What are the treatment options for a broken tooth in an adult?

Management of Broken Tooth in Adults

The management of a broken tooth in an adult depends on the type and severity of the fracture, with treatment options ranging from simple smoothing of rough edges to extraction and implant placement. 1, 2

Classification of Tooth Fractures

Different types of tooth fractures require different management approaches:

1. Craze lines

   • Minor cracks affecting only the enamel
   • Usually asymptomatic and require no treatment

2. Enamel fractures (uncomplicated)

   • Fractures limited to the enamel layer
   • Treatment: Smoothing rough edges or no treatment if edges are smooth 1
   • Generally minimal sensitivity and no immediate dental referral needed

3. Enamel and dentin fractures (uncomplicated)

   • Fractures extending into dentin but not exposing pulp
   • Treatment: Restoration with tooth-colored material or rebonding of the fragment if available 1
   • Referral to dentist within a few days is recommended
   • More sensitive teeth require more urgent attention

4. Crown fractures with pulp exposure (complicated)

   • Fractures exposing the pulpal tissue
   • Treatment: Immediate pulp therapy to preserve vitality 1
   • For mature teeth, root canal therapy is usually indicated
   • For immature teeth (less than 3 years after eruption), monitoring for continued root development

5. Crown-root fractures

   • Fractures involving both crown and root
   • Treatment: Removal of the crown fragment and assessment of remaining fragment
   • May require orthodontic extrusion and full-coverage crown

6. Root fractures

   • Fractures in the root portion of the tooth
   • Treatment depends on location - apical fractures have better prognosis
   • May require splinting for 4 weeks 1

7. Split teeth

   • Complete fracture extending through both marginal ridges
   • Often requires extraction or removal of the mobile segment

Immediate Management

For emergency situations:

1. For avulsed (knocked-out) permanent teeth:

   • Immediate replantation is the treatment of choice 1, 3
   • If replantation isn't possible, store in appropriate medium (milk, Hank's Balanced Salt Solution, or saliva) 3, 4
   • Avoid storing in water as it damages root cells 1
   • Seek immediate dental care

2. For fractured teeth with sensitivity:

   • Cover exposed dentin to reduce discomfort and prevent bacterial contamination 1
   • The more sensitive the tooth, the more urgent the dental visit

3. For teeth with pulp exposure:

   • Immediate dental referral for appropriate pulp therapy 1

Definitive Treatment Options

Based on fracture type and severity:

1. Conservative approaches:

   • Smoothing rough edges for minor fractures
   • Bonding with tooth-colored materials for uncomplicated fractures
   • Rebonding original fragment if available

2. Restorative approaches:

   • Composite restorations for moderate fractures
   • Full-coverage crowns for extensive fractures
   • Post and core buildup may be necessary for severely damaged teeth

3. Endodontic treatment:

   • Root canal therapy for teeth with pulp exposure or necrosis
   • May be followed by post and crown placement

4. Extraction and replacement:

   • For non-restorable teeth with severe fractures
   • Replacement options include:
     • Implants (maintain gap of at least 2mm between implant and facial bone wall) 2
     • Fixed bridges
     • Removable prosthetics

Post-Treatment Considerations

1. Follow-up care:

   • Monitor for signs of pulpal necrosis (discoloration, abscess formation)
   • Soft diet for 10 days after procedures 2
   • Good oral hygiene practices

2. Potential complications:

   • Pulpal necrosis
   • Alveolar bone loss
   • Damage to adjacent structures 2

Diagnostic Challenges

Cracked teeth can present diagnostic difficulties:

• Patient's symptoms and dental history are primary diagnostic tools 5
• Clinical aids like occlusal bite devices and cold water application help isolate the affected tooth 5
• Radiographs are secondary in making a diagnosis 5

Prevention

For patients with restored teeth or previous fractures:

• Consider protective devices (night guards, sports guards)
• Address parafunctional habits like bruxism
• Regular dental check-ups to monitor existing restorations

Remember that early diagnosis and appropriate treatment significantly improve the prognosis for broken teeth. The treatment approach should prioritize preserving tooth structure and function while addressing pain and preventing further complications.