Dental fractures can easily happen to anyone without any major accident, and can range from minor to severe.
A minor fracture could involve chipping of the outer tooth layers called enamel and dentin. A severe fracture could involve 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 living tooth tissue called the pulp.
The portion of the tooth that is visible in the mouth is called the crown and is only a part of the entire tooth structure. The remaining portion of the tooth is buried in the bone and is called the root.
Risk factors for dental fractures
Tooth fractures are more common in older adults because teeth wear down over time. However, people of all ages can experience a tooth fracture.
The factors that may increase the chances of tooth fractures include:
- Teeth with current tooth decay or damage
- Teeth that have been restored with silver alloy
- Chewing on hard foods like hard candy or ice
- Collision sports like hockey and football
- Teeth that are exposed to temperature extremes within a short time period
- Teeth grinding and jaw clenching
Dental fracture diagnosis
To help locate the fracture or determine the extent of the fracture, your dentist may do the following tests:
- Dye staining; a solution is put on the tooth to help see the crack
- Transillumination; passing a light through the tooth
- Periodontal probing; using special tools to look for the extent of crack
- Bite test; you will be asked to bite down on a stick to find the specific tooth causing problems
- X-ray; to look for certain defects, since not all fractures can be seen on x-ray
Treatment for dental fractures
Teeth cannot heal, therefore, if the tooth is fractured it will not regrown or heal by itself.
An early diagnosis may help save the tooth before the fracture progresses and causes any further damage. The treatment goal is to protect the tooth and the pulp interior.
Your treatment will depend on the severity of damage to the tooth. Options may include:
- Gluing the fragment of tooth back on
- Composite bonding. This is when a plastic resin is used to fill the crack. Unlike crowns or veneers, composite bonding does not require any of the healthy parts of the tooth to be removed during treatment.
- 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.
- Crown. A cap is placed over the tooth. A temporary crown will be placed at first to make sure it corrects the problem. A permanent crown will eventually be placed.
- Dental Veneer. A thin covering that is placed over the tooth if you have small chip in the surface.
- Root canal. This treatment may be needed if there is severe damage to the pulp. A root canal clears out the damaged pulp and places a new filler in the tooth.
- Tooth extraction. The tooth may need to be removed if the crack extends below the gum line.
- Removal of the fractured portion. This may be possible in a vertical root fracture.
What should I do if I have a cracked or chipped tooth?
A minor tooth fracture usually involves chipping of the enamel only. The tooth is not displaced out of its position and there is no bleeding from the gums. The only symptom of such minor chipping may be sharp or rough tooth edges that irritate the cheek and tongue. The injured tooth itself may not be painful or sensitive to food or temperature. The risk of pulp injury is low and treatment is usually not considered urgent. However, you should still see a dentist as soon as possible, even if you think the damage is minimal. Your dentist will assess the severity of the damage and explain your options for treatment.
Depending on the amount of enamel lost, definitive treatment usually involves placing a dental filling or a crown to restore the tooth to normal contour.
What should I do if I have a more serious dental fracture?
A deeper fracture can involve both the enamel and the dentin of a tooth. Even though a deep fracture is present, the tooth may not be displaced or out of position and the gums may not be bleeding.
These deeper fractures may be sensitive to changes in temperature, chewing, or biting. Prolonged exposure of dentin leaves the tooth vulnerable to decay that can advance rapidly.
Therefore, fractures involving the dentin are treated promptly. Treatment involves placing a dental filling or a crown. Unless there are continuing symptoms of pain, the tooth can be monitored with routine dental x-rays to ensure that the tooth is healthy.
If a fracture has significantly injured the pulp, then treatment involves either extraction of the tooth or root canal treatment.
Extraction is indicated if the tooth has been significantly weakened by the fracture and its form and function cannot be properly restored.
If the tooth's form and function can be restored, root canal treatment is performed to prevent infection. This procedure involves removing all the dying pulp tissue and replacing it with an inert material in order to keep infection out.
Once the root canal treatment is complete, the tooth can be restored with a filling or crown.
What is the treatment for a displaced tooth?
Instead of being completely knocked out of the mouth, a tooth can be displaced into another position. In the mouth, a displaced tooth may be pulled out and appear elongated, or be pushed in and appear shorter. A displaced tooth can also be pushed forward, backward, sideways, or rotated.
The sooner the dentist can splint or realign the tooth with orthodontic brackets and wires, the easier it can be brought back into proper alignment.
Trauma significant enough to cause tooth displacement can also lead to pulp injury. As a result, a displaced tooth should be evaluated periodically for several months to determine if a root canal procedure or tooth extraction is needed.
Examples of dental negligence in fracture treatment
Your dentist may make the following mistakes that could constitute a negligent treatment:
- Failure to take a full history as to what happened and properly examine the patient. This is essential in order to evaluate the seriousness of the tooth fracture and help to decide on the appropriate treatment options.
- Failure to discuss all available treatment options, including the risks associated with the treatments proposed.
- Depending on the treatment option that has been chosen, a failure to arrange a follow up in order to monitor the healing process. This is particularly important if the tooth has been left to heal and requires periodical visits to the dentist in ordered to evaluate the progress.
- Failure to carry out the chosen treatment, such as filling, crown, veneer and/or root canal, according to the reasonable standards of care. Please see the articles related to these dental treatments for more information.