Treatment of Fractured Tooth

Tooth fractures can range from minor (chipping of the outer tooth) to severe (vertical, diagonal, or horizontal) fractures of the tooth and/or root.

Enamel and dentin are the two outer protective layers of the tooth. The enamel is the outermost white hard surface. The dentin is a yellow layer lying just beneath the enamel. Enamel and dentin both serve to protect the inner vital part of the tooth tissue called the pulp.

Different tests are performed to determine if a tooth is fractured. In some instances, dental X-rays can help to diagnose, locate, and measure the extent of tooth fractures. A serious fracture is one that exposes both the dentin and the pulp tissue and should be treated promptly. Serious fractures may make the tooth displaced and loose, and cause the gums to bleed. To prevent the loose tooth from falling out completely, we can splint the loose tooth by bonding it to the adjacent teeth to help stabilize it while the underlying bone and gums heal. Because of the high risk of pulp infection after the exposure of the pulp to the oral environment, a root canal procedure may need to be performed during the first visit. Alternatively, we may elect to only apply a sedative dressing on the splinted tooth to help calm the tooth pain. The tooth will then be re-evaluated in two to four weeks to determine if a root canal procedure is necessary. If the tooth appears to have recovered and is stable in the mouth, the splint is removed at that time and a filling or crown is placed to restore the fractured tooth. The tooth may still require periodic monitoring over time (months to a year) to determine if any further treatment will be needed.

The most serious injuries involve vertical, diagonal, or horizontal fractures of the tooth roots. In most instances, a fracture of the tooth root leaves the injured tooth very loose and unable to be restored, thus necessitating tooth extraction. The extracted tooth is often replaced. There are some specific instances where teeth with horizontal fractures near the tip of the root may not need extraction. Root canal treatment for the injured tooth may be required in the future if symptoms of pulp death and tooth infection appear. Periodic dental X-rays of the fractured tooth are performed to monitor it closely.

Depending on the severity fractures can be classified into,

  • Craze lines – these are tiny cracks that affect only the outer enamel of the tooth. They are common in most adult teeth and cause no pain.  Craze lines need no treatment.
  • Cracked cusp – the cusp is the pointed part of the biting surface of the tooth.  If a cusp becomes damaged, the tooth may break.  You will usually get a sharp pain in that tooth when biting. This is a horizontal fracture in the cusp of the tooth, usually found on filled double teeth. There will be pain when biting and chewing because the crack and pain will only be present when pressure is applied.
  • Cracked tooth – this is when a crack runs from the biting surface of the tooth down towards the root. Sometimes it goes below the gum line and into the root.  A cracked tooth is not split into two parts but the soft, inner tissue of the tooth is usually damaged.
  • Split tooth – this is often the result of an untreated cracked tooth. The tooth splits into two parts.  Vertical root fractures are cracks that begin in the crown and extend to the root as well.

Many things can cause teeth to crack; such as:

  • extreme tooth grinding, which can put the teeth under enormous pressure
  • large fillings that weaken the tooth
  • chewing or biting on something hard, for example, ice, fruit stones, meat bones, muesli or granary bread.
  • a blow to the chin or lower jaw
  • gum disease, where there has been bone loss that could make the teeth more likely to suffer from root fractures
  • sudden changes in mouth temperature
  • Teeth become more brittle as we get older.

Few common signs of cracked tooth are, when you are chewing, especially when you release the biting pressure.  Extreme temperatures, especially cold, may cause discomfort, or you may be sensitive to sweetness, but with no signs of decay.  Swelling may be limited to a small area near the gum tissue of affected tooth.

Unfortunately, dental x-rays sometimes don’t show up the cracked tooth.  This is because the x-ray beam must be parallel to the crack before it can penetrate it.  With a vertical root fracture, if the crack has been there long enough, vertical bone loss near to the root can be seen.  Your dentist may use a bright light or a magnifying glass to find the crack.  They may also use a special dye to follow the course of the crack.

It is important to get advice as soon as possible to help the treatment be more effective.  If they are not treated, cracked teeth can lead to the death of the nerve, and an abscess might grow that could need root canal treatment or extraction.  In severe cases the tooth can actually split in two.  If this happens we will not be able to save the tooth and it will need to be taken out.

Types of treatments available,

Cosmetic contouring – this is done when the chip is very small.  The rough edges of the tooth are rounded and polished to blend away the crack

Bonding – this is when a plastic resin is used to fill the crack and it can easily repair a small chip off the biting edge of the tooth. Bonding can restore the shape of the tooth.

Veneers – these are ideal for a tooth that still has a fair amount of structure remaining, as they are long lasting and need the least amount of tooth removing first.  A veneer is a thin layer of porcelain or plastic material made to fit over the front surface of the tooth.

Crowns – these are used as a last resort for a tooth that is not suitable for a veneer.  A crown fits right over what is left of the tooth, making it strong and giving it the appearance of a natural tooth.

Root canal treatment followed by crown- If the nerve has been damaged and becomes infected you may need to have root canal treatment first.  This involves removing all infection from the root canal.  The root is then cleaned and filled to prevent any further infections.  The tooth would then be fitted with a crown to give it extra support.

Unlike broken bones, the crack in a tooth will never heal completely. Sometimes, after treatment, a crack may get worse and you could still lose the tooth.  It is still important that you get treatment because most cracked teeth can work normally for years after treatment. we will be able to tell you more about your particular problem and recommended treatment.

Patients with one cracked tooth will frequently return with the same problem in another tooth, but there are some precautions you can take:

Wear a mouthguard – if you grind your teeth at night, have a night guard made to protect the teeth.  If you play sports, wear a custom-made mouthguard. avoid biting or chewing on hard objects.