Broken teeth and their repair. -

An explanation of how teeth that have broken (minor chips, cracks, lost fragments, gum line fractures) can be fixed. / Managing problems and symptoms. / What to expect.

This page discusses:

  • Different types of tooth breakage. - Ranging from cracks, chips, lost fillings or tooth portions, to teeth or crowns that have broken off right at the gum line.
  • How dentists typically deal with each type of situation as an emergency. - Managing tooth pain, sharp edges, voids, loose bits, hot and cold sensitivity.
  • Ways broken teeth can be repaired. - In most cases by way of dental crown or filling placement. (Or if no repair is possible by tooth extraction.)


Possible scenarios involving broken teeth.

1) The tooth has fractured, a portion has come off or is loose.

Some traumatic events result in outright tooth fracture (a part has physically separated). The piece that comes loose may:

  1. Break away cleanly.
  2. Or if it's still attached to gum tissue, remain tethered in place.
Prompt attention is needed.

Any tooth that has splintered should always be inspected by your dentist. In fact, a stitch in time really can save nine when it comes to teeth that have a piece missing.

Broken teeth that are left untreated may fracture further, possibly catastrophically. Or since they now have a missing piece where dental plaque and debris can trap easily, tooth decay developing over the coming weeks and months can be a concern.

Reasons why a fractured tooth might (or might not) hurt.

The level of discomfort associated with a tooth that has had a piece break off will vary depending on the specifics of the situation. Here are some possible scenarios:

a) The tooth may not be painful at all.

  • Not all teeth that break end up hurting. The broken fragment might be very small, or from an area on the tooth that's relatively distant from its pulp tissue (nerve).
  • In other cases, the tooth's nerve may already have died (a necrotic tooth) or been previously removed during root canal treatment.

In either case, pain may not be an issue.

b) The tooth may show signs of pain.

Some broken teeth are spontaneously painful.

A tooth that hurts on its own without any provocation suggests that its pulp tissue has been substantially traumatized by the event that has caused its fracture.

Possible outcomes.

  • There's some potential that your tooth may settle down in the days that follow. This is more likely in cases where steps are taken to aid with its recovery.
  • If it doesn't or isn't expected to, your tooth will require root canal treatment before it can be rebuilt.

Only an evaluation by your dentist can determine which of these avenues seems most appropriate to pursue. Seeking treatment from them promptly is important both for the outlook of your tooth's nerve and your comfort.

The tooth may be painful to biting pressure.

Sensitivity to biting pressure can be an indication of more than one condition.

  • It may suggest that beyond just being fractured (a piece has broken off) the tooth is cracked too. With this scenario, when pressure is applied the cracked portions shift, thus causing pain.
  • Another explanation could be that the tooth has fractured but the loose portion is still attached to gum tissue and therefore hasn't fallen off yet. When pressure is applied, the position of the loose fragment shifts and causes gum-tissue pain.
  • In yet other cases, the tooth may have broken coincident with its developing need for root canal treatment. If so, the pain may be a sign of that underlying condition.
The tooth may have sensitivity to hot and cold.

Some fractured teeth hurt more so or are only painful when exposed to hot and cold temperature extremes, such as those caused by consuming foods and beverages.

  • The situation where your tooth is irritated by thermal insult but then when the stimuli is removed it immediately settles back down typically suggests that its nerve is still healthy and once a repair is made the tooth will likely be fine.
  • At the other extreme, a painful response to a heat stimulus that lingers may indicate that the tooth's nerve is compromised and will require root canal treatment before it can be permanently repaired.
Broken teeth can irritate soft tissues.
  • The pain associated with a fractured tooth may come from the soft tissues (cheek, tongue, lips) that rub against its sharp edges.
  • In the case where a piece of tooth is loose but hasn't come off yet, its attached gum tissue may be the source of pain.
A broken tooth.

Tooth fracture where a piece has separated.

Fixing broken teeth.

It's not always a catastrophic event when a tooth breaks. And in fact, in most cases it usually isn't. This can even include cases where the tooth has broken off down at the gum line.

a) When just minor repair is needed.

  • It's conceivable that such a small portion of the tooth has fractured off that it only requires some minor smoothing using a dental drill.
  • With larger defects, just placing a small, conservative filling may make a satisfactory fix.
  • Depending on what they discover during their examination, your dentist may feel that even after your tooth's repair it will remain at risk for further damage. If so, they may recommend the placement of a dental crown (see next section).

b) More extensive fractures.

Teeth that have larger sections missing will require more extensive work. But you don't necessarily have to be concerned that a repair can be made.

Even teeth that have had a substantial portion break off are usually salvageable, even including those that appear to be broken off flat at the gum line. And performing this work is probably pretty routine for your dentist.

Restoration types.
  • It may be that placing a filling can provide a suitable repair. However doing so may still leave the tooth at risk for further breakage.
  • Dental crown placement helps to reinforce and strengthen a tooth. And for teeth that have already experienced an initial catastrophic event, choosing this option frequently makes the more prudent choice.

    (This page explains the benefits of a crown vs. just placing a large filling.)

  • In cases where a substantial portion of a tooth has been lost (like when broken off at the gum line), simply anchoring a filling in the tooth may pose a challenge. If so, placing a crown may be the only way to successfully rebuild the tooth.

c) More problematic cases.

Complications arise in cases where the tooth's fracture either:

  • Extends far below its gum line. - (Gum surgery will be needed.)
  • Has resulted in serious damage or insult to the tooth's pulp tissue (nerve). - (Root canal treatment will be required.)
1) Cases where gum surgery will be required.

This complication arises when the tooth's fracture extends far below its gum line and involves its root (see animation).

A tooth that has fractured below the gum line.

Fracture that involves the tooth's root.

The problem.

The difficulty associated with this situation can be twofold:

  • If the edge of the dental restoration needed for the repair lies too close to the level of the bone, the gum tissue in the area will remain persistently irritated and inflamed.
  • If too little tooth structure extends above the bone and gums, the dentist may not be able to adequately anchor a new restoration (crown or filling).

You don't have to be unduly concerned that you have this situation. Even teeth that seem broken off right at the gum line to a lay person may be readily rebuildable (see x-ray image above). A tip-off that this condition might exist is when a loose tooth fragment remains stubbornly attached to gum tissue.

Crown lengthening.

A type of gum surgery termed "crown lengthening" may be able to resolve either issue. It's a minor surgical procedure where the level of the gum and bone tissue surrounding a tooth is lowered, thus exposing more of the tooth.

After healing has occurred, a restoration can be placed. If the fracture is too extensive, crown lengthening may not be possible. If not, then extracting the tooth may be the only solution.

A crowned tooth that has had root canal treatment.

This broken tooth required root canal and a crown.

2) Cases where root canal treatment will need to be performed.

In situations where a tooth's nerve has been compromised or damaged as a result of its fracture, root canal therapy will need to be performed before its permanent restoration can be placed.

  • It can be impossible for a lay person to know just by looking whether this step will be required or not. Even teeth that seem to be broken off even with the gum line may not have this complication whereas much smaller looking fractures do.
  • Clearly your tooth's level of symptoms (pain) tends to suggest that a nerve problem exists or is developing.

How dentists manage and temporize fractured teeth.

Until that time when arrangements can be made to permanently repair your tooth, your dentist will take steps to alleviate the symptoms you are experiencing. If direct attention from them is not possible, they may instruct you in how to perform these steps on your own using OTC (over-the-counter) products.

Tooth pain.

Anti-inflammatory medications.

In some cases a tooth's discomfort is due to reversible pulpitis (nerve inflammation). (A condition where the tooth's pulp is still healthy, just temporarily irritated due to events associated with the fracture.)

If so, a dentist may suggest that a NSAID medication (non-steroidal anti-inflammatory drug) should be taken. Examples include: ibuprofen (Motrin, Advil), aspirin, naproxen (Aleve). (Each is available as an OTC product.)

NSAIDS help to prevent/minimize/reduce the level of inflammation, thus reducing the level of pain experienced and aiding in the pulp tissue's recovery.

Sedative fillings.

Some type of temporary filling materials have sedative properties and can help to both relieve tooth pain and aid with pulp tissue recovery. The one most commonly used by dentists is a mixture of zinc oxide (powder) and eugenol (liquid). (Available as an OTC product.)

Initiating root canal treatment.

In cases where the above steps either can't, aren't expected to, or else aren't an appropriate method for controlling the patient's pain, a dentist will initiate root canal therapy. If for whatever reason this approach isn't chosen, the dentist's only other option will be to extract the tooth.

Prescription pain relievers.

Especially when direct attention from your dentist isn't possible, they may prescribe a narcotic (prescription) pain reliever for you.

Narcotic compounds on their own only help to control discomfort. They do nothing toward aiding the recovery of the tooth's pulp tissue (in cases where that's possible). Using them is simply a temporary, palliative solution until more definitive treatment can be performed.

Loose tooth fragments.

Dentists can't reattach broken tooth parts. So in the case where a tooth has fractured and a portion is loose but hasn't come off yet (it's still attached to the gums), they will remove it.

In many cases the patient has no real pain unless they manipulate or bite down on the piece that's loose. If that's your situation, until that point in time when you receive treatment from your dentist the obvious solution is to simply make sure your tooth is not disturbed.

Removing the broken part.

In the simplest cases, a dentist can just twist the loose part off with their fingers. In others, a dental instrument may be required to get a hold of or pry at the piece.

Depending on how extensively the gums are attached, you can expect that there will be some minor bleeding after the fragment has been removed.

Numbing the gums.

Numbing up the attached gum tissue may or may not be needed. If so, dabbing on a topical anesthetic (benzocaine, available OTC) may suffice. If not, local anesthetic (a dental injection) will be necessary.

Managing missing tooth parts.

Especially if your tooth is sensitive (like to hot and cold foods) or has sharp edges your dentist will fill in where your tooth has broken with a temporary dental filling.

Temporary fillings.

As explained above, a common choice is zinc oxide and eugenol paste (available OTC). As alternatives, a dentist may place something that is more esthetic (for front teeth) or has the ability to adhere to tooth structure (used in cases where restoration retention is expected to be a problem).

If they can't provide direct attention, a dentist will sometimes instruct their patient in how to place dental wax (available OTC) in their tooth's broken area as a temporary measure to alleviate both tooth sharpness and thermal sensitivity.

Your tooth will remain at risk.

Of course, even after a temporary repair has been made your tooth will remain fragile and vulnerable to further breakdown.

The tooth must be favored (like when eating) so pressure isn't applied that may damage it. As a way of helping with this, your dentist may trim your tooth down so it's slightly shorter (the tooth is "taken out of contact").


2) The tooth has cracked but no piece has come off or become mobile.

A tooth whose filling played a role in it cracking.

This tooth has cracked but no piece has separated off.

Short of outright fracture, a tooth may crack instead. Unfortunately, unlike with bones cracks in teeth don't heal.

In fact, once one has formed it may increase in size over time due to repeated exposure to biting forces. If it advances far enough, tooth fracture or nerve damage may occur.

a) Teeth that crack - Some pain or discomfort is involved.

Cracked teeth can be sensitive. When biting pressure is applied the portions of the tooth on each side of the crack will tend to shift (ever so minutely), which triggers a painful response.

Here are some of the classic signs of a cracked tooth:

  • The tooth gives a sudden sharp pain when you bite down.
  • The pain subsides immediately once the biting pressure has been released.
  • You may not feel the pain every time you close. Sometimes it takes biting or biting on something, at just the right angle, to trigger the response.
  • More than likely, you will not be able to visualize the crack or feel it with your tongue.

b) Teeth that crack - Little or no pain is involved.

Not all cracked teeth produce significant or consistent symptoms. In fact, it can be very difficult for a dentist to diagnose exactly which tooth lies at fault. It may take some time, including investigating on your own at home, to identify which tooth lies at fault.

  • Tooth cracks can be exceedingly difficult, if not impossible, to visualize. Dentists sometimes locate them by applying a dye that seeps in and makes them obvious.
  • "Cracks" that are obvious but produce no symptoms are often just tooth enamel craze lines that require no attention.
  • It's rare that a crack will show up on a dental x-ray. To be visible, the crack would have to lie in perfect alignment with the orientation of the x-ray machine's rays. While possible, this alignment rarely occurs.

How dentists repair cracked teeth.

There are a range of solutions that dentists use to treat cracked teeth.

Minor cases.

If your symptoms are just minimal, it's possible that your dentist may determine that your tooth requires little or no treatment. Sometimes just buffing the tooth down so it's a tiny bit shorter than its neighbors (so it gets less biting pressure) provides a lasting solution.

When more major repair is needed.

Especially in the case where your symptoms are persistent or severe, your dentist will need to provide some type of fix.

  • It's possible that placing a filling as a repair might suffice. This would be more likely in the case where the dentist feels they have identified the crack and anticipate that they understand its extent.
A dental crown placed over a cracked tooth.

A crown can splint a cracked tooth together.

  • Especially in the case where the crack can't be observed or the patient's symptoms are severe, the dentist may feel that a dental crown should be placed (so to splint the tooth together and prevent further cracking).

    This approach probably makes the safest and most predictable choice for treating a cracked tooth.

  • In some cases (typically those that are most painful), the dentist may determine that the crack reaches deep into the interior of the tooth and that root canal treatment is required before a dental crown can be placed.

    Or root canal may be needed because the tooth's nerve tissue has been too traumatized by its ordeal and not able to recover.

  • It's possible that even after placing a dental crown and performing root canal treatment that the tooth is so compromised that symptoms continue. If so, the tooth will need to be extracted.

How dentists manage and temporize cracked teeth.

Just as with broken ones, a dentist's initial treatment of a cracked tooth will be to attempt to alleviate the patient's pain and stabilize the tooth.

Reducing the tooth.

In cases where symptoms are relatively minor, the dentist may just buff the tooth down so it receives less biting pressure.

Doing so can provide enough relief for the tooth that its symptoms subside. It also helps to reduce the risk that further damage will occur.

Temporary restoration placement.

When symptoms are severe, the dentist may feel that they need to place some type of restoration promptly.

  • They may remove the tooth's permanent filling and place a temporary one. As explained above, if the type selected has sedative properties it may help the tooth to settle down and even avert pulp tissue (nerve) damage.
  • In other cases the dentist may feel that the tooth requires the protection of a crown promptly. If so, they may begin the crowning process so a temporary one can be placed immediately.
Anti-inflammatory medications.

As discussed above, a dentist may recommend taking a NSAID medication. Doing so can both help to control the patient's pain and be instrumental in helping their tooth's nerve to recover from the insult it has received.

Allow your tooth some rest.

No matter what treatment has been provided, giving your tooth some rest will almost certainly be recommended.

Continually testing your tooth may only serve to damage or aggravate it further. Simply staying off your tooth may substantially increase the odds that your tooth's traumatized nerve will be able to recover from its ordeal.

 

 
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