the end of the world. If caught early (like in this case), it may not even need a crown. To treat a severely damaged or dying tooth, your dentist may recommend:

• A root canal to remove the dead pulp while keeping the tooth intact.

• Cosmetic treatments, like internal bleaching to restore the tooth’s natural color. No one will ever know the difference.

• A mini dental implant works in some cases. The reason is that it functions as a long-term replacement for a natural tooth. 

• Leaving the space alone can be an option if it’s not in a prominent position. This is common among patients with health-related limitations. Consult with your dentist if the risks of replacement outweigh the benefits.

✅ Tell your dentist about past injuries: Even if nothing seems wrong now, it’s better to be safe than sorry.
✅ Get a thorough dental care check-up: X-rays can help identify risks before treatment starts.
✅ Watch for changes: Tooth turning grey? Feeling extra sensitive? Don’t ignore it—call your dentist right away.
✅ Trust your provider: A solid orthodontist/dentist will look out for you and discuss any concerns upfront.
✅ Know that solutions exist: Even if a tooth does die, modern dentistry has your back. Root canals, whitening, and other treatments can keep your smile looking fresh.

Invisalign doesn’t cause teeth to die—but if you have past dental trauma, it can bring underlying issues to light. That’s why it’s important to watch for symptoms or changes in how your teeth feel. Your dentist can recommend the best solution to restore a healthy smile. The key is being proactive. Keep your dental team in the loop, stay on top of any changes, and remember: even if a tooth needs some extra TLC, your dream smile is still within reach!

Sources:

1. NIH. Impact of Clear Aligners on Oral Health and Oral Microbiome During Orthodontic Treatment. https://pmc.ncbi.nlm.nih.gov/articles/PMC10509397/  
2. NIH. Root resorption during orthodontic treatment with Invisalign®: a radiometric study. https://pmc.ncbi.nlm.nih.gov/articles/PMC5430001/  
3. Medrxiv. Risk of root resorption between Invisalign and fixed orthodontic treatment: A retrospective study. https://www.medrxiv.org/content/10.1101/2024.12.05.24318570v1.full 

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At PUL Dental, our goal is to provide clear, reliable, and helpful information to patients and dental professionals navigating the world of clear aligner treatment. All content on our blog is written by our cofounder, a Registered Dental Assistant with over a decade of experience in the dental field and a specialized background in adult orthodontics.

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