A dentist points to a small bright spot inside one of your back teeth on an X-ray and calls it a pulp stone. It is a hard, calcified lump that has formed in the soft tissue in the centre of the tooth. Pulp stones are common, they are usually found by chance, and on their own they do not usually cause symptoms. They mainly become relevant if that tooth ever needs root canal treatment.
This article covers what pulp stones are, how common they are, whether they explain a toothache, what they mean for root canal treatment, and what the research on links with heart disease, kidney stones and diabetes does and does not show.
A calcified deposit inside the pulp
The pulp is the soft tissue in the middle of a tooth, containing nerves and blood vessels. It sits in a chamber in the crown and runs down narrow canals in the roots. A pulp stone is a calcified mass inside that tissue, either in the chamber or in a root canal. Because it is mineralised, it shows up as a bright (radiopaque) area on an X-ray.
A 2026 systematic review by Sanches and colleagues in the Journal of Applied Oral Science describes pulp stones as typically symptom-free and usually detected incidentally on X-rays. They have been found in baby teeth and adult teeth, in healthy and diseased teeth, and even in teeth that have not yet come through the gum (Pietrzycka and Pawlicka, Dental and Medical Problems, 2020). What causes them to form is still largely unknown, as a review in the International Endodontic Journal (Goga and colleagues, 2008) concluded.
Estimates of how common they are vary widely
Estimates vary a great deal between studies, partly because studies used different types of X-ray and looked at different groups of people. Ordinary two-dimensional X-rays show the tooth as a flat shadow, while cone beam CT (a 3D scan) shows it in slices.
| Study | What was examined | People with at least one pulp stone | Teeth affected |
|---|---|---|---|
| Jannati and colleagues, Journal of Evidence-Based Medicine, 2019 (meta-analysis) | 16 studies, 14,093 people | About 37% | About 10% |
| Sanches and colleagues, 2026 (meta-analysis) | 24 studies, 10,738 people | 46% | 20% |
| Hsieh and colleagues, Journal of Dental Sciences, 2018 (Taiwan, 3D scans) | 144 patients, 2,554 teeth | 83.3% | 31.3% |
| Sanz and colleagues, Journal of Clinical Medicine, 2025 (Spain, 3D scans) | 300 scans, 5,485 teeth | 88.3% | 61.2% |
Sanches and colleagues rated the overall certainty of the prevalence evidence as very low, because the studies differed so much. In a laboratory study of 52 extracted teeth (Kaabi and colleagues, Diagnostics, 2026), the most detailed 3D scan setting detected pulp stones in 63.5% of teeth and digital two-dimensional X-rays in 50%, although the differences between methods were not statistically significant.
Put simply, finding a pulp stone is not unusual. Many people who have never been told about one may have them.
Where they tend to turn up
Pulp stones are found most often in molars. In the Taiwanese study, half of first molars had one, compared with 18.8% of first premolars, and they were more common in the upper jaw than the lower. The Spanish study also found more pulp stones in upper teeth and in molars, and found them 3.7 times more often in teeth with decay, 4.7 times more often in teeth with fillings and 2.3 times more often where there was bone loss around the tooth.
Orthodontic treatment may also play a part. A 2026 systematic review (Pouliezou and colleagues, International Orthodontics) found that pulp calcifications, especially pulp stones, tended to be seen more often after braces or aligners, but the increase was modest, the evidence was of low to very low certainty, and the changes did not cause symptoms.
Pulp stones are usually found in teeth without symptoms
Because pulp stones are typically symptom-free and usually found by chance, a dentist who sees one in a sore tooth will usually also look for other common causes of pain, such as decay, a cracked tooth or an inflamed pulp. Our articles on reversible and irreversible pulpitis and on pain that is hard to pin to one tooth explain how those are tested for.
A common worry is whether a pulp stone stops a tooth from going numb. In a 2026 study of 126 patients having root canal treatment on molars (Parirokh and colleagues, Iranian Endodontic Journal), the presence of pulp stones made no significant difference to whether the anaesthetic worked.
Healthdirect advises getting emergency medical care if toothache or gum swelling causes problems with breathing, problems with speaking, or swelling around your eye or neck. It advises seeing your dentist if toothache and gum swelling come with a fever (a temperature over 38°C), trouble swallowing, pain when you bite, a bad taste in your mouth, or swelling in your cheek or jaw. If you have an urgent dental problem, we offer emergency dental appointments. The practice is open Monday to Saturday, until 9pm on Thursdays, and on Sundays by appointment.
Where they do matter: root canal treatment
Pulp stones become important if a tooth needs root canal treatment. A stone in the pulp chamber can make it harder to find the openings of the root canals, as Hsieh and colleagues noted, and a stone inside a canal can block access and get in the way of cleaning and shaping it (Pietrzycka and Pawlicka, 2020). In their case series, the stones were removed with long burs and an ultrasonic instrument under an operating microscope, and the authors described removal as a complex procedure that needs skill and the right equipment.
Lumi has an Orthophos 3D X-ray unit that takes both standard OPG and 3D scans, which may help with planning when a tooth has calcified canals. Some teeth with heavily calcified canals may be referred to an endodontist, a registered specialist in root canal treatment, and our article on when to see an endodontist for root canal treatment explains how that decision is made.
Links with heart disease, kidney stones and diabetes
Because pulp stones are a type of calcification, researchers have asked whether they are more common in people with calcification elsewhere in the body. The findings so far are associations, not proof of cause, and where reviews graded the certainty of the evidence, they rated it very low.
- Heart and blood vessel disease. A 2022 meta-analysis in the Journal of Endodontics (Almadhoon and colleagues, 19 studies) found an association between pulp stones and cardiovascular disease (odds ratio 3.35). A 2023 meta-analysis (Vieira and colleagues, Dentomaxillofacial Radiology) found people with pulp stones on panoramic X-rays were more likely to have calcified plaque in the carotid or coronary arteries (odds ratio 1.70), with very low certainty of evidence.
- Kidney stones. The evidence is mixed. A 2019 meta-analysis that pooled two studies found an association (Gabardo and colleagues, odds ratio 1.97), while the 2022 Almadhoon review found no association.
- Diabetes. In a study from southwest China of 240 people aged 40 to 69 (Chen and colleagues, BMC Oral Health, 2026), pulp stones were found in 81.7% of those with diabetes compared with 52.5% of those without.
The 2026 Sanches review added a twist: people with both heart and kidney disease had a higher prevalence of pulp stones, but people with heart disease alone had a lower prevalence than healthy people. With results like these, a pulp stone on a dental X-ray is not a reliable sign of heart disease, kidney stones or diabetes. If you have concerns about those conditions, your GP is the right person to talk to.
What patients ask about pulp stones
Do pulp stones need to be removed?
Not usually because of the stone alone. Pulp stones are typically symptom-free. They mainly matter if that tooth needs root canal treatment, where a stone can block access to the canals and may need to be removed as part of that treatment.
Will every X-ray show a pulp stone?
No. Small stones, especially in the root canals, can be missed on two-dimensional X-rays and seen on a 3D scan, which may be one reason prevalence figures vary so much.
Can children have pulp stones?
Yes. They have been reported in baby teeth as well as adult teeth.
Ask about anything you see on your X-ray
If a pulp stone or any other finding on your X-rays has left you with questions, ask at your next visit with our general dentists in Melrose Park. We can go through the image with you and explain what it shows.
Sources
- Sanches YA and colleagues. Prevalence and factors associated with pulp stones: a systematic review with meta-analysis and meta-regression. Journal of Applied Oral Science, 2026. PubMed 42561213
- Jannati R and colleagues. Prevalence of pulp stones: a systematic review and meta-analysis. Journal of Evidence-Based Medicine, 2019. PubMed 30461204
- Hsieh CY and colleagues. The prevalence and distribution of radiopaque, calcified pulp stones: a cone-beam computed tomography study in a northern Taiwanese population. Journal of Dental Sciences, 2018. PubMed 30895109
- Sanz JL and colleagues. Cone-beam computed tomography assessment of the prevalence and association of pulp calcification with dental and periodontal pathology. Journal of Clinical Medicine, 2025. PubMed 40004903
- Kaabi HH and colleagues. Comparative detection and inter-modality agreement of pulp stones using digital periapical radiography and CBCT at two voxel sizes. Diagnostics, 2026. PubMed 41975674
- Goga R, Chandler NP, Oginni AO. Pulp stones: a review. International Endodontic Journal, 2008. PubMed 18422587
- Pietrzycka K, Pawlicka H. Clinical aspects of pulp stones: a case report series. Dental and Medical Problems, 2020. PubMed 32603035
- Pouliezou I and colleagues. Occurrence of dental pulp calcifications after orthodontic treatment: a systematic review. International Orthodontics, 2026. PubMed 42033857
- Parirokh M and colleagues. Investigating the association between the presence of pulp stone and anesthesia failure in upper and lower molar teeth. Iranian Endodontic Journal, 2026. PubMed 42291795
- Almadhoon HW and colleagues. The association of dental pulp stones to cardiovascular and renal diseases: a systematic review and meta-analysis. Journal of Endodontics, 2022. PubMed 35447295
- Vieira WA and colleagues. Association between the prevalence of pulp stones and calcified atherosclerotic plaques: a systematic review and meta-analysis. Dentomaxillofacial Radiology, 2023. PubMed 37052394
- Gabardo MCL and colleagues. Association between pulp stones and kidney stones: a systematic review and meta-analysis. Journal of Endodontics, 2019. PubMed 31351581
- Chen C and colleagues. Association between diabetes and pulp stone prevalence and morphological characteristics: a CBCT-based retrospective study. BMC Oral Health, 2026. PubMed 41634665
- Healthdirect Australia. Toothache and gum swelling. healthdirect.gov.au
This article is general information only and is not a substitute for an in-person assessment by a dental professional.
