Most traumatic dental injuries occur in children, but people of all ages can be affected. Whether the injury is a result of an automobile accident, a sports mishap, an altercation or a bad fall, the severity and type of injury will determine the treatment necessary.  

There are a number of common injuries that occur to teeth. Many of them affect the inner soft tissues of the tooth, known as the dental pulp. When the pulp becomes injured or inflamed, root canal treatment may be needed.  


Chipped or Fractured Teeth 
Chipped teeth account for the majority of all dental trauma. The remaining represent more serious problems, including dislodged and knocked-out teeth. Treatment depends on the type, location and severity of each injury. When any dental injury occurs, the most important thing is to see your dentist or endodontist immediately. The outcome, or prognosis, for your specific injury often depends on how quickly you see your dentist.   Most chipped teeth can be repaired with a simple filling. Sometimes a chip will expose the pulp of the tooth. Some exposures can be treated by placing a filling over the injured area. Other exposures, however, may require root canal treatment.   Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split teeth. Cracks may or may not extend into the root. If the crack does not extend into the root, the tooth can usually be restored by your dentist with a full crown. If the crack does extend into the root and affects the pulp, root canal treatment is usually necessary in an attempt to save all or a portion of your tooth.
Cracked Teeth
With their more sophisticated procedures, dentists are helping people keep their teeth longer. Because people are living longer and more stressful lives, they are exposing their teeth to many more years of crack-inducing habits, such as clenching, grinding, and chewing on hard objects. These habits make our teeth more susceptible to cracks.  
How do I know if my tooth is cracked?
Cracked teeth show a variety of symptoms, including erratic pain when chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes. In many cases, the pain may come and go, and your dentist may have difficulty locating which tooth is causing the discomfort.
Why does a cracked tooth hurt?

To understand why a cracked tooth hurts, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is the inner soft tissue called the pulp. The loose pulp is a connective tissue that contains cells, blood vessels and nerves.  

When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.  

How will my cracked tooth be treated?
There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.  
After treatment for a cracked tooth, will my tooth completely heal?
Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.   The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your Endodontist about your particular diagnosis and treatment recommendations. They will advise you on how to keep your natural teeth and achieve optimum dental health. What can I do to prevent my teeth from cracking? While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.
  • Don't chew on hard objects such as ice, unpopped popcorn kernels or pens
  • Don't clench or grind your teeth
  • If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth
  • Wear a mouthguard or protective mask when playing contact sports
Craze Lines
Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearances.
Fractured Cusp
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your tooth will usually be restored with a full crown by your dentist.
More information about Cracked Teeth

This crack extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Your dentist will then restore your tooth with a crown to hold the pieces together and protect the cracked tooth. At times, the crack may extend below the gingival tissue line, requiring extraction. An untreatable tooth is shown in the graphic below. 

Early diagnosis is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.


 

Split Tooth
A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth.  
Vertical Root Fracture
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may, therefore, go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However, Endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.
Dislodged Teeth
During an injury, a tooth may be pushed into its socket. This can be one of the more serious injuries. Your Endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury, and medication, such as calcium hydroxide, may be put inside the tooth. A permanent root canal filling will be placed at a later date. You should continue to have the tooth monitored periodically by your dentist to assure proper healing. Sometimes a tooth is pushed partially out of the socket. Repositioning and stabilization of the tooth are usually necessary. If the pulp remains healthy, no additional treatment may be needed. If the pulp is injured, your dentist or Endodontist may need to start root canal treatment. Medication, such as calcium hydroxide, may be placed inside the tooth and should be followed by a permanent root canal filling at a later date.




Avulsed Teeth
If a tooth is completely knocked out of your mouth, time is of the essence. If this type of injury happens to you, pick up your tooth by the crown, or chewing portion. Try not to touch the root. If the tooth is dirty, gently rinse it in water. Do not use soap or any other cleaning agent. If possible, place the tooth back into its socket. Go to the dentist immediately. If you cannot put the tooth back in its socket, be sure to keep it moist. The less time the tooth spends drying out, the better the chance of saving the tooth. Solutions to keep your tooth moist are available at local drug stores. You can also put the tooth in milk or a glass of water with only a pinch of salt, or you can simply put it in your mouth between your gum and cheek. Bring your tooth to the dentist immediately. 

If the tooth has been put back in its socket, your dentist may stabilize the tooth with a splint and check for any other facial injuries. If the tooth has not been put back into its socket, your dentist will examine the tooth to determine if it is still intact and check for other facial injuries. Your dentist will clean the tooth carefully and place it gently back into the socket. Your tooth may need to be stabilized with a splint for a period of time. Depending on the stage of root development, your dentist or Endodontist may start root canal treatment. A medication may be placed in the tooth followed by a permanent root canal filling at a later date. The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist may influence the type of treatment you receive. You should contact your physician to see if a tetanus booster is necessary.  


Immature Teeth

An immature permanent tooth that has been dislodged may require minimal or no treatment other than follow-up until it has matured. If the tooth is severely dislodged, orthodontic or surgical repositioning and stabilization may be necessary.  

If an immature permanent tooth has been out of the mouth for less than one hour, the tooth should be placed back in its socket, stabilized and watched closely by your dentist or endodontist for three to four weeks. During this time, your dentist will look for changes in tooth colour, pain, swelling or loosening of the tooth. If any of these problems arise, an apexification procedure followed by a permanent root canal filling may be needed.  

If the immature permanent tooth has been out of the mouth and dry for more than one hour, the tooth may be put back in the socket, filled with medication and re-evaluated in six to eight weeks. The long-term health of this tooth is generally poor, so your dentist or Endodontist may discuss other treatment options with you.