What is the appropriate management for an adult patient with no significant medical history presenting with a broken tooth?

Management of a Broken Tooth in Adults

The appropriate management of a broken tooth depends entirely on the depth of the fracture: enamel-only fractures require only smoothing of sharp edges or no treatment, enamel-dentin fractures need dental referral within a few days for restoration, and fractures with visible pulp exposure require immediate same-day dental referral to preserve tooth vitality. 1

Initial Assessment and Classification

The first critical step is determining the fracture depth, which dictates both urgency and treatment approach:

• Enamel-only fractures (infractions) appear as superficial cracks or chips without tooth sensitivity and can be identified by their smooth surface 2
• Enamel-dentin fractures expose yellowish dentin beneath white enamel and typically cause temperature sensitivity 2
• Complicated crown fractures show visible red pulp tissue in the center of the fracture—this is the key red flag requiring urgent action 1, 2
• Root fractures require radiographic examination to determine location and prognosis 1

Treatment Algorithm by Fracture Depth

Enamel-Only Fractures

• Smooth any sharp edges with a dental handpiece and polishing bur, or leave untreated if the fracture site is smooth to touch 1, 2
• No urgent dental referral is needed 1
• Monitor for signs of pulpal necrosis (gray discoloration, gingival swelling, parulis formation) 1

Enamel-Dentin Fractures (No Pulp Exposure)

• Refer to a dentist within a few days—not emergent but should not be delayed beyond several days 1, 2
• The dentist will restore with tooth-colored dental material to cover exposed dentin and prevent bacterial contamination 1
• Prescribe ibuprofen for pain control as first-line, with acetaminophen as alternative 1

Complicated Crown Fractures (Visible Pulp Exposure)

• Immediate same-day dental referral is mandatory to preserve tooth vitality 1, 2
• The exposed pulp has high risk of infection from oral flora and requires pulp therapy (pulpotomy or pulpectomy) followed by restoration 1
• This is the most critical distinction to make during your initial assessment

Root Fractures

• Refer to dentist for radiographic examination to determine fracture location 1
• Fractures near the root apex have excellent prognosis; fractures near the crown have poor prognosis 1, 3
• Treatment ranges from monitoring to extraction depending on location and mobility 3

Immediate Pain Management and Supportive Care

• Prescribe ibuprofen (NSAIDs) as first-line for pain control, with acetaminophen as alternative 1, 2
• Apply cold compresses to reduce swelling 1, 2
• Instruct patient to maintain a soft diet for 10 days after any dental procedure to minimize mechanical stress 1
• Avoid temperature extremes with food and beverages 1
• Do not prescribe systemic antibiotics for uncomplicated fractures in healthy patients 1

Critical Red Flags Requiring Immediate Same-Day Referral

Beyond visible pulp exposure, watch for these additional urgent scenarios:

• Multiple teeth moving together as a segment, suggesting alveolar fracture 1, 2
• Severe tooth mobility with aspiration risk 1, 2
• Inability to close jaw properly or interference with occlusion 1, 2
• Extensive gingival or facial swelling suggesting abscess 1, 2

Follow-Up Monitoring for All Fracture Types

A common pitfall is assuming that minor fractures require no follow-up. All fractured teeth must be monitored for signs of pulpal necrosis, regardless of initial fracture depth:

• Gray discoloration of the tooth 1, 2
• Gingival swelling with increased mobility 4, 1
• Parulis formation (gum boil adjacent to the tooth root) 1, 2

These complications can develop weeks to months after the initial injury, so patients should be counseled to remain vigilant and return if any of these symptoms develop 4

Common Pitfalls to Avoid

• Failing to distinguish between enamel-dentin fractures and complicated crown fractures—the presence of visible red pulp tissue changes management from semi-urgent to same-day urgent 1, 2
• Prescribing antibiotics unnecessarily—they are not indicated for uncomplicated fractures in healthy patients 1
• Neglecting to counsel patients about delayed complications—pulpal necrosis can develop even after seemingly minor trauma 4, 1
• Storing avulsed teeth in water if replantation is being considered—milk or saline are preferred storage media, though this is more relevant for complete avulsions than fractures 4