From the Guidelines
The treatment for an open tooth fracture requires immediate dental attention to prevent infection and promote healing, with the goal of preserving the tooth and maintaining quality of life. The first step is to rinse the mouth gently with warm water to clean the area and apply a cold compress to reduce swelling. Over-the-counter pain medication such as ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) can be taken for pain management 1. If the fracture has exposed the dental pulp, a dentist will likely perform either a pulp capping procedure or a root canal treatment depending on the severity, as the timeliness of pulp therapy is crucial in preserving pulp vitality, especially in young permanent teeth 1.
For minor exposures, direct pulp capping using calcium hydroxide or mineral trioxide aggregate (MTA) may be sufficient, while more extensive fractures typically require root canal therapy followed by placement of a crown or other restoration to protect the remaining tooth structure. The dentist may prescribe antibiotics such as amoxicillin (500mg three times daily for 7 days) if there's a risk of infection. Prompt treatment is crucial because exposed pulp can quickly become infected, leading to more serious complications including abscess formation. The specific treatment approach depends on factors including the fracture's location, extent, and whether it extends below the gumline. In cases where the fracture line involves the root, known as a crown-root fracture, the crown fragment must be removed, and the health of the remaining fragment must be determined, with options including orthodontic extrusion and restoration or submerging the remaining root to maintain alveolar bone for a future implant 1.
Key considerations in the treatment of an open tooth fracture include:
- The need for immediate dental attention to prevent infection and promote healing
- The importance of pulp therapy in preserving pulp vitality, especially in young permanent teeth
- The role of root canal therapy and restoration in protecting the remaining tooth structure
- The potential for complications, including abscess formation, if prompt treatment is not received
- The consideration of factors such as the fracture's location, extent, and whether it extends below the gumline in determining the specific treatment approach.
From the Research
Treatment for Open Tooth Fracture
The treatment for an open tooth fracture can vary depending on the severity and location of the fracture.
- In cases of uncomplicated fractures involving enamel and dentine, immediate protection of the dentinal wound is crucial for preserving tooth vitality 2.
- For complicated enamel-dentine fractures, an endodontic treatment may be necessary when root formation is complete 2.
- If the fracture is deep or vertical, restoration with composite material or extraction may be indicated 2.
Endodontic Treatment
Endodontic treatment may be required in cases of:
- Complicated crown fractures 3
- Complicated crown-root fractures 3
- Supra-crestal coronal third root fractures 3
- Injuries where pulp necrosis is predictable or highly likely to occur 3
Follow-up Care
Regular follow-up is necessary to monitor the pulp for any adverse changes, particularly pulp necrosis and infection of the root canal system 2, 3.
Restoration
Restoration options may include: