Broken or fractured tooth? What to do, treatment options and prevention

Have you fractured or broken a tooth? However careful we are, it can happen to anyone, whether from eating very hard food, falling off a bike or neglecting a cavity.

Don't worry: in this article you will find out what to do immediately after the injury and the many ways a broken or fractured tooth can be repaired.

In most cases, a fractured tooth always causes panic, especially if it is a visible front tooth. The first thing to do is stay calm. Nowadays almost any type of dental fracture can be repaired effectively and often non-invasively.

The cause of a fractured tooth is often traumatic: facial injuries, bruxism (teeth grinding), sports that expose us to accidents, very hard foods, or habits such as chewing pens or biting nails. However, fractures are not always of this kind. If the tooth is particularly weakened by decay, it can in fact break down.

When the injury is not serious, the patient feels no pain either at the time or afterwards. If, however, the tooth has suffered a serious fracture involving the dental pulp, the patient can expect to feel pain, because the nerve is affected by exposure to external factors. If the pain is very severe, we recommend taking painkillers or anti-inflammatories (ideally following your doctor's advice).

When a tooth breaks, cracks, chips or snaps, you should see your dentist as soon as possible. This is because, with a more serious injury, there is a risk that the pulp becomes infected and that, over time, this leads to the loss of the tooth. Also, if the tooth breaks, it can injure and cut the tongue or lips.

Here are some practical tips to follow before you go to the dentist:

• Rinse your mouth straight away with warm water or salt water to reduce inflammation and keep your mouth clean.
• If there is bleeding, apply gauze and press until the bleeding stops.
• To prevent swelling and possible pain, apply ice to the outside of your mouth.
• In the meantime, eat only soft foods and do not chew with the damaged tooth.
• If you find the broken fragment of tooth, rinse it with water and keep it in a glass of saline or water so that it does not dry out until you reach the dental clinic. In some cases, it can be bonded back in place.

There are many types of dental fracture and each requires different dental treatment:

• Minor cracks – These are superficial cracks that affect only the white outer surface of the tooth, called the enamel. They rarely need treatment, but sometimes the dentist may lightly polish the area to smooth out any rough spots.
• Chipped tooth – This type of fracture affects the whole tooth, from the chewing surface down to the nerve, and gradually extends. In this case, a special composite material is used to rebuild it. If the dental pulp is damaged, root canal (endodontic) treatment may be needed.
• Cusp fracture – The cusp is the pointed tip of the tooth, which can be damaged. These cases rarely cause pain. Treatment mainly targets the appearance of the affected tooth and aims to restore its shape with veneers or dental crowns.
• Serious fractures – In this case the dentine and nerve may be exposed, and the patient usually feels very severe pain and suffers from tooth hypersensitivity. The tooth usually bleeds because the internal capillaries are also damaged. The most suitable treatment is root canal treatment or, in the most serious cases, fitting a dental crown.
• Vertical fractures – These are cracks that start at the base of the tooth and extend vertically up to the chewing surface. They are often painful because the area around the base can become inflamed or infected. In most cases the tooth will need to be removed, and it can be replaced with a dental implant or a dental bridge.
• Fracture caused by extensive decay –  In this case the tooth breaks because decay has weakened it. The dentist will assess the situation and suggest the best treatment to restore the tooth. In some cases, if the cavity is very large, the tooth may need to be removed, and it can be replaced with a dental implant or a dental bridge.

The tips listed above should be seen as temporary remedies, to be used only until you see the dentist. There are, however, many options the dentist can consider for fractured or broken teeth:

• Dental filling: if the damage is limited to a minor, visible fracture that does not involve the nerve, a composite filling will be enough. This treatment restores the original appearance of the tooth.
• Dental veneers: another viable option for a fractured tooth is to cover it with a veneer. Veneers are usually used when a front tooth is fractured. It is a very good solution, especially as it is not an invasive treatment.
• Dental crowns: if the damage is more serious, to the point where very little of the tooth structure remains, there is only one solution: a dental crown. How is it done? The dentist prepares the tooth, takes a digital impression with the dental scanner and fits a temporary crown, all in the same appointment, so the patient does not have to put up with any aesthetic or functional discomfort. A full zirconia crown is then made in the clinic using CAD CAM technology; zirconia is a biocompatible, bioinert material that does not cause allergic reactions, with unquestionable strength and aesthetics. The crown is then cemented onto the tooth and adjusted to the bite, replacing the temporary one.

Because prevention is, and always will be, the most pleasant treatment, here is what you can do to prevent dental fractures:

• avoid very hard foods; instead of biting into an apple, cut it into small pieces;
• if you know you suffer from bruxism, ask your dentist for a custom night guard; 
• stay away from activities that could lead to facial injuries;
• protect yourself when playing sport, again with a custom mouthguard or suitable protective equipment;
• don't ignore dental fractures, even if it seems like “just a chip” – they do not heal on their own and, on the contrary, can get worse extremely quickly, which automatically means higher costs.