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It’s the weekend. You’re having a great time playing catch with your kids when suddenly you trip and fall headfirst on your face. There’s a big thud, a crack, and with a sinking feeling, you realize you now have a broken tooth right in the middle of your face. 

Injuries to the teeth and surrounding structures are common, be it physical (a blow or suddenly biting into something hard), chemical (by acids), mechanical (incorrect brushing techniques) or because of growing cavities that weaken the teeth.

In any case, chipped/broken teeth need to be managed promptly to ensure the best chances of their survival. Dentists can perform a variety of procedures to save such a tooth, however, if the tooth is very damaged, removing the tooth and replacing it with an artificial one would be the last resort. 

Causes of chipped/broken down tooth 

Some reasons why a tooth may fall weak and chip/break off: 

• biting on something hard 
• teeth grinding habit
• a heavy blow to the face (during contact sports like hockey, soccer, wrestling etc)
• fall or accident  
• old age
• unhealthy/decayed teeth 

Risk factors for Chipped tooth 

Weak teeth are more likely to crack, chip, or break off whenever there is a sudden or heavy force acting on them. Some factors that decrease a tooth’s strength are:

• Tooth Decay – results in loss of healthy tooth structure and weakens the tooth. (A tooth with a large filling is also weaker than a natural tooth)
• Habits like teeth clenching and teeth grinding – wear down the tooth 
• Sugary drinks – eat away at the enamel through bacterial action 
• Frequent consumption of acid-producing foods like coffee, fruit juices, soda etc – destroys the integrity of enamel 
• Digestive disorders like acid reflux and heartburn – bring up strong acids from the stomach to the mouth and damage the teeth 
• Frequent vomiting – in case of an eating disorder (like bulimia nervosa) and alcohol abuse; cause stomach acids to come up to the stomach and weaken the teeth 
• Old Age – enamel naturally thins down with age, hence elderly people have weaker teeth, more prone to cracks or fracture 

Diagnosing a Chipped Tooth 

Depending on the extent of the crack or fracture, you will experience different symptoms. Your dentist will do a thorough examination to determine how bad the damage is. 

• If a large part of the tooth has chipped off, the inner dentine layer is exposed and there will be pain on contact with hot or cold. (There isn’t any pain if only a small part has chipped off)
• A cracked tooth may have intense pain on biting.
• The jagged surfaces of the chipped tooth might cut the gums or tongue on repeated contact, sometimes even causing mouth ulcers and difficulty eating.

Asymptomatic Crack lines: 

Often, a tooth that has undergone some trauma may not fracture completely, and result in superficial crack lines on the outer enamel layer. These rarely present with any symptoms like pain, sensitivity, or decay in the beginning and do not require any restorative treatment. However, these crack lines exist as ticking time bombs and provide decay-causing bacteria with a pathway into the deeper layers of the teeth. If left untreated and unmonitored, they can ultimately lead to extensive tooth decay (not visible on the outside of the teeth), complete tooth fracture, and even gum disease. A study confirmed that asymptomatic crack lines are the forerunners of the painful cracked tooth syndrome. 

Temporary Care for Chipped teeth 

There are some things you can do to care for your broken or chipped off teeth before you visit the dentist: 

• Cover the sharp edges of the chipped tooth with dental wax or sugar-free chewing gum to protect the gums and tongue
• Avoid chewing on the side of the broken tooth 
• Pain relief using over-the-counter pain medications (ibuprofen, paracetamol), or natural remedies like ice and cooling tea bags/clove oil to soothe painful gums 
• Keep the area around the broken down tooth clean and free of food lodgement by flossing. Food accumulation can further weaken the tooth. 

Treatment Options of Chipped tooth 

1. Fragment reattachment 

Fractures of the anterior teeth are a common occurrence. The fractures can be classified into levels depending on how much damage has occurred. If only a tiny part of the crown has chipped off, your dentist will polish or round off the rough edges to prevent trauma on the gums and soft tissues. 

Intact tooth fragments can also be reattached to the tooth using composite resin material. This is better than restoring the entire chipped off space with new dental filling material since the natural look and colour of the tooth will be maintained. 

2. tooth-coloured Restorations

Composite and GIC restorations can help replicate natural tooth contours if fractured tooth fragments cannot be saved for re-attachment.

Glass Ionomer Cement (GIC) is a tooth-coloured material that can be moulded into fine tooth cracks and successfully restore chipped teeth. However, composite material is more widely used since it gives better strength and durability to the filling over time. 

Sometimes, when the damage involves deeper layers like the pulp, a root canal must be performed to save the tooth. If not, the tooth may develop an infection or complication later on. After the root canal treatment is done, a permanent restoration is placed on the tooth. 

3. Veneers

Veneers are thin shells of tooth-coloured material that attach to the front surfaces of your teeth. They are a great way to restore natural tooth contours and your smile without trimming down much tooth structure. 

Two types of veneers are available at the dental office – Porcelain and Composite Veneers. Both porcelain and composite veneers can replicate the natural shade and colour of the teeth closely. However, porcelain veneers are preferred out of the two. They have a longer life-span (10-15 years, if maintained properly) because of stain-resistant properties and better strength. Composite veneers are more affordable but stain over time and tend to wear down with time. 

4. Crowns 

Dental crowns are artificial “caps” that cover all the tooth surfaces. They restore the normal appearance and function of the tooth. Since large fillings weaken a tooth, whenever there is extensive damage due to decay or any other trauma to the tooth, crowns are the preferred treatment option. 

Extensively chipped off or broken down teeth almost always require a root canal treatment to save the tooth, and placing a crown becomes mandatory in that case. 

Multiple types of dental crowns are available at the dentist, depending on the material they are made of. They include – Metal crowns (gold, nickel, chromium, titanium), Metal Fused to Porcelain (PFM) crowns, Ceramic crowns, Composite Resin crowns and Stainless Steel Crowns (recommended only for baby teeth). Your dentist will suggest the best crown for you after taking into account several factors. 

• The position of the tooth that has broken down (front teeth require tooth coloured crowns, whereas back teeth can do without) 
• Cost (Metal crowns are the most affordable, followed by PFM and ceramic crowns respectively) 
• How much of natural tooth structure is remaining 
• The function of the tooth 
• Other factors like strength, durability, presence of opposing natural or artificial teeth in the mouth, etc 

5. Onlays 

Dental Onlays are partial crowns, or coverings, usually placed on the molars (back teeth). They can effectively restore moderately broken down or cracked teeth. Onlays can be made of metal, composite resin or ceramic. 

Using photographs, x-rays and digital scanners, your dentist will create a digital impression of the tooth. Then your tooth impression will be sent to the lab for fabrication of the onlay. At your next appointment, the onlay will be bonded to your tooth using strong bonding cements. With CAD/CAM technology, onlays can be fabricated in the dental office and delivered on the same day too, eliminating the need to visit the dentist again. 

6. Extraction 

If a tooth is so extensively damaged that it cannot be saved even after root canal treatment, then it must be extracted and replaced with an artificial one. 

Dental extractions are painless, and there is no need to fear one. Your dentist will give you a local anesthetic to numb the tooth and surrounding area. Only a slight pressure will be felt as your dentist uses elevators and forceps to remove the tooth carefully. Teeth fractured or broken down by decay are usually quite brittle, so special care must be taken to ensure the tooth comes out in one piece and no remaining fragments are embedded in the gums. 

7. Bridges

A dental bridge comprises a central pontic (artificial tooth), and two abutments on either side, which are bonded to anchor teeth in the mouth for stability. In this way, a bridge can easily replace a broken down unrestorable tooth after extraction. 

There are mainly five types of bridges available: Traditional bridges, Cantilever bridges, Maryland bridges, Implant-supported bridges and Composite bridges 

Your dentist will perform a full mouth check to ascertain the kind of bridge you need based on the following factors:

• Location of the missing tooth/gap 
• Number of teeth required to fill the gap 
• Gum Health of teeth adjacent to the gap 
• Cost of materials (metal, composite resin and porcelain may be used)

Implant-supported bridges are the costliest of the lot but offer the most stability and strength. They often last a lifetime, unlike regular bridges which may have to be changed every 5-15 years. 

8. Implants

While Dental Implants are certainly not easy on the pocket, they do offer a permanent lifelong solution for broken down unrestorable teeth. There are many benefits of placing an implant over other treatment options (like bridges). Some of them are:

• Implants maintain the health of the underlying bone and gums 
• Implants are lifelong (if good oral hygiene is maintained)
• Implants offer maximum stability and durability

Complications of Chipped tooth 

If a cracked, chipped, or broken tooth is left on its own and not managed with the right treatment, it can escalate into a full-blown infection. The infection can spread from the tooth to the surrounding bone and gums, causing their destruction as well. In rare cases, the infection may travel to other parts of the head and neck region, causing major complications. An infection arising from an untreated broken down tooth can present with: 

• Inflammation of the soft tissues surrounding the tooth 
• Traumatic ulcers
• Foul smell because of food debris and bacteria collected around
• Pus in the gums
• Bleeding gums
• Pain on biting 
• Tooth sensitivity

Takeaway 

Chipped/broken teeth must be treated at the earliest. Some broken teeth are restorable and require minimal treatment only, whereas other teeth may not be restorable using conventional restorative procedures and may need to be managed by extraction and replacement of the missing tooth. Always check with your dentist what your treatment options are.