broken chipped or fractured tooth and its restoration

Broken, chipped, cracked or fractured teeth in children usually result from one of the following:

  • Trauma or accident to the head and neck
  • Dental Caries, decay or cavities that weaken the teeth
  • Biting down too hard
  • Having a large restoration or filling

Trauma is common is children because they are playful and unfortunately their hands and feet coordination is not fully developed to protect them from such injuries. They may be caused by sports, car accidents, fights, falling, biting on hard foods/objects and drinking hot liquids followed by cold liquids.

Dental caries is also common in children and when hidden between the teeth in the flossing surfaces, it can considerably weaken the tooth before being noticed. Hence, the tooth might break and you might be wondering why it broke not knowing the cavity existed in the first place. These type of cavities can be detected on routine radiographs or x-rays we take at Stouffville Smiles Dentistry. Restoring or filling these cavities can prevent teeth from breaking and eventually loss of the tooth.

Biting down too hard can happen with children because they are more care-free than us. Although, our teeth and jaws usually have a good sensory mechanism to avoid or prevent us from biting too hard, sometimes it fails and teeth can break in the process. This can also happen if there are hard substances such as stones, etc in food items specially grains.

These type of injuries to the teeth can cause cracks, chips, fractures, concussion of the tooth socket and vessels and nerves, knocking out or avulsion of the teeth, fracture of the jawbones or sometimes nothing. We recommend these types of injuries be always checked by the dentist to make sure we know what we are dealing with as sometimes even if no pain exists, the consequences will manifest later in life that can be reduced or completely avoided with professional care.

Depending on the severity of the damage, your child may or may not be in pain and may or may not need any treatment but we highly recommend an examination to diagnose the damage if any as most of such damages are not visible to the naked eye and require radiographs, CBCT (3D radiographs or x-rays), etc to be detected. Let’s explore and see some of the possiblities and the corresponding recommended or suggested treatment for it:

Chipped, Fractured and Broken Teeth:

Such chips can be either minor or major and either involve the nerves and vessels of the tooth or not. In minor ones, sometimes just rounding off the sharp edges and/or doing a small white filling on the tooth will ensure bacteria cannot infiltrate the tooth and damage the pulp and cause issues later in life. If the chip or fracture is major, then the tooth may require a root canal therapy which is removal of the nerves and vessels inside the tooth and replacing them with a filling material then doing a restoration on the tooth itself to restore the broken or fractured part. These teeth typically will discolor over time and will require a veneer or a crown later in life. If the tooth’s development hadn’t been completed before the trauma happened – it may require us to allow the development of the root to finish before doing all this. In any case, major fractures can be complicated and not attending to them can severely hamper the life and longevity of the tooth.

If the tooth is badly broken down to the point that it cannot be restore anymore with current dental technology and materials, we will recommend that the tooth be taken out and the space maintained. As the teeth that go through trauma are usually the front teeth, replacing them immediately may not be possible as most restorations like dental implants, bridges, etc can only be done after the development is complete and the child has turned over 18 years or so. We will place a temporary prosthesis in the meantime that may need to be changed every now and then to help maintain the space for a future implant or bridge or a prosthesis.

Dislodged (Luxated) Teeth:

Due to the injury, teeth may be pushed to one side or out of or into its socket. These teeth typically need to be repositioned and stabilized as soon as possible. If it is a permanent tooth, it usually  requires a root canal therapy or treatment. If the tooth is still developing, then they may not need a root canal treatment and the stem cells can allow the tooth’s roots to complete formation and allow the pulp to heal. In any case, consultation and examination is the most important step.

Knocked Out (Avulsed) Teeth:

For an avulsed or knocked out tooth, immediate and emergency care is very important. If your child is over 10-12 years of age, we recommend that you wash the tooth gently by holding it from the crown part only and not the roots and place it back into the socket of the tooth if possible. To stabilize the tooth and minimize bleeding, gently bite on a clean gauze or a wet tea bag until you reach us. If this is not possible or if your child is below 10 years of age then we recommend placing the tooth under the tongue or in milk or in patient’s saliva or in save-a-tooth solution available at Drug Stores – if going to the drug store is going to cost you more time – avoid it and just place it in saliva. Do not brush the tooth outside the mouth or try to rub the roots clean just let gentle water stream do its job. If you’re not comfortable doing so, just store it and bring it to us within two hours. The longer you wait, the less will be chances of the tooth integrating back into the jawbone.

It has been shown that if the tooth is placed back within 30 min in a moist condition, it has a very good chance of success. This will avoid dental implants and tooth replacements in the long run and nothing is as good as your child’s own teeth. Therefore, whenever we can, we will save their natural teeth.

While all of these are true, primary teeth are usually not replanted and the socket is allowed to heal and if the space should be maintained then we will advise a space maintainer to do so so there is space for the permanent tooth. Replanting primary teeth may damage the developing permanent teeth and renders no real benefits.

Broken Jaws:

Sometimes, after an accident, you cannot bring your lower and upper teeth together and cannot close your teeth properly. A lot of times, there is a combination of dental and jawbone damage that needs to be addressed. In cases of broken jaws, we recommend immediate attention at Stouffville Smiles or if not then the emergency room. A broken jaw can cause long term TMJ or TMD issues and needs to be set in the proper position and stabilized with wires as it heals which could take six weeks or more depending on the severity of the fracture and the age. This is usually referred out to an oral and maxillofacial surgeon.