Broken Teeth

OUCH!

Just as a rule of thumb -Teeth that have been badly fractured may have an exposed nerve. If a badly fractured tooth has sharp pain or pulsing pain than you should see a dentist as soon as possible. If it is predictably “sore” , but not causing sharp pain, then this is a good indication that the nerve is not exposed and less immediate care would be fine.

In either case, the tooth will need attention within a week or so, to avoid decay, infection, abscess, and pain.

There are four basic possibilities when a person bumps a tooth or breaks a chunk of tooth off:

The tooth will simply receive a serious jolt, but does not have an obvious fracture. These teeth may have a hint of blood around the gum-line and they commonly hurt too much to chew on for a week or so. There is a small chance that the tooth’s injury may cause the nerve to due at any point in the future. No treatment is necessary, but care should be taken to avoid any trauma again for two weeks.
The tooth will fracture at the edge or corner, but the nerve tissue inside is not exposed. These teeth may just be sharp to the tongue, or they may also be sensitive to cold. For tiny chips we can simply smooth the enamel and there is only a small chance that the nerve of the tooth will die. For large missing pieces, we will add tooth colored plastic to the tooth. There is a 50/50 chance that the nerve may die if the fracture was large.
The tooth will fracture in such a way that the nerve is exposed. These teeth may be exquisitely painful or they may be numb. We must remember that the inside of the tooth was originally a sterile environment, but now the bacteria in the mouth has been able to get inside the hollow chamber where the never lives. There is a 99% chance that such a tooth will become infected, turn dark, and cause a great deal of discomfort and swelling if simply put a filling in to repair the fracture sight. Usually, the best course is to clean out the nerve chamber (a root canal procedure) and then seal the tooth permanently so that no bacteria can grow there.
The tooth may fracture “vertically” through the length of the tooth, so deep under the gums that we can wiggle a portion of the tooth but the root of the tooth remains firm. The only thing holding the tooth temporarily in place is the fragile gum tissue surrounding it. Sometimes gum surgery can create a situation that makes it practical to restore the tooth. Often though, these teeth need to be extracted because we can never get the tissue deep under the bone to heal properly.

“Baby teeth” and “Permanent Teeth” will tend to react similarly to a bump. If we have managed to avoid a root canal or extraction, then you should be careful for two weeks following the accident.

For two weeks do not use your teeth as compared to the neighbor teeth: no tough meats, hard pizza crust, hard breads, chewy candy, beef jerky, apples, etc…..
Look for any changes in the color of the tooth as compared to the neighbor teeth. T the first sign of the tooth darkening, call us for an appointment.
If a tooth ache, swelling or bubble on the gums becomes apparent, call us for an appointment.
Most teeth that have been bumped can be brushed lightly and thoroughly again after 48 hours. (Do not leave them alone longer than that or you can develop other needless problems.) Within two weeks you should be able to brush vigorously there again.
If the gum around the tooth has been cut, scraped, or pulled back in the accident,… this can be the most unpleasant looking result of the mishap… But it is the most forgiving, because gum tissue is remarkably quick t o recover. Usually this tissue is far too fragile and thin to stitch back in place. Unless you have a flap of gum the size of a dime, and thick tissue surrounding it, there is no way to suture it back in place. If left in place, undisturbed for 48 hours, it will likely reattach on its own.

In a day or so you may look at the tissue around the tooth and think it is infected because it looks white and mushy. This is simply the way a scab looks when you have been in the bathtub for several minutes. (The mouth is a constantly moist environment and the scab that has formed on the cut gums will persist in looking like a “bathtub scab”.)
Leave the area alone for 48 hours to allow the tissue to reattach, and then begin brushing this gum tissue lightly. (If you go more than 48 hours without removing the bacteria that collects there, then you will develop a dental infection!)

Lastly, it is important to understand that most teeth will give us signals of their future needs within a month after an accident. If a month passes without incident, color changes, toothache, or swelling, then you have a very, very good chance that the tooth will remain healthy.

But, there is always a slight chance that the tooth might change, spontaneously, at any point in the future sometimes months or years after the accident. Be sure to let us know if you notice anything suspicious.