Select Your Current Condition:
- Minor Fracture
- Fracture Moderate
- Severe Fracture
- Sharp Pain When Chewing
- Broken Filling, Crown or Braces
Intro
RULE OUT:
Aspiration of Fragment
Tooth Nerve Exposure
Mobility > 2mm / Tooth Out Of Position
It’s Usually Multifactorial
Consider these pre-existing conditions which may have weakened your tooth before it broke:
- Previous accident or trauma to your mouth
- Habitual grinding & clenching at night or during the day
- Teeth that have lost a significant portion of structure through aging, acidic breakdown, wear, or decay
- Old outdated dental fillings: ie worn, leaky or broken down
- History of a Root Canal (therapeutic access to roots weakens the coronal tooth)
- Poor quality or quantity of remaining tooth structure needed to retain a crown or filling (tooth ferrule)
- Exposing tooth enamel to extreme changes in temperatures, such as eating hot food and drinking ice water
- Daytime Oral Habits (Parafunctional habits) like clinching and chewing on objects i.e. ice, pens, nuts, finger nails, lip biting etc.
- A bad unbalanced bite
In all cases, rinse your mouth with warm water to keep the area clean. If needed, place a cold compress on your face to reduce any swelling. Call our office as soon as you can.
The amount of missing tooth structure will determine the extent of treatment needed. Regardless of the damage, treatment should always be determined after receiving a consultation at our office.
In all of the following examples, it is not normal to experience night awakening with continuous throbbing tooth pain. It is also not normal to experience continuous throbbing pain which is a result of chewing force and/or cold stimulus. Please note the key words which are; continuous and throbbing pain. If you experience this type of pain, please call our office, you may have indirectly damaged the nerve of the tooth and may need root canal therapy to save your tooth.
#1 Minor Fracture
(Sm – Medium Chip)
Minor fractures can be smoothed by Dr Landers with a sandpaper disc or simply left alone. Another option is to restore the missing tooth structure with cosmetic Bonding. In either case, a few days of tooth sensitivity after tooth trauma is normal.
If you have rough or sharp edges which are cutting your cheek or tongue and you are unable to get to our office. You can use orthodontic wax to cover. Do not smooth or alter a sharp tooth which your dentist has already shaped for a final restoration such as an Onlay.
Patient is to keep area rinsed with water or saline to keep free of debris until dental visit.
Real Patient Treated by Dr Kevin Landers
Related Links
Chipped Tooth Repair Before & Afters
#2 Fracture Moderate
(>25% of visible tooth)
Moderate fractures include damage to the enamel, dentin, and/or pulp (tooth nerve). If the pulp is not permanently damaged, the tooth may optionally be restored with cosmetic bonding, veneer, cosmetic crown or onlay. If dental nerve damage does occur, further dental treatment will be required.
CLINICAL PRESENTATION IF YOU HAVE DENTIN EXPOSURE
- Pinkish or yellowish inner dentin tooth structure exposed vs. more white outer enamel.
- Sensitive to hot, cold, air or touch
CLINICAL PRESENTATION IF THE NERVE IS EXPOSED:
- Drops of blood visible or red blush of dentin in the center of the tooth.
- Tooth may be extremely painful or in shock (no sensitivity)
its important to note that the tooth nerve can be damaged and need root canal therapy even it the nerve is not exposed. For this reason, even after the tooth is definitively repaired, you should follow up and keep regular dental visits for years to come. This will allow the dentist to watch the traumatized tooth.
If tooth fragments are loosened (but still attached) they may still be causing pain. Do not attempt to remove the fragment. Avoid the area of the tooth fracture. Rinse the area with warm water or saline to keep area free of debris until your dental visit.
Often patients will think their tooth simply fractured from chewing pressure and will not realize that bacterial decay has invaded the understructure of the tooth. The subsequent weakened tooth structure is in many cases the reason for the fracture. If the missing tooth is filled with temporary “OTC” (over the counter) filling it may lock in bacterial and may serve little benefit. A temporary can also lead to a false sense of security and a delay in needed professional treatment.
Don’t chew food in the area of the missing filling. Food impaction can result in gum tissue infections.
Rx: See: “Rx Over the counter for Pain” under “post-visit Emergencies”
Visit our office ASAP (24-48 hours)
#3 Severe Fracture
(Sharp Pain With Pressure)
Severe fractures often mean a traumatized tooth with a slim chance of recovery. These types of Fractures are vertical with a direction towards the root.
If the vertical fracture is slightly below the bone, Dr Landers can save the tooth and perform a minor gum contouring surgery. This gum contouring is performed to expose sound tooth structure below the crack so that a crown can cover, and protect the area of the missing tooth structure.
If tooth fragments are loosened (but still attached) they may still be causing pain. Do not attempt to remove the fragment. Avoid the area of the tooth fracture. Rinse the area with warm water or saline to keep area free of debris until your dental visit. Also note that splinter sized tooth fragments may have made their way under the gum tissue during the traumatic incident.
Worse case scenario:
If the vertical fracture is too deep and/or involves the root of the tooth, the prognosis is not favorable. In this situation, Dr Landers will replace the broken down tooth root with a man made root. This procedure is completed at our office in one visit. Dr Landers also uses a modern day dental computer which will determine if he can immediately place a dental temporary on the man-made root. An advantage of man-made roots is they don’t brake.
In either case, fractures may include damage to the enamel, dentin, and/or pulp (tooth nerve). If the pulp is not permanently damaged, the tooth may optionally be restored with a full permanent crown or Onlay. If pulpal damage does occur, further dental treatment will be required.
CLINICAL PRESENTATION IF NERVE IS EXPOSED:
- Drops of blood visible or red blush of dentin in the center of the tooth.
- Tooth may be extremely painful or in shock (no sensitivity)
Often patients will conclude that their tooth simply fractured from chewing pressure alone and will not realize that bacterial decay has unknowingly invaded the understructure of the tooth. Unsupported tooth structure which is undermined by decay is prone to fracture.
Please be careful, if the missing tooth is filled with temporary “OTC” (over the counter) filling it may lock in bacterial and may serve little benefit. A temporary can also lead to a false sense of security and a delay in needed professional treatment.
Don’t chew food in the area of the missing filling. Food impaction can result in gum tissue infections.
Rx: See: “Rx Over the counter for Pain” under “post-visit Emergencies”
Visit our office ASAP (24-48 hours)
#4 Sharp Pain When Chewing
(Crack Tooth Syndrome)
When you bite down you feel sharp pain.
It quickly disappears and perhaps you ignore it. You avoid certain foods or chew on one side of your mouth. Does this sound familiar?
You may have a cracked tooth.
A crack may appear as a hairline size fracture, possible running vertically towards the root of the tooth. A crack often is not detectable to the visual inspection and may not show on an x-ray, for these reasons diagnosis is difficult. At our office we use fiber optic light technology to illuminate tooth cracks on a computer screen. “See what the doctor sees.”
Please remember, dental pain is poorly localized. Pain may refer to opposing arch but does not cross midline. It is often difficult to identify the offending arch and even more difficult to identify the offending tooth. For this reason, it is useful if you decide to help us determine which tooth may be causing the problem. Our suggestion is to note when and where you have sensitivity to heat or cold, to sweet, sour or sticky food and approximately where the pain is when you are chewing. Don’t just assume you know the location or tooth! Starting from the last tooth in the back of your mouth, progress forward until you locate the actual teeth for which you sense tenderness or pain. Make a mental note and remember the count from the back of your mouth.
A cracked tooth may hurt because the pressure of biting causes the crack to open. When you stop biting, the pressure is released and a sharp pain results as the crack quickly closes. This pain upon release of biting pressure is characteristic of “cracked tooth syndrome” and you should let us know if you experience this symptom.
Even though the crack may be microscopic, when the crack opens, the pulp (living tissue) inside the tooth may become irritated. If the crack irritates the pulp, the tooth will likely become sensitive to temperature extremes. Subsequently, the pulp may become damaged or diseased with invading bacteria. Root canal treatment may be necessary to save the tooth.
Depending on the size and location of the crack, Dr Landers may restore the tooth with bonding, an Onlay, or a crown. A severely cracked tooth may need extraction. Dr Landers will conservatively advise you of the best treatment options.
Tiny cracks are common and usually do not cause problems. Often, Dr Landers will make notes if cracks are around old dental fillings, since these are more likely to cause future problems. Regular dental checkups are important. They allow our dental team to diagnose and treat problems in the early stage. If you continue to have pain, avoid chewing on that side of your mouth and give us a call.
#5 Broken Filling, Crown or Braces
Poor quality or quantity of remaining tooth or a history of worn, leaky and/or broken down old dental fillings is usually the cause of a broken filling. Our philosophy is to advise our patients to replace old broken down fillings before tooth fracture results. Generally speaking, we use fiber-optic dental handpiece technology. The fiber-optic light at the tip of the dental handpiece allows for more accurate filling replacement and nominal healthy tooth removal when fillings are being updated.
Broken Porcelain Restoration:
Dr Landers does not recommend any form of permanent Porcelain repair.while we use the best materials and techniques, in most situations, porcelain repair is a temporary fix.. The good news is, most of the time, the porcelain restoration can be smoothed and reshaped and therefore do not need to be replaced.
Moderate fractures include damage to the enamel, dentin, and/or pulp (tooth nerve). If the pulp is not permanently damaged, the tooth may optionally be restored with a full permanent crown or Onlay. If pulpal damage does occur, further dental treatment will be required.
CLINICAL PRESENTATION IF DENTIN EXPOSURE
- Pinkish or yellowish inner dentin tooth structure exposed vs. more white outer enamel.
- Sensitive to hot, cold, air or touch
Before your filling broke, there is a good chance the filling was loose. A loose filling has the potential to wedge your healthy tooth structure and cause fractures of unsupported tooth walls. If this is the case you may notice the loosened (but still attached) fragments may be still causing pain. Do not attempt to remove the fragment. Avoid the area of the tooth. Rinsed the area with warm water or saline to keep area free of debris until dental visit.
Often patients will conclude that they only lost a filling because of chewing pressure alone and will not realize that bacterial decay has unknowingly invaded the understructure of the filling. Unsupported tooth structure or dental fillings which are undermined by decay are prone to fracture.
If the missing filling is replaced with temporary “OTC” filling and decay is in fact present, it may lock in the bacteria. Furthermore, the temporary may serve little benefit. A temporary can also lead to a false sense of security and a delay in needed professional treatment.
BROKEN BRACES AND WIRES
If a broken appliance can be removed easily, take it out. If it cannot, cover the sharp or protruding portion with cotton balls, gauze or chewing gum. DO NOT remove it. Take the child to a dentist immediately. Loose or broken appliances that do not bother the child usually do not require emergency attention.
Don’t chew food in the area of the missing filling. Food impaction can result in gum tissue infections.
Rx: See: “Rx Over the counter for Pain” under “post-visit Emergencies”
Visit our office ASAP (24-48 hours)
