Definition

A dental fracture, or tooth fracture, is a form of dental trauma that results in a crack or break in the tooth structure, which can involve the enamel, dentin, or even the pulp. The enamel is the outer protective layer of the tooth, while the dentin lies beneath it, and the pulp contains connective tissue, blood vessels, and nerves.

Most dental fractures occur in the upper front teeth (incisors), as they are located at the front of the oral cavity. This condition is commonly observed in children and young adults. Approximately 5% of all traumatic dental injuries involve tooth fractures. These fractures can happen under various circumstances, but the most common cause is sudden trauma to the teeth or oral tissue, such as in traffic accidents, physical altercations, or sports injuries.

Tooth fractures may lead to pain, swelling, and damage to the tooth, ranging from small chips to complete dislodgement from the mouth. However, some cases may present no symptoms at all.

Tooth fractures vary in type, including:

• Dental craze lines

Tiny cracks that appear on the enamel. These usually cause no symptoms and don't require treatment.

• Broken tooth crown

Cracks appear on the surface used for chewing.

• Completely cracked tooth

The crack extends from the tooth surface down to the root.

• Tooth split in half

The fracture reaches the root, causing the tooth to split in half.

• Vertical tooth fracture

The crack starts from the root and extends up to the tooth surface.

Causes

Several factors can contribute to tooth fractures, including:

• Increased pressure on cavities.
• Teeth grinding, which exerts excessive pressure on the teeth.
• Large dental fillings that cause improper alignment with opposing teeth when biting.
• Chewing or biting hard substances such as ice cubes, nuts, or candy.
• Accidents involving the mouth, such as falls, motor vehicle accidents, or sports injuries.
• Blunt force trauma to the head and mouth.
• Extreme temperature changes in the mouth, such as consuming hot food followed by cold food.

Risk Factor

Tooth fractures often occur alongside other mouth injuries. The prevalence of tooth fractures in men is 2-3 times higher than in women. Patients' ages vary, but fractures are frequently seen in teenagers and young adults. Risk factors include participation in contact sports and reckless driving habits. Additionally, underlying conditions such as tooth decay or misaligned teeth can increase the risk of fractures.

Symptoms

The symptoms of a tooth fracture depend on the severity of the injury. Some individuals may not even realize they have a tooth fracture, as certain fractures do not cause noticeable symptoms or require treatment.

However, in cases where symptoms are present, they may include:

• Intermittent pain, especially when chewing or biting.
• Pain around the gums and teeth, with an unclear source.
• Swelling of the gums near the fractured tooth.
• Sudden sensitivity to sweet foods or drinks.
• Visible changes in the tooth’s color or shape.

Diagnosis

Tooth fractures are sometimes difficult to detect with the naked eye. For diagnosis, a dentist will begin by asking about your medical and dental history, including questions such as:

• Have you recently chewed hard foods or objects?
• When did the pain start?
• What types of foods trigger the pain?

The dentist may also conduct additional tests to confirm the diagnosis, including:

• Dental X-rays to visualize the fracture.
• Special dye application to highlight small cracks.
• Probing the tooth surface with a special tool.
• Bite tests, where you will be asked to bite down on an object to pinpoint the problematic tooth.

Management

First Aid

In cases of tooth fractures caused by external trauma, a cold compress can be applied to the affected area to reduce pain and swelling before further dental treatment. If there are wounds or bleeding around the mouth, proper wound care is necessary.

The treatment of tooth fractures focuses on restoring the hard tissues of the teeth, so that their structure and function return to normal. In addition, soft tissue around the teeth is also treated. The healing process can take several weeks to months, depending on the severity and cause of the trauma.

Aesthetic considerations are also important when selecting a treatment method. Fractures of the front (anterior) teeth can affect self-esteem, especially in teenagers. Restoring the front teeth can improve both appearance and quality of life.

The choice of treatment depends on the severity of the tooth fracture, and may include the following options:

1. Dental fillings

This procedure is used when the crack is mild and the tooth’s shape can be restored with a filling. The edges of the fractured tooth will be smoothed with a bur, allowing it to be properly filled.

2. Veneers

For less severe fractures, veneers may be used to restore the tooth’s original shape. You can consult your dentist about the type of veneer that suits your condition.

3. Jacket crown installation

If a large portion of the tooth crown is damaged, but the root remains intact, a jacket crown can be placed. 

Jacket crown is a false tooth covering the remaining original tooth, permanently attached to the original tooth using special materials.

4. Root canal treatment

When the fracture extends to the tooth’s nerve layer, root canal treatment may be recommended by your dentist. This treatment is necessary to remove the damaged nerve. 

After the root canal treatment is complete, a jacket crown can be installed. This procedure will restore the tooth’s shape to its original condition.

5. Tooth extraction

This is the last option if the fracture is too severe for other treatments to be effective.

Complications

Tooth fractures can lead to several complications, including:

• Pulp death and infection, the most common complication.
• Discoloration of the tooth crown.
• Formation of a periapical abscess (a pus-filled pocket).
• Root canal obliteration, where the root canal narrows.

Prevention

Although accidents leading to broken teeth can’t be fully prevented, certain measures can reduce the risk:

• Avoid chewing or biting on hard objects like ice cubes or pens.
• Stop grinding your teeth. 
• If grinding occurs while sleeping, consult your dentist for a protective device to wear at night.
• Use protective gear when engaging in contact sports.

When to See a Doctor?

See a dentist immediately if you experience any of the symptoms described. Even if there is no pain, you should consult a dentist if you notice a crack in your teeth. 

The longer a cracked or fractured tooth is left untreated, the greater the risk of damage, which may lead to more complicated treatments, including tooth extraction.

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