Broken tooth

When a child falls or generally is rough-housing, sometimes, they fracture a tooth. Ugh, why does it have to the be the front teeth, the ones everyone sees? Almost every Monday, we receive a call from a parent with a child or teenager that fell over the weekend and chipped, broke, or otherwise fractured a tooth. Teeth can sustain a lot of force, but a sharp hard force concentrated in one spot can cause a fracture or “broken tooth”. Now, baby teeth often have multiple small chips on the edges or facets from “normal” wear and tear. Of course, a fracture in a permanent tooth can be cause for concern.

Fractures are classified as to location and basic level of severity with the Ellis classification system:

Class 1–Chips or fractures in the outer enamel layer only
Class 2–Fractures into the dentin layer
Class 3–Fractures into the pulp of the tooth
Class 4–Fractures onto the root often vertical fractures

What to do?

Well, sometimes baby teeth are handled differently than permanent teeth. In general, the principles are the same:

Class 1–Well, they may look bad, but are usually not sensitive. If it is very small, we often just smooth off the edge. It is very difficult to do a very thin filling on the edge of a tooth. You can, but it will chip off again in a heartbeat. If the chip is larger, you often have to do a composite filling (bonding). It’s the same material we use for white fillings. It is “bonded” onto the tooth -sort of like gluing something onto a flat wall.

Class 2–Larger fractures. Very common and sometimes sensitive to cold water/air, -at least for a while. A composite restoration is indicated to cover the sensitive dentin and for looks. A very large fracture may eventually need a crown or porcelain facing, but in growing children a more conservative approach is often indicated till growth and orthodontic treatment is completed. Although it often looks pretty good, a composite can be difficult to match existing tooth structure with all the minor enamel inclusions and shadings. So, if you are looking at the photographs below and think, “wow, that’s not too bad”, you are correct, but most results are not this good. With most repairs, if you look really close, you can see where the tooth ends and the filling begins. That’s why porcelain work is often indicated later on.
Class 3–Always needs attention as bacteria are entering into the pulp. In adults this often means a root canal will be needed. This is not often the case in young permanent teeth. The more vigorous pulps with a better blood supply can often recover quite well. If most of the crown of the tooth is missing, a root canal may be indicated just to create something to hold a crown.

Class 4–Not common, but difficult to treat, and often need removal. Dental heroics may be needed to save such a tooth. Treatment may include orthodontic extrusion, a root canal, post and core, and a crown–if you are lucky.
Once teeth are restored, there still may be problems later on due to the initial trauma. The tooth may abscess or have other problems.

Treatment is sometimes different for a baby tooth. Often parents want whatever it takes to “save” a baby tooth that is not of any real consequence other than appearance. We are much more likely to just remove a severely damaged baby tooth rather than do a “baby tooth root canal”. The main objective is protecting the developing permanent tooth. Small fillings in front baby teeth are more difficult to retain without doing a crown. Having said this, we still try and “fix” fractured baby teeth if we can. The age of the patient can dictate what you are able to do (or not). A chip in the tooth of a two year old may be handled differently than that of a 5 year old. Behavioral considerations, the need for sedation, and how much root is left on the baby tooth will influence the ultimate decision.

There is more on the blog on trauma (and I know you want more info on this one):

Fractured teeth, Knocked out teeth, and other pediatric dental accidents

When to call the dentist, when to go to the emergency room