Tooth Fractures

Falls, sports, road traffic accidents and physical violence can fracture teeth. Dental caries can weaken enamel so that even minor trauma causes a break; increased overjet or lips that do not fully cover the upper incisors raise the risk of upper-incisor injury.

An enamel fracture stays within enamel and does not expose dentin or pulp. A crown-root fracture extends below the gum line and can involve the pulp; a loose attached fragment may be painful when tapped or pressed.

Children can fracture primary teeth in falls and collisions. Sports injuries occur more often in teenagers, while violence-related injuries peak between ages 21 and 25. Caries, increased overjet and inadequate lip coverage also make upper incisors more vulnerable.

A crown-root fracture is assessed clinically and with radiographs because its full extent below the gum line can be hard to see. Imaging may include a periapical radiograph, two additional angled views and an occlusal radiograph; CBCT is used when those views do not provide enough detail.

Small enamel infractions often need no treatment, although a more severe crack can be etched and sealed with bonding resin. An enamel fragment may be reattached, sharp edges smoothed, or the defect restored with resin composite. A pulp-involved fracture may require root canal treatment.

Treatment ranges from sealing a crack or smoothing an edge to restoring a tooth, root canal treatment, or extraction for some vertical root and severe crown-root fractures. That difference in treatment needed changes what a visit involves.

A deeper untreated fracture can lead to infection or an abscess. Reported complications include pulp necrosis, crown discolouration, pulpal obliteration, root resorption and periapical abscesses; pulp necrosis is reported most often.

Custom-made mouthguards can prevent traumatic injuries in contact sports. Good oral hygiene reduces infection risk, and avoiding excessive biting force on the treated tooth helps protect it after care.