The problems our teeth present go beyond just dental caries; sometimes there can be discomfort, ranging from the slightest to  strongest pain, even to an almost unbearable level. It can be caused by a dental fracture. When we talk about dental fractures, we imagine they result from an accident or  strong impact that affects the mouth. However, their origins may be due to  “harmless” factors. Let’s review some of them:

CAUSES OF A DENTAL FRACTURE:

Teeth have a very complex, interesting, and unique internal and external mineral structure; each  has the necessary volume and shape to perform the work for which they were designed: the anterior teeth are made to cut and tear food, while the rear ones  grind food. All together, they create  the phonation and swallowing systems.

One of the most frequent causes is when the teeth are exposed to forces  not adequate to the support exerted or their location. They can reach the point of suffering fatigue  to a point that exceeds their flexing capabilities and the structure can fracture. These forces may have been applied consciously, as when we perform chewing movements or unconsciously when sleeping.

Frequent and/or excessive sudden changes in temperature in the mouth, going from cold to hot or vice versa suddenly, is also a frequent cause of dental fractures that range from very minor,superficial injuries (which generally result in unattractive lines in the teeth) to  sensitivity or hypersensitivity the degree of which depends on the structural damage This can cause discomfort from very mild and sporadic to very intense, frequent or permanent. 

Definitely, accidents involving teeth may lead to fractures with even more damaging results. That is why when practicing contact sports, it is advisable to wear a mouthguard. Fractures in children’s or adult’s teeth after a fall are also rather frequent.

Restoration procedures with designs and materials appropriate for the case can engender a greater  stress; for example, teeth showing a lot of loss of their structure, insufficient cusp protection, having had a placement of dentin pins and/or an inadequate  restorative material.

Occlusal trauma and related factors, functional forces, bruxism, parafunctional habits, the presence of foreign bodies in the mouth, bad tongue habits, certain oral accessories and piercings are also probable causes of eventual dental fractures.

CLASSIFICATION AND SYMPTOMS:

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The American Association of Endodontics classified dental fractures into 5 types:

1. Superficial fractures  limited to the crown of the tooth that generally do not cause any symptoms and with an excellent  treatment prognosis.

2. Dental cusp fracture:  limited  to the dental crown without affecting the root. can cause mild or moderate discomfort when biting or experiencing a sensation of cold; generally the tooth remains vital and has a good prognosis for treatment.

3. The fractured or broken tooth itself, both in the coronal portion and the root, will cause symptoms of acute pain when biting and occasionally when experiencing cold. The vitality of the pulp is variable, and the prognosis of the treatment may be questionable; It depends on the depth and extent of the fracture.

4. Dental fracture with separation of structures: compromises both the crown and the root of the tooth. It presents with severe pain when biting or chewing, and generally occurs in teeth that have been endodontically treated and had an inadequate restoration. In this case,the prognosis for recovery is poor, unless the fracture lies subgingivally.

5. Vertical root fractures: the fracture origin is at the root and presents with a vague pain. It is frequently related to periodontal disease. It mainly occurs in . The prognosis for recovery is poor and a resection of the affected root will be needed if it is a multi-radicular tooth. Diagnosis is difficult and the origin is generally only found when the tooth has been extracted and analyzed outside the mouth (or if the tooth has been lost somehow).

Is important to assess  the main problem of a cracked tooth and the possibility of bacteria penetrating the pulp, which can cause pulpitis and, ultimately, apical periodontitis. The critical issues involved in saving teeth with fissures are: proper confirmation of the cracks, improvement of the symptoms and signs, and proper choice of final restoration.

DIAGNOSIS:

Because symptoms are varied, an adequate diagnosis is often a challenge for the dental clinician. Yet  an early diagnosis is related to successful restorative management and therefore a good prognosis.

DENTAL HISTORY: Patients who have received extensive restorations and occlusal adjustments, have a probable history of parafunctions such as clenching, or display parafunctional habits,  sensitivity to cold, or sharp pain upon biting into hard foods (that ceases when pressure is removed) are important indicators. Symptoms will vary according to the depth and orientation of the fracture.

CLINICAL EVALUATION: must be carried out  by a clinical professional, including an auxiliary evaluation such as x-rays or  tomography. It may be necessary to add a periodontal evaluation since the presence of detailed caries is important.

BITE TESTS: pain when biting or pressing is always indicative of a dental problem in the affected tooth.

VITALITY TESTS: performed to determine if the damage affecting the tooth is reversible or irreversible as it helps determine the diagnosis of the fractured tooth.

TRANSILLUMINATION: transillumination tests will be necessary.he presence of fracture lines can be determined from the smallest to the largest, as long as they are in the dental crown or an area accessible to direct vision.

TREATMENT AND MANAGEMENT OF CASES:

The pain history associated with a cracked tooth may be confusing as it often suggests  dentine hypersensitivity, but the patient will  also complain of occasional tenderness upon biting (but only with specific types of food), indicating periapical periodontitis. However, the duration of the discomfort – which can remain severe and unchanged over many years – coupled with an absence of swelling or radiographic changes suggest non-odontogenic pain diagnoses such as trigeminal neuralgia or persistent orofacial pain.

Once a crack has been identified, the next stage is to assess whether the tooth is responsible for the patient’s pain. The patient will be asked to close firmly and slowly onto a resilient material (e.g. plastic saliva ejector or rubberised dental mirror handle) and then  to open quickly. If the tooth is the  responsible, the identification is immediate.

The treatment of a fractured tooth depends upon the location, direction, size, and angle of the fracture. Superficial fractures are easy to detect and  manage; they are usually treated with a restoration or crown.

Fractures where the dental pulp has been affected will require prior root canal treatment and a crown to protect the tooth.In the worst cases, a fractured tooth cannot be repaired, especially when the fracture has reached the dental root. In these cases there will be no other solution than to remove the tooth and replace it with a dental bridge or, ideally, a dental implant.

In short, the prognosis for restoring a fractured piece can be excellent, good, or poor. It depends on when it is identified and the way the fracture occurred.

CONTACT US

If you need help contact us at Channel Island Family Dental, as well as on our Facebook page. At Channel Island Family Dental, we are always attentive to your needs to make a timely diagnosis. In addition, our dentists in Oxnard, Santa Paula, Newbury Park  Ventura, and  Port Hueneme will guide you to the best treatment to give you back your best smile.

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