Tooth Fracture

Overview

What is a Tooth Fracture?

A tooth fracture is a break or crack in a tooth that can range from minor enamel chips to severe fractures involving the root. Fractures are classified based on their extent and which tooth structures are involved.

• Can involve enamel, dentin, pulp, or root
• Severity ranges from minor chips to root fractures
• Common in anterior teeth from trauma
• Posterior teeth fracture from biting forces
• Treatment depends on fracture type and extent

Overview of the Condition

Tooth fractures are classified according to the Ellis classification or WHO classification based on tissues involved. Treatment ranges from simple smoothing for enamel cracks to extraction for severe root fractures. Prompt treatment improves prognosis.

References

• NCBI - Dental Trauma
• AAE - Cracked Teeth

Symptoms and Causes

Symptoms

• Visible crack or missing piece of tooth
• Sharp edges irritating tongue or cheek
• Pain when biting or chewing
• Sensitivity to temperature or sweets
• Spontaneous pain if pulp exposed
• Swelling if infection develops
• Bleeding from gums in severe trauma
• Tooth mobility if root involved

Causes

• Trauma from falls, sports, accidents
• Biting on hard objects
• Bruxism (grinding teeth)
• Large restorations weakening tooth
• Decay undermining tooth structure
• Age-related brittle teeth
• Sudden temperature changes
• Root canal treated teeth (more brittle)

Diagnosis and Treatment Options

Diagnosis

• Visual examination
• Dental radiographs (periapical and PA views)
• Transillumination
• Pulp vitality testing
• Percussion and mobility testing
• Probing for root fractures

Treatment by Fracture Type

• Enamel infraction (crack): observation or sealing
• Enamel fracture: smoothing or composite restoration
• Enamel-dentin fracture: composite or crown
• Complicated crown fracture (pulp exposed): pulp capping or root canal
• Crown-root fracture: depends on extent
• Root fracture: splinting, possible extraction

Non-Surgical Care

Conservative Management

Minor fractures limited to enamel may only require smoothing sharp edges or minimal composite restoration. Dentin fractures without pulp exposure can be restored with composite bonding or crowns.

Immediate Care

1. Save any tooth fragments in milk or saliva
2. Rinse mouth gently with water
3. Apply pressure if bleeding
4. Take pain relievers as needed
5. Cover sharp edges with wax if irritating
6. See a dentist as soon as possible

Surgical Care

When is More Extensive Treatment Needed?

Fractures involving the pulp require endodontic treatment. Severe crown fractures need crowns for protection. Root fractures may require splinting, root canal, or extraction depending on the fracture location.

Surgical Options

• Pulp capping for small pulp exposures
• Root canal treatment for larger exposures
• Crown placement for extensive crown fractures
• Splinting for root fractures
• Extraction for vertical root fractures
• Dental implant or bridge after extraction

Anatomy and Affected Areas

Anatomy Overview

Fractures are classified by which tooth structures are involved. The prognosis worsens as fractures extend from enamel to dentin, pulp, and root. Horizontal root fractures have better prognosis than vertical ones.

Fracture Classification

• Enamel infraction: crack lines only
• Enamel fracture: enamel chip
• Enamel-dentin fracture: involves dentin
• Complicated crown fracture: pulp exposed
• Crown-root fracture: extends below gum line
• Root fracture: horizontal or vertical

Frequently Asked Questions

Frequently Asked Questions

QuestionAnswerShould I save the broken piece?Yes, store it in milk or saliva; it may be reattached.How urgent is a tooth fracture?Pulp exposure is urgent; minor chips can wait for a regular appointment.Can a fractured tooth be saved?Many can be saved depending on fracture type and extent.Will my tooth look normal again?Modern restorations can achieve excellent esthetics.Is a fractured tooth an emergency?Depends on severity; pain, bleeding, or pulp exposure require prompt care.What if the fracture is below the gum line?May require crown lengthening or extraction depending on extent.

Prevention Tips

Prevention Strategies

• Wear mouthguards during sports
• Avoid chewing ice and hard candy
• Don't use teeth as tools
• Treat bruxism with night guards
• Maintain good oral health
• Crown heavily restored teeth
• Wear seatbelts to prevent trauma

Related Conditions

Related Conditions

• Cracked tooth syndrome
• Dental luxation
• Tooth avulsion
• Alveolar fracture
• Pulp exposure injuries

Prognosis

Prognosis depends on fracture type and prompt treatment. Enamel and uncomplicated dentin fractures have excellent prognosis. Root fractures in the middle or apical third can often be saved with splinting. Vertical root fractures generally require extraction.