Is a Pulpless Tooth a Dead Tooth - An Age-Old Controversy that Lingers Today

Leonard Koecker was outspoken in 1821 when he criticized the procedure of pulp extirpation and tooth retention, a procedure that had been advocated and practiced by Fauchard and others. He again registered his thoughts on this issue in 1826 in the publication of his textbook entitled "Principles of Dental Surgery". He claimed the tooth was dead and a repugnant foreign body that impacted on the surrounding living tissues. This controversial position ensued for close to a century, with advocates for Koecker's position, especially in the time of the Focal Infection and those opposed who favored a biological/scientific approach to this issue. Although today the desire to retain teeth through pulpal extirpation and proper root canal procedures is the treatment of choice when possible, it is common globally to frame the pulpless tooth as a dead tooth by both the dental professional and laypersons alike.