The first premolars are two spaces ahead of the molar teeth and help start the chewing-related food grinding the rear molars finish. If a first premolar becomes infected and doesn't receive treatment, the infection can worsen to the point of damaging the vital pulp material that travels through the canal system to keep the tooth alive. If the pulp dies, the tooth dies with it.

There is a couple of dental treatments possible when a first premolar has a severe dental infection with pulp damage. The right course of treatment will depend on whether or not the level of pulp damage is reversible.

Root Canal and Apicoectomy with Dental Crown

The root canal system stretches from the lower tips or apexes of the tooth roots all the way up through the tooth's central canal and into the upper pulp chamber right under the top of the tooth. If the pulp has become infected, the infection can travel up and down the canal system causing damage as it passes. Pulp that becomes damaged can start to cause more structural damage to the inside of the tooth.

Your dentist will need to completely remove all of the damaged and infected pulp in order to have a chance at saving the tooth. The pulp removal is formally called root canal therapy.

In root canal therapy, the dentist will drill into the tooth to slide a thin tool into the canal and scrape out the pulp. The canal is then rinsed with antibiotics, to erase any lingering infection, and then filled with a dissolving bio-foam, which will temporarily hold the canal closed so more infected pulp from lower in the system can't reenter. The tooth is then sealed shut with a dental crown. 

Pulp can become trapped in the root apexes, which is fixed with an apicoectomy. The dentist gets to the roots through the gums and jawbone then snips off the tips and treats the root ends with the same rinse and foam as with the root canal procedure.

Dental Extraction with Bridge or implant Replacement

Dead or necrotic pulp won't regenerate even if removed with a root canal procedure. The dead pulp will lead to a dead tooth. Your dentist will extract the dying tooth before that dead material has a chance to start damaging bone, soft tissue, and other teeth.

An extracted tooth leaves a hole that makes for uncomfortable chewing and cosmetic concerns. The dentist can close the hole quickly with a dental bridge, which has a false tooth supported by flanking dental crowns that are cemented to the natural teeth on either side of the missing bicuspid. Dental bridges are fast to install and removable if you want to go with another replacement later on.

Dental implants are sturdier but take longer because the metal root inserted into the jawbone needs to have the bone heal completely around it for support. Only then can the artificial tooth snap onto the top of the root.