A fractured tooth crown, even when the root remains intact, requires immediate professional attention. The visible tooth structure (clinical crown) is compromised, exposing delicate underlying tissues to the oral environment. Prompt action maximizes the chances of successful restoration, prevents infection, and minimizes long-term complications. The initial response significantly influences the available restorative options.
Immediate Steps for Managing the Injury
If the broken tooth fragment is located, pick it up carefully, avoiding the fractured surface. The fragment must be kept moist to prevent dehydration, which compromises successful reattachment. Store the fragment in milk, saline solution, or saliva during the trip to the dentist. Control any bleeding from the gum tissue or fracture site by applying light pressure with sterile gauze or a clean cloth. To manage discomfort and swelling, take over-the-counter NSAIDs (like ibuprofen) if safe, and apply a cold compress to the exterior cheek for ten-minute intervals. Contacting a dental office immediately is essential, as prompt treatment often yields the best prognosis.
Understanding the Severity of the Fracture
Fracture severity depends on how deeply the break penetrates the layers of the tooth structure. The outermost layer is the enamel, a hard, protective tissue. Beneath the enamel is the dentin, a softer, yellowish layer that contains microscopic tubules leading directly to the pulp chamber.
A fracture involving only the enamel is generally the least severe, primarily posing an aesthetic and minor sensitivity concern. When the fracture extends into the dentin, the exposed tubules cause increased sensitivity to temperature and air, requiring immediate sealing to prevent bacterial ingress.
The most serious type is a complicated fracture, where the break reaches the pulp chamber containing the nerve and blood vessels. Pulp exposure introduces bacteria directly into the innermost, living tissue of the tooth, necessitating rapid intervention to prevent irreversible damage and infection. The promptness of treatment impacts pulp viability and determines if simple repair or extensive nerve treatment will be needed.
Dentist’s Diagnostic Procedures
The professional begins with a thorough clinical and radiographic assessment to precisely determine the extent of the damage. A visual examination involves probing the fracture line and evaluating surrounding soft tissues, such as the gums and periodontal ligaments, for concurrent injuries. The dentist may use transillumination (a specialized light source) to reveal the full length of the fracture line, which is sometimes invisible.
X-rays are taken to confirm the root structure remains intact and to rule out fractures extending below the gum line or into the jawbone. These images also help identify any displacement of the root or surrounding bone loss that might not be clinically apparent. Pulp vitality testing uses cold, heat, or an electric pulp tester to assess the nerve tissue’s responsiveness. This test determines if the pulp has been damaged or is experiencing reversible shock from the trauma.
Restorative Treatment Options
Treatment depends on the fracture depth and the health of the underlying pulp tissue. If the fracture is small and confined only to the enamel, the tooth can often be restored aesthetically using composite resin bonding, a tooth-colored material sculpted directly onto the tooth surface. For slightly larger fractures involving dentin without pulp exposure, bonding is still viable, but the dentin must first be sealed to prevent sensitivity.
If the original tooth fragment was preserved and the fracture line is clean, it can often be reattached using specialized dental adhesives. This technique offers the best aesthetic outcome by restoring the tooth with its natural material. Extensive fractures, or cases where reattachment is not feasible, may require a custom-fabricated veneer or a full crown to restore shape, strength, and function.
Addressing Pulp Exposure
If the trauma resulted in a complicated fracture with pulp exposure, the professional must address the exposed nerve tissue. For a very minor exposure and immediate care, the dentist may perform a pulp capping procedure, covering the tiny exposure with a medicament to encourage healing. If the exposure is larger but the pulp is still considered healthy, a partial pulpotomy may be performed, removing only the superficial, damaged portion of the pulp. If the nerve tissue is confirmed to be irreversibly damaged or infected, full root canal therapy is necessary. This procedure removes all pulp tissue, sterilizes the interior, and seals the tooth before a final restoration is placed.