Various types of fractures lead in frequency among injuries to permanent teeth; the central incisors of the upper jaw are most often damaged. As a percentage, fractures account for about 67% of all types of injuries to permanent teeth; for baby teeth this figure is much lower - about 7%.
The success of treating dental fractures directly depends on the speed at which the patient seeks dental care; in some cases, this must be done in the first hours after the injury occurs.
What is
Not everyone knows about a tooth fracture, but dentists encounter this problem quite often. Many fractures occur in children, boxers, stuntmen, and active sports enthusiasts. Another common option is accidents when a fracture is caused by accidental mechanical damage. It often occurs during an accident or fight.
As is the case with various parts of the body, a fracture negatively affects the anatomy and natural shape of the tooth.
A tooth fracture is a violation of the integrity of dental tissue (one or more of its layers) down to the tooth root. In most cases, the upper front teeth, in particular the central incisors, are affected. A fracture of the alveolar process, root or crown may also occur.
Classification of dental injuries
The ICD-10 (International Classification of Diseases) classification of dental injuries includes more than ten types of dental injuries. To summarize, all mechanical damage is divided into:
- for injuries to the tooth itself or fractures;
- tooth displacement or dislocation;
- damage to soft tissues and jaws.
It is also worth noting a bruise - minimal damage to a tooth when it looks intact and visually no damage is visible - no chips, no cracks. But due to the impact, the blood supply to the tooth pulp may be disrupted, and subsequently the tooth may darken. Tooth bruises belong to the first class of injuries according to ICD-10. It hurts to touch, bite and chew food.
First aid for a bruise is to give pain relief if necessary, and consult a dentist as soon as possible.
Common Causes
In addition to the factors mentioned above, it is also worth noting unqualified treatment. For example, when removing a lower jaw tooth with forceps, you can damage one of the upper teeth with the instrument. If a tooth is weakened by various diseases or is in poor condition, the likelihood of a fracture is very high. Of course, such cases are very rare, but they do happen. Another reason for a fracture is an error at the stage of selecting the size of the holes in the pins. It is important to note that the lack of treatment for caries also negatively affects the condition of the enamel, as a result of which sometimes eating solid foods can provoke a crown fracture. Do not forget about the anatomical features of the jaw. If its structure has certain defects, the pressure will be distributed incorrectly.
Prevention
Take regular care of your mouth, visit the dentist, and eat right. This will minimize the risk of damage.
Do not chew hard objects, get rid of such bad habits. At one point, your oral cavity may suffer. Do not eat excessively hard foods or dishes that may contain bones; eat them carefully.
Trust endodontic treatment only to an experienced, competent dentist. This will help avoid damage.
You can break a tooth through negligence. Try to avoid such life situations. The injury is very painful and the cost of recovery can be significant.
Diagnostics
If a tooth is fractured, you must consult a dentist. Of course, if the problem does not cause discomfort, which occurs in rare cases, there is no need to rush. But delay can cause even more serious damage, resulting in the tooth having to be removed. Fracture of the anterior elements of the dentition has an extremely negative effect on the beauty of the smile.
A specialist can easily diagnose a tooth fracture. You just need to establish the extent of the fracture and understand whether the remains of the tooth can be saved. To do this, an x-ray is taken, with which the doctor checks for displacement, damage to the root, adjacent tissues and the direction of the fracture. The specialist examines the injured area, analyzes the presence of external damage, swelling, and changes in the color of the enamel. The latter may be a sign of soft tissue necrosis or damage to the neurovascular bundle and filling of the dentinal tubules with blood.
If during percussion a person experiences painful sensations in the damaged tooth and nearby elements of the dentition, this may be a sign of injury to the periodontal and periapical tissues or tooth dislocation. Electroodontometric diagnostics may also be necessary, with which the doctor checks the viability of the pulp in the event of a serious fracture, so that in some cases it can be preserved.
Possible complications
A fracture of a baby tooth in a child usually does not lead to complications, as it is accompanied by the removal of a temporary tooth and subsequent observation.
In adults, trauma to a permanent tooth can lead to its loss and a long recovery process. Delayed contact with the dentist leads to:
- To an abscess of the maxillofacial area.
- The formation of phlegmon is a purulent-necrotic inflammation that can lead to sepsis or meningitis.
- Tooth loosening and loss.
- Acute pulpitis.
- Pulp atrophy, that is, its replacement with connective tissue.
- Inflammation of the periosteum (periostitis).
Long-term consequences of injury include root resorption, that is, resorption of the bone tissue surrounding the tooth. This phenomenon is normally observed in children when changing baby teeth.
If, after a minor injury, a person does not go to the dentist, then it should be taken into account that the integrity of the tooth may be compromised. A crack or break is not always noticeable outwardly, and the painful syndrome is mild. In this case, the tooth may not withstand normal chewing load. This can lead to a complete fracture.
Signs
The most common and obvious sign of a tooth fracture is pain, which in some cases can be very severe. Pain sensations increase noticeably at the moment of closing and opening the jaw. If we are talking about a minimal fracture (the enamel is damaged, but the pulp and dentin layer are kept healthy), the pain will be less noticeable compared to a tooth root fracture.
Fractures can be complete or incomplete. During the first, the pulp is opened, as a result of which various irritants can make the pain more severe. Complete fractures are considered to be a fracture of the entire root or its apex, as well as a fracture of the neck of the tooth. In case of an incomplete fracture, damage to dentin and enamel may occur.
Additional symptoms of tooth fractures may include loosening of teeth, problems with speech, bleeding gum tissue, and difficulty opening or closing the mouth.
Varieties
In addition to those mentioned above, there are the following types of fractures:
- Transverse. This is the least problematic option, especially if the pulp is not damaged. The choice of treatment method is determined taking into account the degree of the fracture. If only the crown is damaged, it can be increased. If the pulp is damaged, in most cases it must be removed, after which the tooth is restored based on the existing root. If, as a result of the fracture, only the root remains, the tooth is built up with pins.
- Longitudinal or vertical. In this case, it is impossible to restore the tooth with a pin, since the remnants of the root are not capable of serving as the basis for a crown or pin. If an element of the dentition is broken in half, it is very difficult to identify the problem. People often waste time, and the condition of the tissue quickly deteriorates, as a result of which the tooth is usually removed.
- Splintered and oblique. In such situations, the development of events occurs approximately the same as in the case of longitudinal fractures.
Crown fracture
This is one of the types of transverse fractures, it is quite easy to identify. The choice of treatment depends on the size of the chipped segment and the condition of the pulp. If the dentin is not damaged, but only part of the enamel is affected, a composite filling is the solution. In case of a fracture of the front tooth, extensions or veneers can be used.
If dentin is affected, doctors use special insulating pads. In cases where a tooth breaks in half and the pulp is damaged, it is removed and the canal is filled. Next, a pin can be installed followed by the use of a filling composite in order to restore the original shape.
A fracture of the neck of the tooth is also common. There are cases when the tooth wall breaks completely, but the pulp sac is not damaged. Typically, in such situations, specialists are in no hurry to get rid of the root, since it can become a good basis for a pin. In this case, in any case, the pulp is removed.
Root fracture
In the event of a tooth root fracture, a specialist analyzes its position to select the appropriate treatment. The fracture can occur near the neck, at the apex, in the middle part, or at the border of the upper and middle parts. In most cases, transverse fractures occur.
Diagnosis of such damage does not cause any difficulties. First of all, a person feels pain while chewing food and biting it. During palpation, mobility of the injured element of the dentition is observed. When percussing and closing the jaw, the patient experiences discomfort and pain. And if the fracture is located near the crown, the enamel may take on a pink tint. Radiography helps to clearly establish the number of cracks, as well as their position.
Treatment options
First of all, patients are prescribed an odontometric and x-ray examination. The information obtained helps determine the degree of fracture, the presence or absence of fragments, the condition of the pulp, as well as the number of fractures and their direction. If there is minimal damage, for example, a fracture of a front tooth with a small chip, its natural shape is restored using appropriate composite materials.
If oblique, comminuted or vertical fractures are found, in most cases the tooth must be removed, since its root is not capable of becoming a full-fledged basis for restoration with a pin. Usually the problem is solved by tooth extraction and further use of implantation.
If a tooth is broken at the root, it can also be restored. Otherwise, a metal-ceramic crown is used, the appearance of which is completely identical to the shape and color of the natural tooth.
If the pulp is damaged, it is usually removed. Then the canal is filled and the tooth is restored using a filling. But you must also make sure that its shape looks natural. Otherwise, closing the jaw may cause subsequent damage to the restored tooth. Another possible problem is the formation of an incorrect bite.
If a dead tooth is fractured at the root, implantation is used or a crown is installed. When a wisdom tooth is fractured, specialists usually remove them immediately. Limited access to these teeth makes them extremely difficult to fully restore.
Restoration method – bridge prosthesis
Dental bridges got their name for their visual resemblance to a bridge - they are a structure of two crowns, between which artificial teeth are located.
Crowns are placed on your own ground teeth. The advantages of bridges are good aesthetics and reliable fixation. Dental bridges are permanent, making them very comfortable. This type of dental prosthetics requires several visits to the doctor. First, impressions are made, from which a temporary prosthesis is made in a denture laboratory or clinic - the patient will not experience discomfort when communicating due to the absence of a front tooth. At the same time, the dental clinic prepares the supporting teeth. They are ground to install a crown to a shape that is optimally suitable for this, and most often (but not always) they are depulped. After the grinding is completed, impressions are taken again, from which dentists make a permanent prosthesis, and after that it is installed on the supporting teeth and fixed with cement.
The main disadvantage of a bridge is the need for depulpation and grinding of healthy supporting teeth. In addition, its installation, which leads to an uneven load on the alveolar bone and its thinning in the area of the missing tooth..
Alveolar ridge fractures
The appearance of such fractures occurs as a result of a direct blow, which affects several adjacent teeth at once. Since the upper jaw is in front, it is the one that suffers in most cases. This fracture can be determined by painful palpation, as well as the presence of damage to the mucous membranes. The process begins to move, and elements of the dentition may be broken or dislocated. Part of the jaw may be torn out or supported only by soft tissues.
Such a significant jaw injury is usually accompanied by dizziness, severe headaches, traumatic brain injury, and nausea. Using an x-ray, you can determine the location and direction of damage, as well as determine whether the broken part can be repaired. If it is viable, the specialist installs a splint that provides fixation of the bone for full fusion. In case of serious injuries, teeth that cannot be restored are removed, followed by fixation of the alveolar process.
If the injury is irreversible, the broken part is removed, since in the event of a rupture of the periosteum and adjacent soft tissues, the process usually cannot take root. In such situations, the damaged area is covered by the periosteum.
Dislocation
When a tooth is dislocated, sometimes it is impossible to completely close the mouth, or the tooth becomes loose and changes its position relative to other teeth. How to distinguish a tooth dislocation from a fracture? If the appearance of the teeth has changed - they have become shorter, tilted, etc., and the gums are bleeding, then you are dealing with a dislocation.
First aid for dislocation is the most correct tactic: do not let the child close the teeth, do not touch them and do not try to set them back on their own, because such displacements can be accompanied by injuries to the bone and gums. It is best to immediately contact a dentist, who will take a three-dimensional photograph, return the teeth to the correct position, and apply dental plaster for several weeks. The sooner you do this, the better.
Experts distinguish between many types of dislocations, including partial, complete and impacted.
Partial dislocation
With such damage, the tooth partially falls out of the socket. Often the alveolar wall is damaged, there is a tear in the periodontal fibers, and therefore the tooth becomes loose, bleeding occurs, and severe pain occurs when pressing and chewing. However, the anatomical structure is not disturbed, so the main task is to fix the tooth in the correct position in the socket until healing. In case of partial dislocation, this is achieved using special caps or splinting. The key point is to get the victim to the dentist as quickly as possible.
Complete dislocation
The tooth completely falls out of the socket, which is accompanied by heavy bleeding. When a baby tooth falls out, it is not reinserted, since placing the baby tooth in the socket can damage the germ of the permanent one. But if a permanent tooth falls out, then the necessary first aid is to find the tooth, wash it with water, but do not rub it or treat it with alcohol, since there are still living cells on it. Then the tooth needs to be inserted into the socket or, if this is not possible, put the tooth in milk and call the clinic to get instructions on how to do this.
If the tooth is placed back into the socket within 5 minutes, the prognosis is favorable - the tooth will successfully take root. Over a period of 5 to 10 minutes, the chances decrease as the number of living cells decreases. If the tooth has been exposed to air for a long time and has dried out, it will not take root for long, just a few years.
In any case, you need to get to the clinic as soon as possible - preferably within half an hour. If this is not possible, then contacting a dentist is still necessary. It is necessary to carry out root canal treatment, since when a tooth is severely displaced or falls out completely, the blood supply to it stops.
Impacted dislocation
Milk teeth are very often driven deep into the socket, since when they fall, the impact force is directed from bottom to top. This is very dangerous for the buds of permanent teeth, which are located behind the roots of baby teeth. Due to such trauma, various disturbances in the formation of the enamel of permanent teeth can occur, which manifest themselves in the form of yellow and white spots or defects in the shape of the tooth. It is necessary to take a targeted picture on a visiograph to assess the risks for permanent teeth. If a baby tooth is impacted too deeply, it is removed to reduce the risk of developing defects in permanent teeth. Sometimes tooth reduction is performed, in which the dentist very carefully returns the impacted tooth to its correct position and then splints it.
Tooth injuries are often accompanied by damage to soft tissues - cheeks, gums, lips. In this case, the dentist prescribes mild antiseptics - most often chlorhexidine preparations, as well as a gentle diet without harsh foods.
Tooth extraction after a fracture
It is necessary to remove a tooth only if it cannot be restored. If, after a fracture, an element of the dentition becomes loose, it is necessary to seek the help of a specialist as quickly as possible.
Tooth extraction is performed under anesthesia. Thanks to this, a person can completely relax and also get rid of pain. Usually everything happens very quickly, but in complex cases when a serious fracture has occurred, difficulties may arise. Sometimes the specialist has to cut the gum and pull out the remaining parts of the root, after which sutures are placed in this place. After some time they are removed. Depending on the specifics of a particular case, a specialist may recommend physical therapy and the installation of a dental implant.
