A sudden fracture of a piece of a tooth is common in adults, especially in teeth with large fillings. The force of chewing over the years can lead to hairline cracks at the base of the filling until a piece of tooth breaks away. It is usually not painful. Patients should not worry that they did something to cause this or that it will become increasingly painful. However, it does need to be restored to prevent further fracture. While non-painful posterior teeth can usually wait for an appropriate appointment, a fractured front tooth is an esthetic problem. We would see you promptly for treatment.
Unexplained pain in posterior teeth is usually due to cracks in the chewing part of the tooth. Cracks worsen with time and chewing, similar to a small crack in a windshield gradually lengthen. Cracks can lead to broken cusps in posterior teeth or broken segments around large fillings in anterior teeth.
More worrisome, cracks can extend into the nerve of the tooth or into the root. Teeth with cracked roots cannot be repaired, so prompt diagnosis and treatment are important. Any tooth that is especially painful to biting may be broken under the gum or into the nerve. This is a dental emergency; you need to see us as soon as possible. If the tooth is severely fractured, it may need root canal treatment or it may not be savable. If needed, we will arrange for you to see an endodontist or oral surgeon the same day.
Crowns: A crown is the most reliable restoration for a cracked or broken tooth and the best way to relieve the pain return full dental function. Crowns can be made of all ceramic (porcelain), porcelain fused to gold, or all gold. Porcelain, metal-free crowns are the most esthetic but also the most fragile. Gold is the strongest, but is visible. Porcelain fused to a metal substructure is a good combination of strength and esthetics. In teeth with root canal fillings, crowns can prevent breakage.
Inlays and Onlays: These are smaller versions of crowns that leave undamaged areas of the tooth intact. These are more conservative than crowns, and are best for teeth with minor damage. Inlays and Onlays can be made from a processed composite resin, porcelain, or gold. As with crowns, the composite or porcelain options are more esthetic but more fragile. Gold restorations are strong but gold colored.
Fillings: Teeth with broken cusps can be repaired with a larger filling, although this does not strengthen the tooth or protect it from further fracture. This is generally a short-term treatment.