Definition

A tooth fracture is a break or crack in the hard shell of the tooth. The outer shell of the tooth is called the enamel. It protects the softer inner pulp of the tooth that contains nerves and blood vessels. Depending on the type of fracture, the tooth may not cause any problems or it may cause pain.

Types of tooth fractures include:

• Craze lines—shallow cracks that cause no pain and require no treatment
• Fractured cusp—breaks in the chewing surface of the tooth
• Cracked tooth—the tooth cracks from the chewing surface down toward the root of the tooth
• Split tooth—cracks down through the root, separating a section of tooth
• Vertical root fracture—cracks begin in the root and move up toward chewing surface

Tooth Fracture Copyright © Nucleus Medical Media, Inc.

Causes

Chewing on hard foods or accidentally biting down on a hard object can lead to a crack in the tooth. Teeth can also be fractured with a blow to the face that can occur with a car accident or during a sporting event.

Risk Factors

Tooth fractures are more common in older adults because teeth wear down over time.

Other factors that may increase the chances of tooth fractures:

• Teeth with current tooth decay or damage
• Teeth that have been restored with silver alloy
• Chewing on hard foods like hard candy or ice
• Collision sports like hockey and football
• Teeth that are exposed to temperature extremes within a short time period
• Teeth grinding and jaw clenching

Symptoms

Not all tooth fractures cause symptoms. For example, craze lines rarely cause problems.

Other fractures may expose the sensitive pulp to fluid, food, and bacteria in the mouth. It can cause irritation or infection in the pulp. This can lead to:

• Pain with chewing
• Chewing only on one side of your mouth to avoid discomfort
• Sharp pain when you bite down
• Pain with cold or hot air or food
• Random pain

Vertical root fractures may not be noticed until a bone or gum infection develops.

Diagnosis

A fracture may not be seen with the naked eye. Your dentist will ask about your symptoms. You may be asked:

• Do you remember biting down hard on something?
• When do you notice pain?
• What types of food cause pain?

You may not able to identify the exact tooth that has a fracture. Your dentist will look for the fracture based on your feedback, but may not be able to identify it right away. To help locate the fracture or determine the extent of the fracture, your dentist may do the following tests:

• Dye staining—a solution is put on the tooth to help see the crack
• Transillumination—passing a light through the tooth
• Periodontal probing—using special tools to look for the extent of crack
• Bite test—you will be asked to bite down on a stick to find the specific tooth causing problems
• X-ray—to look for certain defects, since not all fractures can be seen on x-ray

Early diagnosis may help save the tooth before the fracture progresses.

Treatment

Teeth cannot heal. The treatment goal is to protect the tooth and the pulp interior.

Talk with your dentist about the best treatment plan for you. The treatment will depend on the severity of damage to the tooth. Options may include:

• Crown—A cap is placed over the tooth. A temporary crown will be placed at first to make sure it corrects the problem. A permanent crown will eventually be placed.
• Dental Veneer—A thin covering that is placed over the tooth if you have small chip in the surface.
• Root canal—May be needed if there is severe damage to the pulp. A root canal clears out the damaged pulp and places a new filler in the tooth.
• Tooth extraction—The tooth may need to be removed if the crack extends below the gum line.
• Removal of the fractured portion—May be possible in vertical root fracture.

Prevention

To help reduce the chances of fractured teeth:

• Avoid chewing on hard objects such as ice, hard candy, popcorn kernels, or pens.
• Be aware of temperature extremes between foods and drinks..
• Wear a mouth guard for sports or recreational activities.
• Do not use your teeth to cut things or open plastic bags.
• Avoid clenching or grinding your teeth.
• Talk to your dentist if you grind your teeth at night.