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.
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.
- 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
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.
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.