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Fractured Teeth and Tooth Injuries Throughout the lifetime of a tooth, it is exposed repeatedly to tremendous chewing forces which ultimately over time can lead to tooth injury, namely tooth fracture. A fractured tooth may display many different symptoms ranging from pain upon chewing, to temperature sensitivity, to a throbbing or dull toothache, or a sharp pain that is unprovoked. It is often true that the patient can not pinpoint which tooth is the source of this discomfort, and the pain might come and go. It is very important that when these symptoms arise, the patient makes an appointment with their dentist immediately.
Chewing or clenching of the teeth may cause movement of the cracked pieces of your natural tooth, or cracked filling material, and the nerve within the tooth becomes irritated. Also true is when the biting pressure is released, there is “snap back” movement which also causes pain. Eventually the nerve of the tooth becomes damaged from the described movement, and the tooth will eventually continue to hurt constantly, even when you are not chewing. Adding to the nerve irritation is the fact that food and liquids are now entering the crack and are becoming a continuous source of irritation to the nerve, resulting in more pain. This leads to infection of the nerve, which can ultimately spread to the bone and surrounding gum of the fractured tooth. The final result of this progression can require treatment ranging from simple restoration with early detection, to requiring a crown or root canal/core/crown, or possibly worst case scenario, tooth loss. There are 5 classifications generally used to define cracks or fractures of the natural teeth: A) Craze Lines: These are tiny crack lines visible in the enamel that do not penetrate to the underlying dentin layer of the tooth. They are common in adults, and when noted in non-stress bearing areas of the tooth, are typically of little concern. However, craze lines in high impact areas should be monitored or restored, to prevent proliferation of the crack and further damage to the tooth. When craze lines are noted in proximity of a filling, it is often necessary to replace the restoration and remove the craze line leading to it, in order to avoid future tooth fracture. B) Cusp Fracture: Posterior teeth have mounds of enamel called cusps. These cusps over time can become weakened from occlusal forces and shear off, quite often along a craze line. When this happens, the patient should visit their dentist immediately. While a cracked tooth can be an indicator of a dead or dying tooth, often times this may not be the case and the tooth can be easily restored via a conventional restoration without requiring endodontic treatment. However, a healthy tooth which fractures and is left open to the oral environment for any extended period of time will suffer nerve damage and endodontic treatment will be necessary. The same is true of a lost filling in that if left untreated, nerve damage is inevitable and endodontic treatment will be necessary. C) Cracked Tooth: It is possible at times to crack a tooth without parts of the tooth shearing off. Sometimes these cracks can travel below the gum line or even below the bone level in a vertical or horizontally diagonal direction into the root. Typically the nerve of the tooth has also been damaged, and this tooth will require endodontic treatment. A tooth with this type of injury that is not endodontically treated and subsequently crowned, will eventually suffer catastrophic fracture necessitating in tooth loss. Early detection is essential in these cases, and another reason why your regular 6 month dental check-up is so important. D) Split Tooth: A split tooth is the result of a cracked tooth that has been untreated. It can also occur spontaneously in a tooth that has become non-vital or has died slowly without clinical symptomology, but most often the split tooth is the result of neglect. The prognosis for this tooth is hopeless and will certainly result in tooth loss. There are some instances, when a portion of the tooth can be saved via root amputation and restoration, however even then, the long term prognosis is poor to guarded at best. Again, early detection is essential, and a good reason to see your dentist for your regular 6 month check-up. E) Vertical Root Fracture: A vertical root fracture can begin at the base of the root, or can begin at the top of the tooth and extend to the tip of the root. In either case, again the prognosis is poor. While advances in endodontic surgery have made it possible to save a portion of the tooth, typically the tooth must be extracted. Again early detection is essential. Traumatic Injuries There are times when due to blunt force, teeth can be moved from their original position. Typically, there can be soft tissue damage to the lips and gums which might require Hospital Emergency Room Treatment, but it is always important to be seen by your dentist immediately for the teeth to be evaluated. In traumatic injury, time is of the essence and can make the difference between saving your tooth or losing it. There are 2 classifications of Traumatic Injury to the teeth: A) Dislodged Teeth: These are teeth that due to blunt force trauma become repositioned within the tooth socket itself. These teeth can be pushed inward deep into the socket, or they can be pushed in or out, (frontwards or backwards) depending on the direction of the blunt force. These teeth may not be fractured, but just repositioned. It is important to see your dentist immediately after such trauma. Initially, the teeth will be loose, and as the jaw bone can be quite pliable, in the early hours after injury, it may be possible to reposition the teeth back to their original position and splint the tooth for stability. This will allow the jaw bone to heal, anchoring the tooth back to its original position. Just like a broken arm that is not reset and stabilized in a cast, if a tooth is not reset, it will heal into that “new” position, requiring extensive future treatment via orthodontics or oral surgery. Typically, any tooth that has been subjected to blunt force trauma will require endodontic treatment. In young children who traumatize their newly erupting permanent teeth, special endodontic procedures may be required to allow the root to continue to grow and reach its mature length, which is critical to the long term prognosis of the tooth itself. Remember, it is always important to call your dentist immediately whenever your teeth have traumatized. It could mean the difference between saving or losing your tooth. B) Avulsed Teeth: It is physically possible to knock a tooth out completely intact without fracturing it into pieces. This is often seen in sports injuries and in younger patients, but can occur at any age. It is extremely important to know that the clock is ticking against you from the second the tooth leaves its socket. Critical to saving the tooth is keeping it moist and being seen by a dentist as quickly as possible. The best prognosis for the tooth to be saved via re-implantation is when the dentist can re-implant the tooth within 30 minutes of avulsion. Immediately after the tooth has been knocked out, the tooth must be kept moist in any of the following if possible: 1) the patient’s mouth 2) milk or 3) water. By far, the best chance for tooth survival is for the patient to keep the tooth in his own mouth tucked between his cheek and gum if possible. The patient must also be careful not to swallow the tooth. When there is significant injury to the soft tissues around the teeth namely the lips, gums, cheeks, etc., this may not be possible, but preserving the tooth in a small cup with the patients spit or blood will also suffice. The second best choice then would be milk, and thirdly then would be water with a pinch of salt added. In all cases, time is the critical factor and 30 minutes is the difference between success and failure. Once the tooth has been cleaned and re-implanted, the tooth or teeth will be splinted and should the reimplantation be successful, endodontic therapy will be necessary. Depending upon the age of the patient, if the avulsed tooth is a newly erupting permanent tooth, additional endodontic procedures may be required to allow the root to continue to grow and reach its mature length. In summary, remember that early detection is everything in regards to tooth fracture. These are one of the many things we here check for routinely at your recall and cleaning visits. If you are noticing symptoms in your teeth, be sure to tell us when we are examining your teeth. We know have comprehensive tests that allow us to find cracks and to test the nerves of teeth to determine if they are dead or dying. Also, the latest advancements here in Digital Radiography allows us to take x-rays of superior diagnostic value that help us locate decay or fractures. And should you ever dislodge or avulse a tooth, remember to call or page us immediately. Time is of the essence and now you know why. Our Restorative Treatment services include:
Click on one of the linked procedures to read more about our specific services.
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