Dear Dr. Reitz: I recently broke a tooth chewing gum on a Friday evening. The tooth split in half, leaving a loose attached piece that was painful when chewing. I was careful eating until my dentist’s office opened on Monday morning. My dentist said the tooth is too broken to repair, so an implant is planned in the area. Was there any dental first aid that I should have done when the tooth broke? – E.M., Shillington
Dear E.M.: Being prepared to handle a dental emergency, increases the chances of a better outcome. Depending on how a tooth breaks, determines what needs to be done.
Teeth are composed of dentin, covered in an enamel shell. Tooth enamel is a very hard structure made up of crystals called hydroxyapatite. During chewing, the surfaces of the teeth come under a lot of pressure, and over time cracks often form in the enamel shell. When these cracks progress into the dentin, there is an increased risk of a tooth fracture.
A tooth with a crack into the denting often gives a warning, usually as sensitivity to chewing. Each bite on the tooth causes the crack to open, stretching the dentin, resulting in discomfort. A crown placed on a tooth with a crack often protects the tooth from further damage. If untreated, as in your case, one wrong bite on the cracked tooth can result in the tooth breaking. A tooth that breaks while eating generally doesn’t require immediate treatment. You didn’t do any harm by waiting until the next day your dentist office was open.
A tooth also can break from a blow to the face around the mouth. When a blow fractures a tooth, the need for immediate treatment depends on whether the fracture involves just the enamel and dentin of the tooth or extends into the pulp chamber where the nerve is housed. A break that is deep enough to include the pulp chamber can be identified by the bleeding from within the tooth. When a pulp exposure occurs, it is best to contact your dentist immediately so you can be seen as soon as possible to cover the exposed nerve and limit bacterial contamination. In all cases, it’s a good idea to locate any broken pieces, because often the dentist can bond them back in place.
It’s terrible any time a tooth breaks. Fortunately, modern dentistry has many ways to fix the problem. Knowing when to seek dental care can make a difference in the outcome.