Tooth Fracture: Causes, Symptoms & Treatment

A tooth fracture is when the tooth suffers a shattering or breakage. This occurs due to external impacts, such as accidents during sports and leisure activities, but also due to biting too hard. According to statistics, children and adolescents are more often affected than adults.

What is a tooth fracture?

Schematic structure of the tooth and its components. Click to enlarge. A tooth fracture is usually referred to when the tooth suffers a fracture due to external influences. This usually happens as a result of accidents during leisure time or sports, but also as a result of blows to the jaw area and biting down too hard – on a hard object, for example. In the case of a tooth fracture, a distinction is made between different types of fracture: first of all, between the two types of tooth crown and tooth root fractures. In the case of the former, a further distinction is made between a pure fracture of the tooth enamel (called enamel-dentin fracture) or between an enamel-dentin fracture that exposes the nerve canal. The latter type of fracture is considered one of the most painful tooth fractures, as the nerve is no longer adequately protected in this case and can thus become irritated and irritated.

Causes

In the most common cases, the fracture of the tooth structure is caused by external factors. The best examples are accidents that happen during sports, playing around (in children and teenagers) or due to accidents with bicycles or cars. Most of the time, the fracture of the tooth occurs due to the fact that a fall, a collision or a powerful impact on the jaw and tooth area (such as a blow) puts so much stress on the substance of the tooth that it breaks. Of course, this can also happen by biting down too hard without thinking. Common causes of tooth fracture that occur during biting and chewing include biting hard on hard objects, such as bones, shells of nuts and shellfish, or hard fruit pits.

Symptoms, complaints, and signs

Problems from a tooth fracture express themselves depending on the location and progression of the fracture. If the damage is below the gums, it remains undetectable to outsiders for the time being. Superficial fractures do not initially cause any significant suffering. Those affected may notice an irritation caused by overloading when chewing solid food. Cracks through the dentine, on the other hand, already cause patients considerable pain. The fracture exposes the underlying nerve canal. Enamel cracks are considered symptomatically inconspicuous and do not require therapy. They extend to the surface of the dentin, where the spread of the damage usually stops. In fractures of the dental cusp, people develop marked sensitivity to hot, sweet or cold foods. The fissure extends through the enamel and dentin. In some cases, it even extends into the dental pulp. Infractures run only through enamel and the dentin and are considered difficult to diagnose. Affected individuals suffer considerable pain during eating because of the opposing movement of the separated tooth parts. The opening also offers germs from the oral cavity a favorable opportunity to invade the interior of the tooth. As a consequence, there is a risk of inflammation of the nerve tissue and the tooth root. In the long term, the tooth will break due to the mechanical stress. Without a crown or filling to stabilize it, patients face complete tooth loss. Splinter remnants of the dislodged fracture in the gums provoke gingivitis with associated bleeding. Root fractures often penetrate the entire tooth structure. Longitudinal root fractures show a partial crack on the root canal wall, which grow steadily under permanent use of the injured tooth. Isolated root fractures are not necessarily accompanied by permanent symptoms immediately after they occur. Symptoms such as nerve pain or tooth death are sometimes delayed for up to several months.

Diagnosis and progression

In most cases, the affected person notices the fracture of the tooth immediately by himself. Often immediately after it has happened: for example, by a strong cracking sound, which is both audible and perceptible to the affected person. Often, in the first moment of the fracture, not only the tooth itself is stressed, but also the surrounding gums are irritated – for example, by the strong pressure exerted on them.If only part of the tooth crown breaks off, most patients do not feel any pain at first, but are only irritated by the new shape of the tooth. However, this can present sharp edges, which is why care should always be taken when a fracture occurs. A tooth fracture can result in cuts in the tongue or on the inside of the cheeks. If the nerve canal is affected, pain and hypersensitivity may occur. This is not the only reason to see a dentist immediately if a tooth fracture occurs.

Complications

A tooth fracture can result in the loss of the tooth. This can lead to further complications, especially in children and adolescents whose jaws are not yet fully grown. Premature loss of a tooth can then cause misalignment of other teeth or jaw deformity. Complications can also result from the injury to the tooth itself, especially if it is still associated with lacerations to the face or lips. If the injuries are not treated in time or professionally, the risk of inflammation, swelling and abscesses increases. Inflammation can lead to severe damage and loss of not only the tooth, but also tooth-surrounding tissues such as alveolar bone and soft tissue. In addition, such inflammations can spread and affect neighboring teeth, the gums or the oral mucosa. In the worst case, sepsis develops. Depending on the course of the injury, tetanus may also be imminent if the patient has not been vaccinated against tetanus and the vaccination has not been made up in a timely manner. In addition, tooth fractures are very often accompanied by injuries to the skull. Provided the patient has fallen on the head, there is a risk of concussion or more severe consequences such as traumatic brain injury. In addition, if a front tooth is lost or damaged, patients often suffer very severely from the esthetic impairment, as a broken tooth is perceived as disfiguring. This is even more true if the blemish cannot be immediately repaired, for example, due to inflammation.

When should you go to the doctor?

If a split or loss of a tooth occurs after a fall, accident or violence in the area of the face, a visit to the doctor is necessary. Although initially there is no discomfort, severe pain or other sequelae may occur as the condition progresses. In some cases, patients suffer a condition of barely tolerable pain within a few hours. For this reason, a consultation with a doctor should be made as soon as the first irregularities in the area of the teeth become apparent. In case of a bloody taste in the mouth, swellings or impairments in food intake, a medical examination is necessary. If abnormalities or discrepancies can be perceived in the gums, clarification of the complaints is also advisable. In some cases, splinters of the teeth have entered the gums during the triggering event and can trigger impairments there. Hypersensitivity to various stimuli such as cold or heat should be understood as a warning signal of the organism. If these changes occur suddenly, a doctor should be consulted. If there are peculiarities in speech, redness in the mouth as well as irregularities in an existing denture or braces, a doctor should be consulted. If there is a headache, swelling or deformity of the face, and changes in the appearance of the skin on the face, a doctor is also needed.

Treatment and therapy

The dentist will first examine the fracture extensively and decide whether the nerve is affected and whether the tooth can be restored by reconstruction. If possible, the dentist will attempt to restore the tooth with filling materials. Only if more than 70 percent of the tooth is destroyed or the tooth is split or broken down to the canal, it is necessary to think about further reconstruction measures. These could consist of a new and artificial tooth crown (denture), but in very unfavorable cases also in the fact that the broken tooth must be removed. However, this is quite rare – for example, when the fraction is very severe and cannot be treated.

Prevention

Tooth fracture can be conditionally prevented by trying to keep the tooth structure strong – by taking appropriate preventive measures at the dentist and by using toothpastes and more, which strengthen the tooth structure. For risky sports, one should also wear a mouth and tooth protector. Nevertheless, a tooth fracture cannot always be avoided. Therefore, it is important to see a dentist as soon as possible – if one is present.

Aftercare

The aftercare of the tooth fracture is closely related to its cause. It makes a difference whether it is an external event, such as a sports accident, or a behavioral fracture, such as one caused by chronic teeth grinding. If the cause is due to the patient’s behavior, this must be consistently stopped. Teeth grinding can be positively influenced by bite splints or psychotherapy. In addition, aftercare also depends on the type of treatment performed by the dentist. Implants in particular must not be fully loaded during the healing phase. This is achieved by eating softer food or tending to prefer chewing on the other side of the denture. The duration of the healing phase is determined by the dentist. Cooperation of the patient is absolutely required here, also with regard to a control examination in the dental practice. If a tooth replacement is necessary after a tooth fracture, consistent oral hygiene is required. This applies in particular after insertion of an implant to prevent peri-implantitis, the bacterial inflammation around the implant site. In this context, professional tooth cleaning removes hard and soft plaque and also reaches places where the toothbrush has difficulty reaching. In addition, the dentist also offers special implant cleaning. The patient can also achieve relief for the affected tooth after the tooth fracture by grinding food into bite-sized pieces.

What you can do yourself

In the case of a tooth fracture, the possibilities of self-help are not aimed at changing the appearance of the teeth. This can be improved exclusively by doctors. It is necessary to check whether the causes of the tooth fracture can be changed. For example, the practice of sports that lead to violence in the facial area can be reduced. Wearing protective clothing should be optimized as an alternative. In this way, the risk of further fractures is minimized. In parallel, the patient’s own behavior in everyday life should be reviewed. If the tooth fracture occurred as a result of an interpersonal physical confrontation, the patient’s own behavior and reaction patterns should be changed. This will also help to minimize future provocations that may involve violence. Daily dental care is an essential component in the area of self-help. Daily tooth cleaning as well as cleaning of the interdental spaces have a considerable influence on the oral flora. This prevents damage to the enamel as well as the teeth. When eating, it is important to make sure that the food is adapted to the possibilities of the organism. Too large or too solid components of the food can cause damage to the teeth. Likewise, the wearing of jewelry in the mouth area should be avoided. The materials of rings or pins in the cheek or tongue can lead to irreversible problems of the teeth and cause fractures.