Why Did My Tooth Break… and What Happens Next?
Breaking a tooth can be a startling and painful experience, and it often happens in a way that leaves us wondering what we might have done to cause it. Teeth break for a variety of reasons—not all of them preventable—and an underlying problem may have been been present for many years. You can be relatively certain that the real cause was probably not the mashed potatoes you were eating when it happened!
As you might expect, there are many different types of tooth fractures. Aside from the obvious causes such as accidental injury, teeth can weaken and break as a result of normal aging, older fillings, and from excessive pressure that occurs during chronic grinding, clenching or when the teeth fit together abnormally. Some fractures and chips are hard to predict or avoid simply because the process of repairing damaged or decayed teeth sometimes leaves them more vulnerable than the way mother nature made them.
Silver amalgam fillings have been used in dentistry for many decades, and although they are still regarded as safe and appropriate they are often the underlying cause of unexplained broken teeth. Metal fillings expand and contract with temperature changes in the mouth, and over time this process causes movement of the tooth and eventually tiny cracks form. The weakened tooth unexpectedly breaks one day- sometimes while eating something innocent! The culprit was actually simple physics, not your lunch. Many dentists prefer to use white plastic (composite) fillings which do not expand and contract, as a way to prevent this problem.
A cracked tooth or root is one of the most difficult to diagnose issues in dentistry, often causing significant discomfort without being readily detectable visually or on an on x-ray. Vertical root fractures happen most frequently in teeth that have had root canal therapy or teeth in which the nerve has been dead for a long time; sometimes it is the unavoidable result of placing a metal post in the tooth to provide extra support after the root canal is complete. Unfortunately, a root fracture is usually considered catastrophic, requiring that the tooth removed to avoid chronic abscesses.
You probably would not be very surprised to learn that teeth, like the rest of our bodies, are affected by the aging process. With normal aging, nerve tissue and blood vessels that are found in the pulp or core of teeth, gradually become smaller and fewer. As a result of the decreased fluid content, the teeth become brittle. The same process occurs when a root canal is performed and the pulp of the tooth is completely removed; this is the reason why the dentist almost always recommends that a crown (cap) be placed after the root canal is complete. Brittle teeth fracture or chip easily, but fortunately, the reduced nerve tissue means that little if any pain is experienced when a fracture is severe.
The enamel and the underlying dentin also expand and contract at slightly different rates in response to temperature changes from hot and cold foods. Over a lifetime this natural process causes visible, vertical cracks known as craze lines in the more brittle outer layer of enamel. Although painless, craze lines are most noticeable in the front teeth and often cause concern to patients. Dentists regard them as an expected part of the anatomy of the teeth, formed as a result of normal wear and tear and very often they require no treatment.
My Tooth Is Broken. What Next?
Obviously, the treatment your dentist recommends will depend on how severely the tooth was damaged. Breaks can range from small chips to major fractures, so you might need a major procedure, a minor adjustment or no treatment at all. A tooth has three layers: the enamel is the hard outer shell, the dentin is found under the enamel, and the pulp, which is the nerve center, is at the core. Minor chips are common, and involve loss of some enamel. Usually, little or no pain is felt, but if enough tooth enamel is lost the dentin may be exposed which might cause sensitivity to cold. The most severe breaks expose the pulp, which can cause extreme pain and even bleeding.
If you have a small chip in your tooth, make a routine dental appointment, and try an over the counter pain medicine for sensitivity as long as it is safe for you to take it. More serious fractures should be evaluated immediately. Rinse your mouth out with warm water, cover the break with a piece of clean gauze to protect it, and see the dentist as soon as possible. Apply an ice pack to minimize swelling if your mouth or lips were injured, and avoid using aspirin for pain because as it increases the risk of heavy bleeding.
Even if your tooth is only slightly chipped, the dentist is probably going to take an x-ray of the damaged tooth and recommend being gentle with it for a few days. A minor chip can often be smoothed out or repaired with white filling material, often without anesthetic. Even when a break is severe, a tooth can almost always be saved with a permanent crown if the pulp is not damaged. Postponing a crown or replaced filling that has been recommended can place the tooth at risk for a much more serious fracture- perhaps one that cannot be repaired. On those occasions when a tooth must be removed after a fracture, there are several options available for replacing the missing tooth – an implant is often the ideal choice for many people because it provides a permanent solution with a natural appearance.
Could I have Prevented It?
Your dentist may not specifically say so, but he is watching for signs that old silver fillings may need to be replaced or crowned; and he may notice signs of potential problems or risky habits even before you do! If you clench or grind your teeth, he may suggest a mouth guard to wear during stressful times or when sleeping. An abnormal bite may require an adjustment, and sometimes orthodontic treatment may be recommended to reduce unwanted stress and permanently correct the problem.
Not every fracture can be prevented, but using good old fashioned common sense will go a long way. Take reasonable precautions to prevent fractures by protecting children and elderly from falling hazards at home and use a mouth guard while playing sports. Avoid chewing on hard objects like pens, paperclips, finger nails, ice and even candy… especially if you have broken a tooth in the past. Above all, schedule regular dental checkups, because your dental professional is the best source of advice about your risk and what can be done to minimize it.