Cracked Tooth

What to do if the tooth cracked (fractured), chipped, broken

1. If there is bleeding at the gums, and the tooth is still in place, use clean tissue or cotton to apply pressure on the gums to stop bleeding immediately, before seeing the dentist.  Do not touch the broken, fractured tooth.

2. If the tooth partially comes out of the socket, and you have access to the dentist, don't try to push the tooth back into the socket yourself.  Place the cotton rolls or something similar on the other side of the mouth to hold the jaw apart.  Don't rinse your mouth.

3. If the tooth is completely out of the socket; stop the bleeding by compressing the wound with sterile gauze or clean tissue.  Find the tooth and wrap it in a wet cloth.  See the dentist immediately. Apply Anbesol at the gum area will relieve some pain.

4. If only part of the tooth fractured, and a fractured piece came out, find the broken tooth fragments and wrap it in the wet cloth. The dentist may be able to glue them back together.

5. If the tooth has minor chips and no other symptom, but the roughness, place temporary filling such as DenTek Toothache Kit on the rough area by following manufacturer instruction. If you can't find any temporary filling, use orthodontic wax instead.  See a dentist so that the dentist can smooth the roughness as soon as possible.

6. If the tooth cracked and no symptoms, observe if there is any delayed symptom in few weeks.  If you experience some sensitivity, you may need to have a crown to prevent the tooth from further damage.

How do you know if you have cracked tooth

Here are some symptoms and signs of a fractured tooth:

• An abrupt start of mild to extreme discomfort or sensitivity usually to cool and high temperature
 
• The most consistent symptom of a cracked tooth is a pain response to pressure, whether from biting, chewing or from a diagnostic percussion by a dentist. It may be painful for a short time and only if you chew in a particular way.
 
• In a fractured hairline tooth, the pain sensation is alleviated or vanished once the damaged tooth is not being used.
 
• History of chewing on the hard object  (popcorns, sand, seeds, and so on) prior to having discomfort, i.e., pain, sensitivity.
 
• Your tooth seems to shift on slight force
 
• An abrupt start of discomfort/pain or sensitivity on the tooth that has gone through root canal therapy without having a crown (cap)
 
• If the tooth fractured without having a lot of discomforts for an extended time, the infection might develop in the gums around the broken tooth or the root tip. It will eventually show up as a little bump.
 
• Pain in a particular tooth as a result of grinding your teeth at night.
 
• Involving in an accident that has an impact on the teeth, for example, a collision to the face,  falling off the bike facing down, a punch to your face, etc.

In contrast to bone fractures, broken teeth won't recover, in spite of treatment, some cracks may continue to progress and split the tooth into two parts. It is crucial to seek treatment from the dentist as early as possible. In some instances, the tooth can be saved, when the crack hasn't gone too deep. Meanwhile, you should:

• Avoid applying pressure to the tooth
• Consume soft meals or soups
• Drink only warm fluid using straw

What causes chipped or fractured tooth

1. The underlying decay weakens tooth structures and causes part of the tooth to chip off
2. Excessive tooth grinding during stress or sleep can fracture the tooth
3. Malocclusion and fail to replace the extracted posterior tooth, result in tooth shifting towards space.  The upper and lower tooth occlude in an incorrect angle, causing tooth fracture
4. Extensive filling
5. large decay
6. Bite on a hard object like rock, shells, ice, bone or bottle 
7. Root canal treated tooth

What will the dentist do

The fact that there are various degrees of cracks and not all are obvious through the visual exam and x-rays, made it difficult for the dentist to diagnose them.  Some cracks are apparent, and some hairline cracks are difficult to determine.

The dentist may have to incorporate different tools during the initial examination to detect hairline cracks. Some of the diagnostic tools used are tooth percussion (pain response to an application of pressure), and sequential stimulus tests using cold and heat.

Tools used to detect cracked tooth are:

1. Intra-oral camera - The camera magnifies the cracked line so it will be apparent
2. Microscopes - high magnify glasses
3. Transilluminator, i.e., Fiber optic light, composite curing lights
4. Explorer - a sharp instrument tip to feel cracked line
5. Bite stick - use a stick to replicate the symptom, simple procedure but may cause pain and make the symptom worse
6. Stimuli such as hot and cold to the suspected tooth
7. Visual inspection with unaided eyes
8. Stain applied to the suspected tooth

A therapeutic approach to the fracture by the dentist based on the degree of the fracture are:

1. For a small chip, the dentist may smooth the rough surface without doing any filling
2. The dentist might recommend filling or bonding if the enamel broke off, but the dentin is still intact, and the pulp and nerves remain undamaged.
3. Crown (cap) or onlay if the fracture is shallow and located on the outer surface of the tooth involving a dentin, and you only feel sensitive or very minimal pain.
4. Root canal treatment and crown, if the fracture is deep, and the damage extends to the nerve and pulp tissue in the pulp chamber.
5. Extraction of the tooth,  if the fracture is deep, and the damage extends to the nerve inside, and part of the tooth structure breaks off beyond repair under the gum line. 

Often, a general dentist is unable to identify a fractured tooth.  It is wise to seek consultation with an endodontist who specialized in root canal treatment, and would be better qualified to arrive at a conclusive diagnosis. To locate an endodontist near you, click here.