Broken tooth - you should do this immediately
introduction
It is not uncommon for patients to suddenly find them one tooth aborted. See matching: Canine broken off. Nevertheless, a dentist must be visited as soon as possible. The dentist can do the broken tooth (or the tooth piece) possibly fasten again or with a suitable Filling material replace.
In the event of a breakage, it is advisable to keep the piece of tooth and bring it to the treatment appointment. If the broken piece of tooth has been swallowed or lost, there is only the possibility of a new one Tooth filling or a crown. Often the incisors are affected in falls.
If the defect is not clearly visible, most of those affected feel the break lines with their tongue: They perceive that the tooth no longer feels like it used to.
Figure broken off tooth
Broken tooth
Tooth fragment
- Tooth fragment,
broken tooth
or tooth piece
Do not clean! - Storage -
Glass of milk,
sterile saline solution,
moist storage! - One is ideal
Tooth rescue box
(Pharmacy) - As soon as possible
Go to the dentist
(up to 24 hours) - Attached tooth fragment
(special adhesive technology,
Plastic glue)
You can find an overview of all Dr-Gumpert images at: medical illustrations
causes
A tooth can break off for several reasons:
By far the most common occurrence of this is in connection with an accident in which very strong forces act on the Tooth substance act.
Sports accidents top the list of possible causes. Many sufferers report that they drink from severe glass bottle slipped off the lips and then the bottle hit the tooth. In addition, many patients present themselves in the dental practice to whom a spoon has hit the tooth too hard or who hit a hard object (bone or sweet) have bitten.
In addition, teeth that are already filled with roots are particularly often affected. This is due to the fact that during the Root canal treatment Both the nerve branches and the blood vessels from inside the tooth must be removed.
Sooner or later this leads to an insufficient supply of the tooth substance, which then becomes porous and unstable. The same risk applies to resected teeth.
Furthermore, many broken teeth are teeth that are due to extensive carious defect (tooth decay) had to be supplied with a lot of filling material.
The Dentin (Dentine) is one of the hardest, most resistant materials of all and can therefore withstand particularly high forces. However, if in the course of a carious defect a lot of dentine has to be removed and replaced by an artificial material, the resistance of the affected tooth automatically decreases and it tends to break off much more easily.
Cause tooth decay
Tooth decay can often cause a piece of the tooth to break off. This can happen in two ways.
On the one hand, the tooth can be very badly damaged by caries. In this case, the hard external substance of the tooth has been attacked, perhaps the bacteria have already penetrated the inside of the tooth. As a result of this attack, the tooth is no longer so strong because the substances that give it stability have been weakened or have disappeared. Now it can happen that a piece of the tooth breaks off when chewing.
Another case is when a tooth that has been exposed to strong carious influences in the past has been treated with fillings. The caries has been removed and the areas have been filled with a special material. But even at these repair points, the tooth can break off, as the point was added later and thus represents a weaker point in the tooth than if everything consists of a natural material such as tooth enamel. If the tooth decay has progressed so far that a root canal treatment has been carried out, it is not uncommon for the tooth to break off, because such a tooth is more unstable and more prone to breakage due to the lack of the supplying vessels.
Read more on the topic: Caries
Tooth breaks off after root canal treatment
After a root canal treatment, a tooth becomes brittle because all supplying vessels (blood and nerve vessels) have been removed from the pulp. Because the tooth is no longer alive and is supplied with nutrients, it can break more easily. The dental guideline advises root canal treated teeth to be crowned quickly after the end of the root canal treatment so that they are protected from fractures. Because once it is fractured, it can break off so deep that it is no longer worth preserving and has to be pulled.
The dentist makes this diagnostic decision based on where the tooth is fractured. The boundary represents the enamel-cement boundary, which marks the transition between the tooth crown and tooth root. If the tooth is not broken below this limit and the tooth can still be tolerated in its biological width, it can still be treated.
After a root-filled tooth has broken off, restorative therapy consists of treating the broken off part as quickly as possible so that other parts of the tooth do not break off. The tooth is built up beforehand with plastic or cement and the broken off area is replaced by a filling material. Then the tooth has to be fitted with a crown as quickly as possible. Furthermore, a pin is often inserted into the root-filled tooth, which protects the tooth from pulling forces. This pin can be a fiberglass pin or it can be made from cast metal.
The crown shape is then prepared on the post structure, which is cemented in, and finally the crown is attached to it. The broken tooth does not usually cause pain after the root canal treatment because it is not vital and no longer feels any stimuli. Pain is more likely to occur through the surrounding tissue, which may be irritated by the fracture.
You might also be interested in: Pulp necrosis
What to do?
Regardless of the way in which the tooth has been lost, whether it is broken, loosened or knocked out, it is always advisable to visit a dentist or dental clinic as soon as possible. Dental clinics offer an emergency service at later times or on weekends or public holidays, or a dentist is on call.
The broken tooth or the missing piece of tooth should be found and brought to the appointment. It can best be stored in a glass of milk, in a sterile saline solution or in a special tooth rescue box. Tooth rescue boxes contain special nutrients for the tooth, which can extend its extraoral (outside of the mouth) life up to 48 hours and can be purchased in pharmacies. The tooth should be restored using one of the three options within 30 minutes.
When repositioning, you should make sure that you only touch the tooth by the crown. Attempts to reinsert the tooth yourself are not advisable as this can destroy the fine fibers of the root. The treating dentist is given the chance to replace the broken piece or the tooth.
Read more about this under: Tooth broken off - what to do?
First aid
People who have broken a tooth can make the dentist's work much easier with ideal behavior. First and foremost, the patient should take care that Tooth fragmentIf possible, collect them and bring them to the office hours.
Unfortunately, this is not always possible because the broken piece of a tooth can be very small and / or can be swallowed quickly. The broken piece must then be preserved. For example, storage in liquids containing alcohol.
If a tooth breaks off during the weekend, on public holidays or on vacation, an emergency dental service or hospital should be visited as soon as possible. The faster the treatment, the more likely the tooth can be restored by gluing the fragment.
However, if the patient waits too long to see a dentist, the only thing that can be done to save the tooth is an artificial one Filling material, one Crown or one Partial crown can be applied.
Which home remedies help?
There are no home remedies that can help with a fractured tooth. Chamomile tea or chewing on cloves only helps with irritation of the gums, which can often be an accompanying symptom of a fall and a traumatized tooth. However, if the tooth has become unstable and broken, for example due to caries, no home remedies can cure the caries or fill the existing hole.
What to do if the nerve is exposed
If the tooth has broken off in such a way that the nerve and vascular chambers are exposed, the only option is usually to treat it with a root canal treatment. If the tooth has broken off and the pulp marrow and the vessels in it are not contaminated by bacteria, there is theoretically the possibility of trying to cap the nerve chamber.
However, since the pulp has already come into contact with saliva in almost all cases and is bacterially infected, this therapeutic approach is not considered. After root canal treatment and successful root filling, there is an increased risk of fracture and the tooth should be crowned quickly to protect it.
What is behind a black discoloration of the tooth?
A dark tooth discoloration is the reason for the death of the vessels that lie within the medullary chamber of the tooth. The supply of nutrients through the vessels ensures that the tooth does not lose its water reservoir and remains resilient. If this condition is no longer given due to a bacterial infection or a fracture and the vessels are devitalized, the tooth becomes brittle and discolored from dark gray to black.
Read more on the topic: Dead tooth
The tooth turns black when blood remains inside the tooth chamber; this blood breaks down into iron, which is black and is deposited in the enamel. Even a canal that has not been optimally rinsed during a root canal treatment can cause a discolored tooth after completion if there is still blood in the canal. In the case of a fracture, these discolorations come to the fore because the lightest layer, the enamel, breaks off and the discolored layer near the medullary appears. If the fractured tooth is left untreated, tooth decay can also develop, causing black discoloration and "decay".
Read more on the topic: Symptoms of tooth decay
glue
If a tooth has broken off, the dentist may be able to glue it back on. However, the prerequisite for this type of treatment is that the patient concerned finds the fragment, preserves it and hands it over to the treating dentist.
However, many patients report that the broken tooth could not be found or was even swallowed. In addition, a patient who has broken a tooth should see a dentist as soon as possible. The probability of being able to glue the broken tooth fragment back on decreases enormously after just a few days.
If possible, a broken tooth fragment should be kept in a glass of milk or a special nutrient solution. There are now also special tooth rescue boxes that can be purchased in pharmacies.
With suitable conservation, the tooth fragment can be glued to the tooth stump in the jaw for about 24 hours. To bond the tooth, the dentist usually uses a plastic adhesive that has to be cured by polymerization. After the tooth has been attached, however, it should be spared for hours to allow the adhesive to harden completely. In addition, it must be borne in mind that a tooth fragment can only be glued on if the medullary cavity has not been opened. In this case, the tooth nerve usually has to be removed and the root supplied with an artificial filling material.
As a rule, the broken tooth is built up after the root canal treatment using materials containing plastic. If there is a large loss of substance, it may be necessary to produce a crown or partial crown.
Breaking points
Generally, there are no places where teeth tend to break off. In some sufferers, the tooth breaks off as a whole. In dentistry, one speaks of a complete tooth breakage. Basically, the crown of the tooth is completely separated from the tooth root in the jawbone. In such cases it is extremely difficult to preserve the tooth because the pulp and the root fibers in it are damaged.
The method of choice is then a root canal treatment or the removal of the root stump. A tooth can also completely break off on just one side.
If the root fibers were only slightly damaged or not damaged at all, the fragment can be glued on. However, it does not always succeed in saving an affected tooth.
In the case of broken tooth corners or small fragments, the treatment is a lot easier. Usually the fragment is simply glued on or, if the fragment is lost, replaced with a plastic filling material.
The majority of the cases in which a tooth breaks off are teeth that have already been filled. In most cases, not a piece of the natural tooth substance breaks off, but only a piece of the filling material. This is the ideal starting point for the treating dentist, because the defect can then be remedied quickly and easily by placing a new filling.
Generally, parts of molars break (Molars) or premolars (Premolars) with a higher probability. This is due to the significantly higher stress during the chewing process. Biting on a hard piece of candy or a bone can break off your teeth.
Incisors, on the other hand, rarely break off as a result of an accident, but rather because of a dental disease. This is a reason to make an appointment with the dentist as soon as possible and to clarify what type of disease the affected tooth is. Spreading the disease to other teeth should be urgently avoided. In addition, the unsightly appearance of a broken incisor pushes most patients to the dental office quickly.
The fact is that once a tooth has broken, careful oral hygiene becomes increasingly difficult. Broken edges have tiny notches that are almost impossible to reach with the bristles of a toothbrush: a carious defect is often the result.
In most cases, a broken incisor can be preserved without problems and provided with a plastic filling material, a crown or a partial crown.
Broken molar tooth
The premolars and molars belong to the molars. In contrast to the incisors, these are intended to chop up food and can break easily in the process.
Very high chewing forces act on the teeth when chewing, so that when biting on a hard piece of candy or a bone, there is a high probability that a tooth will break. This happens even more easily if the teeth have been treated with root canals or have decayed, as their substance is then weakened. Usually one does not see such changes due to the rear position in the oral cavity itself.
With a broken molar, a quick visit to the dentist should be aimed for so that the existing fracture point is closed as quickly as possible. It can have sharp edges and can easily be attacked by bacteria. Here, too, a break may not be visible, so that if you have any concerns you should be on the safe side and seek medical advice. Often something does not have to have broken off from the tooth, but an older filling can be affected, which generally becomes more prone to breakage over time.
Read more on this topic at: Molar broken off
Broken front tooth
Most often after a fall or trauma, one of the incisors fractures due to its anatomical location. After an accident it is advisable to visit a doctor or the hospital as soon as possible in order to exclude or treat a skull and brain injury. If the craniocerebral trauma is excluded, the dentist should be visited so that further treatment of the incisor can be clarified.
Read more on the topic: Incisor wobbles
If the tooth is not only fractured but also loose, it must be splinted so that the separated fibers can regenerate and strengthen the tooth. The broken piece can be filled with plastic, depending on its size, and provided with a root canal treatment and a subsequent crown when the pulp marrow is open.
Read more on the topic: Broken front tooth
Broken canine tooth
If the canine breaks, almost the same applies as for an incisor. After clarifying the skull and brain trauma, a dentist should be consulted quickly who will treat the fractured tooth. Depending on the size of the defect, the lesion can be filled, if the pulp is opened, root-filled, crowned or, in the case of a very deep defect, the tooth can be extracted.
Pain
A broken tooth does not always have to cause pain. In most cases it is even the case that the affected patient does not feel any problems from the loss of tooth substance. In the case of a broken tooth that does not cause pain, a dentist does not necessarily have to be consulted promptly. However, it should be noted that there is an increased risk of caries formation along the break lines.
Read more on the topic: Caries development
This fact is due to the fact that the breaking edges are usually not completely flat, but rather have depressions and for this reason more and more food scraps accumulate there. As a result, a breeding ground for bacteria and other pathogens is created along the break lines. Furthermore, it can be observed that a broken tooth reacts more sensitively to thermal stimuli (hot / cold) over time.
It is only advisable to go to a dental emergency service immediately if the (front) tooth has broken off in the course of an accident. In some cases, a broken tooth can lead to severe pain and / or bite discomfort.
This pain is usually a symptom of nerve irritation or damage. Pain in a tooth that has broken off can either be caused by a direct mechanical injury to the nerve or the consequence of a carious defect in the area of the fracture edge. In general, pain from a broken tooth cannot be relieved permanently without dental treatment. Painkillers such as paracetamol or ibuprofen can usually only suppress the symptoms temporarily.
The method of first choice for a painful broken tooth is to remove the affected tooth root and close the root canal with a suitable filling material.
Which costs can arise?
The costs of treating a broken tooth are not always covered by the statutory health insurance companies. In many cases, the patient concerned has to pay at least part of the dental bill himself.
If the tooth broke off during school sports, for example, an accident report should be sent to the responsible insurance company. In the event of such accidents, the school insurance institutions are often obliged to pay.
Furthermore, the cost of treating a broken tooth depends on the scope of the measures required. If the tooth fragment only has to be glued on, the costs are in the double-digit range. When opening the root cavity, however, extensive root canal treatment with removal of the tooth root must be carried out.
The costs of the root canal treatment are only covered by the statutory health insurance if certain conditions are met.
These conditions are:
- The tooth must be classified as worthy of preservation
- The tooth is part of a complete row of teeth without gaps
- The root canal treatment and the subsequent gluing of the tooth can prevent the row of teeth from being shortened backwards
- As a result of the measure, an existing denture can be obtained
In general, it can be said that the chances of receiving the cost of this section of treatment are significantly higher for anterior teeth.
In the case of patients who have healthy teeth without losing their teeth, the costs are usually borne without any problems. Furthermore, the price of therapy for a broken tooth, if the fragment cannot be glued, depends on the type of restoration desired by the patient (crown, partial crown, etc.).
Broken teeth during pregnancy
If for various reasons a piece of the tooth is present during a pregnancy breaks off, there is no need to panic.
As described above, the broken tooth should be properly saved and a dentist should be consulted as soon as possible.
He will then treat the tooth, but to what extent depends on the individual situation.
Of course, there are certain things to consider when treating, such as the administration of painkillers, one Anesthesia or the use of a X-ray machine. Most of these obstacles can be avoided, however, so that nothing stands in the way of treating the tooth.
The simple reattachment of a broken piece of tooth is not a problem, among other things. Larger, predictable interventions, such as pulling one Wisdom tooth, but should be done before or after pregnancy unless there is an emergency.
However, one should not ignore that the treatment of a broken tooth or the circumstances caused by it can be very stressful for the mother and the child, so that one should take this into account.
If the tooth has broken off as a result of a fall or a violent blow, care should be taken to ensure that other injuries have not occurred or that the unborn child may have suffered damage as a result.
When is a filling necessary?
A filling after a tooth fracture can have multiple causes. If there is caries underneath the fragment, it must be removed by the dentist and the defect treated with a filling. If the tooth is fractured due to mechanical damage, for example due to a fall or a blow, the lesion does not necessarily have to be replaced with plastic. If the lesion is minimal, the dentist can grind the edge smooth and fluoridate the tooth, which is completely sufficient.
From a certain size of the fracture, however, it must be filled with a filling. In the anterior region, a filling can also be necessary for aesthetic reasons, since otherwise the patient does not want to show himself in public.
Read more on the topic: Tooth filling
When is a provisional solution necessary?
A temporary restoration is necessary if the front teeth are damaged after a fall or trauma, so that the aesthetics must be restored. In these cases, a temporary is made in order to temporarily make the patient legally competent again until the definitive dentures are completed.
Furthermore, a temporary restoration is produced when a fractured tooth is ground for a crown or an inlay in order to protect it until completion, since it is more susceptible to thermal, mechanical and chemical stimuli due to the removed enamel layer.
When is a crown necessary?
If a tooth breaks off, it is possible that it can only be supplied with a crown. This variant occurs when a large piece of the tooth has broken off, so that only 20-25% of the tooth crown substance is preserved. If you were to try to build up this tooth with plastic, two thirds of the chewing surface would consist of the filling material, which cannot restore the tooth's chewing stability. The tooth could no longer withstand the chewing load because the plastic does not give it any stability.
So it would fracture again after a short time, since the defect is simply too big to be absorbed by the plastic to absorb the chewing force. It can happen that the tooth breaks off even deeper or even fractures the entire tooth crown and, in the worst case, the tooth is no longer worth preserving. The chewing stability can only be given if the tooth is protected from the outside by a crown.
Read more on the topic: Dental crown
A crown is also necessary after a tooth has received a completed root canal treatment. After the root canal treatment, the dead tooth becomes brittle and breaks more easily because it is no longer supplied by blood vessels. To counteract this scenario or to protect the tooth after a crown fracture, it should be crowned quickly.
Broken tooth in child
Children like to romp around outside, play with other children and are not yet able to assess possible dangers so well, which is why accidents often occur in which teeth are damaged. In most cases, the front incisors are affected.
In the respective situation, those affected should keep calm and look for the lost tooth, which can then be kept in a glass of milk or a special tooth box until the next visit to the dentist. If the tooth cannot be found immediately, the oral cavity should be searched to prevent it from being swallowed or slipping into the windpipe.
The found tooth should also not be disinfected or attempted to brush cleanly in order not to damage the fine structures. If it bleeds heavily, you can bite a cloth and cool it from the outside.
The sooner the dentist can put the tooth back in place (replantation), the higher the probability that it will grow back on. Outside a tooth rescue box, the tooth's chance of survival is around 30 minutes. The cement-forming cementoblasts must survive to enable successful insertion.
If a tooth is not reinserted and a gap is created, the neighboring teeth will begin to wander and tilt to close this gap. This can lead to changes in the chewing system with long-lasting consequences. In the case of fully grown dentition and permanent teeth, a suitable denture is then made and inserted.
If the knocked out tooth is still a milk tooth, it will be Not reimplanted again and the gap that has arisen provisionally, for example with a plastic tooth, until the development of the remaining teeth is complete and a definitive denture can be inserted. As an alternative, there are fixed or removable placeholders such as braces to which a tooth is fixed. In this way, the surrounding teeth do not tip over into this gap and the space is preserved for the permanent tooth that grows back, so that there are no problems in the dentition later. In addition to chewing, this also ensures the development of correct language formation.
