A broken tooth is a common experience that raises the question of whether it can be repaired with a filling. The answer depends entirely on the extent of the damage, specifically how deep the fracture extends into the tooth’s structure. Teeth are composed of three layers: the hard outer enamel, the softer underlying dentin, and the innermost pulp chamber containing nerves and blood vessels. Treatment shifts based on which of these layers is compromised by the break.
Assessing the Damage: When a Filling is Possible
A broken tooth can be successfully treated with a filling or cosmetic bonding when the damage is minor and confined to the outer layers. Small chips or fractures, often called craze lines or simple enamel fractures, are the most straightforward to repair. These breaks involve only the enamel and typically do not cause pain or sensitivity, though they may feel rough.
Repairs involving the dentin layer, which lies beneath the enamel, can also be candidates for a direct restoration, provided the fracture does not extend too deeply. Dentin contains microscopic tubules that lead directly to the pulp, and exposure can cause sensitivity to hot or cold temperatures. Dentists use composite bonding, applying a tooth-colored resin material directly to the prepared surface. This resin is molded to restore the original shape and sealed with a high-intensity light, effectively replacing the missing structure.
The success of a filling hinges on the fracture remaining away from the internal pulp tissue. If the dentin layer is thick enough to protect the pulp from bacteria and temperature changes, a bonded restoration is a durable solution that restores function and appearance. This approach is reserved for small breaks that do not compromise the structural integrity of the tooth.
Beyond a Filling: When Structural Restoration is Required
When a significant portion of the tooth crown breaks off, a simple filling or bonding material may not provide the strength to withstand chewing forces. The remaining tooth structure is too weak to support a large direct restoration, even if the pulp is not involved. Treatment shifts from replacing the missing piece to covering and protecting the entire remaining tooth structure.
A dental crown, often called a cap, is the standard solution for this level of damage. The dentist prepares the remaining tooth by trimming it down to create a stable foundation, and a custom-made crown is cemented over the top. This crown completely encases the tooth, distributing chewing forces evenly and preventing the fracture from spreading further.
For fractures affecting the front teeth, a porcelain veneer may be used if the damage is confined to the visible surface. A veneer is a thin, custom-made shell bonded to the front of the tooth, which conceals the damage and restores the tooth’s shape. Both crowns and veneers provide a full-coverage restoration, offering long-term strength and protection that a large filling cannot match.
Addressing Severe Breaks and Pulp Involvement
The most serious breaks occur when the fracture extends deep enough to expose the dental pulp, the soft tissue containing the nerve and blood supply. This exposure allows oral bacteria to enter the tooth, leading to infection, often signaled by severe pain or heightened sensitivity. A filling is no longer a viable option because it cannot treat the internal infection.
The procedure necessary to save the tooth is root canal therapy. During this treatment, the infected or damaged pulp tissue is removed from the interior chambers of the tooth. The canals are then cleaned, disinfected, and sealed with an inert material called gutta-percha to prevent reinfection. Following a root canal, the tooth becomes brittle, making a full-coverage crown necessary to protect the weakened structure from fracturing.
In the most extreme cases, such as a vertical root fracture that extends below the gum line, the tooth may be unsalvageable. A complete split or a fracture that deeply compromises the root structure necessitates extraction, as there is no reliable way to prevent the spread of bacteria or repair the foundation. The missing tooth can then be replaced with a dental implant or a bridge.
Immediate Steps and Long-Term Protection
While waiting for a dental appointment, taking immediate action helps manage discomfort and protects the tooth from further damage. First, gently rinse your mouth with warm water to clean the area and remove debris. If there is bleeding, apply light, steady pressure with clean gauze.
To manage pain and swelling, a cold compress or ice pack applied to the cheek near the affected area provides relief. If the broken edge is sharp and irritating the tongue or cheek, temporarily cover it with dental wax, which is available at most pharmacies. Also, avoid chewing on the broken tooth and stick to soft foods to prevent worsening the fracture.
Long-term protection focuses on preventing recurrence of trauma. If the break was caused by a sporting injury, using a custom-fitted mouthguard absorbs impact and cushions the teeth. Preventing future breaks also involves avoiding habits like chewing on hard objects such as ice or pens, and seeking treatment for bruxism, or teeth grinding, which can be managed with a nightguard.