broken-teeth-and-fillingsWhy do I have broken teeth?

Your teeth are the hardest part of your body and are designed to withstand a lot of wear and tear. However, as we grow older and continuously expose our teeth to eating, chewing, drinking, brushing, clenching, grinding, and all sorts of other things, they will over time weaken and can sometimes break. The more things you have had done to your teeth- fillings and restorations etc, the more things that can potentially break. Some other common factors that contribute to a cracked or broken tooth are:

  • Biting on something hard- e.g. olive pits, nuts, bones in chicken, seeds in bread
  • Trauma/ Accidents (falling or being hit in the face or mouth)
  • Cavities and tooth decay
  • Large, old fillings that don’t support the remaining tooth enamel
  • An abnormal bite
  • Lots of sugary/acidic foods and drink
  • Bruxism or clenching

Chewing when you have a cracked tooth can hurt, because it causes the separate pieces to flex, setting off the nerve inside. It can often take hard foods to cause this movement and mean you don’t get pain on softer food. The pulp is very sensitive as it is full of nerves and blood vessels. If left untreated over time, the pulp will swell so much that it becomes irreparable and dies off. This can be very painful, and not just on chewing. It may then lead to an infection inside the tooth and an abscess may result.

What are the types of broken tooth?

A broken tooth can be a fractured cusp, cracked tooth, split tooth, or vertical root fracture. Craze lines are visible superficial cracks (seen often only in a bright light unless stained). They are very common in adults and often don’t require any treatment except aesthetically if this is a problem. It doesn’t cause any pain: they are really just superficial lines in the enamel.
On the other hand, a fractured cusp happens when a piece of the tooth’s biting surface breaks off. This usually happens to the tooth around a filling. When this happens the dentine is exposed and the tooth is often sensitive. Since dentine connects to the pulp- even if it isn’t sensitive- you need to see a dentist as soon as possible to try and protect the nerve inside.
A cracked tooth, however, means that a vertical crack has formed starting from the chewing surface of the tooth that runs towards the root. In this case, the tooth is not yet separated into pieces but it will gradually spread if left untreated. If the crack extends below the gum line, or through the tooth, the prognosis can be very poor and repairing it effectively rather difficult. In such circumstances it may need to be extracted. In most cases, a split tooth is the result of a cracked tooth’s progression. It has, of course, a crack but this has continued through the tooth to the point where the segments have already separated. Unlike the previous types of broken tooth, a split tooth can’t be saved intact. At this point it nearly always needs extracting. Occasionally one root may be sectioned and saved- this will be determined by the position and extent of the crack.
Lastly, vertical root fractures are vertical cracks that begin life at the root and work their way up to the tooth’s biting surface. This type of broken tooth is quite rare and can be quite difficult to diagnose as it sometimes doesn’t show any sign or symptom until it’s too late and the pain is severe. Oftentimes, Vertical root fractures are only detected when an infection has already formed in the surrounding bone and gums of the damaged tooth.

Why do I have broken fillings?

Unfortunately, nothing lasts for ever and anything in the mouth is subject to massive forces; not just pressure but temperature too- hot, cold, hot, cold. so over time this takes its toll. Repeated broken fillings and chipped teeth may be a sign of a grinding or clenching habit. The bigger the filling, the more likely it is to break and so when larger pieces of teeth are missing, a crown or onlay is generally more appropriate for the long term.

Are silver fillings one of the reasons why I have a broken tooth?

Although silver amalgam fillings have been used for many decades and are already proven to be safe, they are often one of the reasons for the unexplained breaking of a tooth. This is because metal fillings react to temperature changes in the mouth—so the fillings continuously expand and contract as we’re eating or drinking hot and cold foods. Over time (many years), this process causes your tooth to move and eventually form micro cracks. These cracks may eventually weaken the tooth so much until one day, the tooth simply breaks. The metal amalgam also expands slightly on setting and when this happens if there is not enough good strong wall to support the filling a small fracture may be set up that could take many years to become a problem.

How does a tooth break?

Since the tooth is one of the hardest parts of our body, the only time it gets broken suddenly (without prior cracks or fractures) is if we encounter an accident or injury that forces trauma to the tooth. Most of the time, a broken tooth happens gradually and slowly as a crack makes its way through the tooth. Take a look at the three layers of the tooth: the enamel, dentin, and the inner sensitive pulp. First, micro cracks form in the hard outer layer that is the enamel. This is very common as we grow older and is painless. It doesn’t require any treatment. However, when the cracks grow bigger and expose the dentin, that’s when you’ll start feeling sensitivity to cold foods. The most severe cracks may reach the pulp or split the tooth and this sensitivity often turns to pain and last much longer at this point.

What are the symptoms of a broken tooth or filling?

When you have a broken tooth or filling, you may experience pain that comes and goes when chewing, or sensitivity to temperature changes in your mouth. You may also feel that you’re getting sensitivity to sweet things even if you don’t have any dental decay. If the crack is through the tooth and bacteria gets in, there may also be swelling in the surrounding gum. Your tongue is a curious beast and can make even a little chip seem like a massive hole. Occasionally, if it’s very rough this can cause an ulcer on the gum or cheek. However, if the pain is chronic and doesn’t go away, this may mean that the damage has reached the pulp and the nerve inside has been affected. When this happens, you are going to want to see your Maroubra dentist as soon as possible. Of course it would be better if you came and saw us before- to try and prevent that from happening!

What happens when I go to the dentist?

Before any treatment is administered, your dentist will first obtain your medical history (or check it if you have been before) and conduct a complete oral examination to assess the case. During this time, your dentist will try to determine the location and cause of the pain by checking for any signs of swelling, sensitivity and tooth damage. Your dentist may also need to take X-rays and perform other tests to further determine what is causing the pain. Unfortunately, a cracked tooth can be hard to find and it rarely ever shows on a dental X-ray. This is because the X-ray beam must be exactly parallel to the crack before it can be detected on an X-ray. However, there are other signs of cracks that may show up. For example, if there is a vertical root fracture (cracks that begin in the root and go up towards the biting surface) your dentist may see vertical bone loss near the root of the affected tooth or an area of infection the crack has caused. Dentists use a bright lights, magnifying lenses and dyes to help try and determine the course of the crack. Having yourself checked by a dentist is very important as an untreated cracked tooth can (over time) lead to the nerve dying and an abscess flaring up. In severe cases, the tooth might as we have mentioned actually split in two. When this happens, your Maroubra dentist will no longer be able to save the tooth and it will have to be extracted. Here are some other treatment options depending on the severity of your broken tooth or filling:

  • Dental Filling or Bonding – If only a small part of your tooth is broken, your dentist may repair it by just filling it in. On your front teeth, this may be called a bonding but it is essentially the same thing; using a tooth-colored composite resin to restore the integrity to the tooth.
  • Crowns – This treatment is done if the tooth has a large area needing restoring be it decay or that a large piece of the tooth broke off or big existing filling has failed. In this procedure, your dentist will file your tooth down slightly to receive a tooth-shaped cap to protect the tooth and enhance its appearance.
  • Veneers – This treatment is very common especially if the damaged tooth is located at the front. This procedure entails the dentist putting a thin coating of tooth-colored porcelain or resin composite material to cover the whole front tooth. The broken part of the tooth will have a thicker coating to fill in the missing part.
  • Root Canal – If the break is severe enough that the pulp gets damaged, Root Canal may be necessary first and then if it is a back tooth, a crown will be required, if it is a front tooth then sometimes a filling is adequate depending on how much is actually missing. In this procedure, the pulp is removed to avoid infection then the root canal is cleaned and sealed.

What treatments should I do at home if I can’t immediately go to the Maroubra clinic?

If going to the dentist is not possible as of the moment, try these home remedies to help ease the pain and discomfort of a broken tooth or filling. They are temporary fixes so be sure to try and get an appointment as soon as possible:

  • Avoid chewing in the affected area
  • Only eat soft foods
  • Take over-the-counter pain medications such as paracetamol (assuming this is ok for you)
  • Rinse your mouth with warm salt water
  • Cover the sharp edge of the broken tooth with either a piece of wax paraffin or sugarless chewing gum to avoid getting cut
  • If your filling is made of gold or ceramic inlay, keep the broken filling—your dentist may be able to reattach it to your tooth after cleaning. If in any doubt- keep it- we can even re-attach front teeth fragments sometimes.
  • Replace the dislodged filling with a temporary dental filling with zinc-oxide that you can buy from your local drugstore to alleviate the pain caused by particles coming in contact with the tooth’s nerves
  • Thoroughly, but gently, brush and floss your teeth to get it as clean as possible
  • Rub eugenol or oil of cloves directly to the gums to numb it

Best to see your dentist as soon as possible, as earlier intervention is always best.

After getting treatment from my dentist, will the broken tooth completely heal?

Cracks are not always predictable and may continue to move through the teeth over time. How it heals depends on the level of the crack, whether it has been completely eliminated or is still present. The habits that caused it and much more. Best to see your dentist as soon as possible, as earlier intervention is always best.

How can I prevent getting a broken tooth or filling?

While getting a broken tooth or filling is not completely preventable (some due to accidents), we can always take some measures to make our teeth less susceptible to cracks. For example, avoid chewing on hard foods such as ice, pens, or candies, and use a mouthguard if you grind or clench your teeth while you sleep or if you play contact sports (ESSENTIAL!) You may also opt to get a white plastic composite filling so you won’t have to worry about the fillings expanding or contracting when eating hot or cold foods. Removing amalgams just to do this is a contentious issue. If you have an abnormal bite, having an orthodontic treatment can be an advantage and if you have missing teeth filling your gaps to help spread the pressure and the load is important. Yes- this means filling in those gaps where you have had teeth removed.