Crunch, crack, snap. Regardless of the sound it makes, it is still a scary moment. You have now broken your tooth and a million thoughts are running through your head. What just broke? Is that my tooth? Was that a piece of food? How much did it break? Does it hurt? Does the tooth have to be pulled? Will I be toothless? Can the tooth be fixed? How will they fix it? What will it look like? Will it be ugly? These questions are just a small sample size of all the things you will be asking yourself in the moment. Here’s how we address a chipped tooth:
Chip, Crack, Fracture, Break. What’s the difference?
Teeth can chip, fracture, and break. There is no exact scientific delineation between all three of these situations, but all should be repaired or addressed. Chipped teeth are usually small and require a small filling or recontouring of the tooth to smooth out the chip. Sometimes chips are too large or the shape of the teeth doesn’t allow for them to be simply smoothed out.
Fractures of teeth happen on a frequent basis. Negative habits such as clenching and grinding of the teeth, chewing on ice, etc can result in stress lines (called craze lines) and cracks in the teeth that make it a high risk of fracture. It is important in these situations that the problems be identified by a dentist and addressed to help avoid or postpone a fracture.
Evaluating the Chip
Some things that are evaluated when someone comes in with a chipped or broken tooth is:
- Where did it break? Some areas of the teeth are easier to fix than others. For example, chipping an area that is in between the teeth can have a better prognosis than chipping an area on a chewing surface. Chipping and fracturing of a front tooth on a chewing surface can be fixed by a filling, but it is also hard to get the filling to stay long term. Think of the extreme forces that are placed on that tooth or filling when you bite into a baby carrot. There is also nothing to retain the filling in place other than the filling adhesive.
Breaking a tooth on a biting surface is better repaired with a crown for long term stability of the tooth than a filling. Crowns are much more solid and are better equipped for retention on the tooth than a filling. Breaking a tooth on the root always means that the tooth needs to be pulled as an infection will soon set in.
- How much did it break? There are too many rules regarding how much and where a tooth breaks and whether a filling or crown is necessary for me to try and explain it today. The general rule is that if over 30-50% of the tooth breaks than a crown must be done. However, as previously explained, a break in the wrong area of a much smaller percentage also requires a crown. We also look at whether the break is deep below the gums or superficial. When a break is too deep below the gums, the tooth is usually pulled because it can’t be saved.
- Did it expose the nerve? A deep fracture can expose the nerve of a tooth. This doesn’t mean that the tooth can’t be saved. It means the tooth requires a root canal and a crown to save it.
- Was the tooth already treated with a root canal? If the answer is yes, then the tooth might not be savable as these fractures can be catastrophic. If you are lucky and the fracture is not catastrophic, then it is important to get a crown on the tooth before it becomes such.
Let’s go over a case where the patient came in and suffered a significant sized fracture of his front tooth. The fracture was above the gum line and did not expose the nerve. The percentage of the fracture was around 20%. However, the area that he fractured is on a biting surface that has a low long-term probability of retention and therefore a crown was suggested. The patient explained how he was just in town for today and was leaving tomorrow to head on a long road trip, so a crown was not able to be done. We decided that for the short term, a filling would have to be done. It was important with this filling that the bottom front teeth didn’t touch the back of the filling when the teeth come together. This would apply stresses that would pop the filling off over time.
The filling had turned out quite nicely from a cosmetic standpoint. We were able to shade match the filling to the tooth quite nicely. The shape and contour of the tooth were able to be restored so it looked normal and natural. The patient left happy and so did I, but he was reminded to take it easy on the tooth and to get in for a crown as soon as possible.
If this has happened to you, give a call to schedule your appointment to fix it.