What are the treatment options for a broken tooth?

Treatment of Broken Teeth

Treatment depends on the depth of the fracture: enamel-only cracks require minimal intervention or simple smoothing, enamel-dentin fractures need bonded restoration within days, and fractures exposing the pulp demand immediate pulp therapy to preserve tooth vitality. 1, 2

Immediate Assessment

When evaluating a broken tooth, determine the fracture depth through clinical examination:

• Enamel-only fractures appear as superficial cracks without dentin exposure and typically cause no sensitivity 1
• Enamel-dentin fractures expose yellowish dentin and often cause temperature sensitivity 1
• Complicated crown fractures expose pink/red pulp tissue and require urgent intervention 1
• Check for tooth mobility, which may indicate root fracture requiring radiographic evaluation 1, 2

Treatment Algorithm by Fracture Type

Enamel-Only Fractures (Uncomplicated)

• Smooth sharp edges with a dental handpiece or leave untreated if already smooth 1
• No urgent dental referral needed, but monitor for signs of pulpal necrosis (discoloration, swelling, sinus tract formation) 1, 2
• Prognosis is excellent with the tooth remaining intact and functional 2

Enamel-Dentin Fractures (Uncomplicated)

• Refer to dentist within a few days—the more sensitive the tooth, the more urgent the referral 1
• Restoration options include tooth-colored composite bonding or rebonding the original tooth fragment if available 1
• The American Academy of Pediatric Dentistry recommends bonded composite or full coverage crown to bind tooth segments together and prevent crack propagation 2
• Covering exposed dentin reduces bacterial contamination risk and discomfort 1
• Monitor for pulpal necrosis during follow-up 1

Crown Fractures With Pulp Exposure (Complicated)

• Immediate dental referral is mandatory to preserve pulp vitality 1, 2
• Timeliness is critical, especially in immature permanent teeth (within 3 years of eruption) 1
• For immature teeth with open apex: pulp therapy allows continued root development 1
• For mature teeth with closed apex: root canal therapy is the treatment of choice 1, 2
• Extraction is indicated only if patient behavior precludes pulp therapy or the crack extends deep into the root 2

Root Fractures

• Obtain radiographic examination when crown mobility is present 1, 2
• Fracture location determines prognosis: apical fractures have excellent outcomes and rarely need treatment, while fractures near the crown have poor prognosis 1, 2, 3
• Extraction is indicated for root fractures near the crown with excessive mobility and aspiration risk 2
• For severe crown-root fractures, the crown fragment must be removed and the remaining fragment assessed for orthodontic extrusion or submersion 1

Immediate Symptomatic Management

• NSAIDs (ibuprofen) are first-line for pain control, with acetaminophen as an alternative 2, 3
• Apply cold compresses to reduce swelling 2
• Follow soft diet for 10 days and avoid temperature extremes with food and beverages 2
• Maintain gentle oral hygiene to prevent infection 4

Critical Pitfalls to Avoid

• Do not delay referral for pulp-exposed fractures—immediate pulp therapy within hours to days significantly improves outcomes for preserving tooth vitality 1
• Never store avulsed tooth fragments in water, as this causes osmotic lysis of root fibroblasts; use milk or saliva instead 1
• Do not assume enamel-only fractures are benign—all fractured teeth require monitoring for delayed pulpal necrosis 1, 2
• Failing to obtain radiographs when mobility is present may miss root fractures 1

Follow-Up Monitoring

• Monitor all fractured teeth for clinical signs of pulpal necrosis: crown discoloration, gingival swelling, increased mobility, sinus tract development 2, 3, 4
• Schedule follow-up examinations to assess healing and identify adverse consequences early 5
• For treated teeth, verify absence of periapical pathology on follow-up radiographs 4