When a front tooth has been chipped, there are a few options on restoring the tooth. If the chip is small enough, the area can be repaired by bonding tooth colored filling material to the enamel. I have many cases where that repair has lasted over ten plus years.
Large defects are better repaired by covering with a porcelain crown. The porcelain is extremely durable and color-stable and can last decades. With children, when a majority of these injuries occur, it is better to do a tooth colored filling, even with large fractures. The main reason is that at least a millimeter and a half of tooth enamel needs to be removed from the tooth in order to get a good cosmetic result and in a child, the nerve in the center of the tooth is extremely large. Taking 1.5 mm of enamel in a patient of that age group can be enough to either expose the nerve or injure it enough that root canal treatment would be needed later on. Also, in a child, the tooth continues to erupt out of the gums, so as the child matures, the edge of the crown can become exposed which can be very unsightly. When a tooth colored filling is done to repair a fracture, it is expected that it will have to be repaired or redone many times during the patient’s lifetime.
If a tooth has been displaced in a traumatic accident, as long as the x-ray doesn’t show any root fractures, then the dentist can usually move the tooth back into its original position. Then, the tooth is usually splinted to the adjacent teeth during the healing period. This is done by attaching a wire to the front teeth with composite. Composite is the tooth colored filling material routinely used to fill cavities.
When one of the teeth has been chipped, the primary focus tends to be on that tooth. However, in a traumatic injury to the mouth, it is not unusual to have multiple teeth having been injured. When a tooth fractures, then, the force of the blow is dissipated. Unfortunately, the intact teeth will transmit all of the energy of the insult directly onto the end of the root. The problem with this is that the end of the root is where the nerves and blood vessels enter the tooth. If the force is great enough, then the nerve and blood vessels can be severed. This will cause the nerve to die and will necessitate root canal treatment to save the tooth. It’s hard for a dentist to tell right away whether a traumatically injured tooth may need root canal treatment. Many times, it takes up to six months before a dead nerve can be detected, and there are times that the damage will show up decades after the initial injury.
If a front tooth has been chipped in a fall, and there is no telltale red dot in the center of the tooth indicating an exposure of the nerve, then immediate treatment is not necessary. It’s likely that the tooth would be very sensitive to cold, so cool liquids are best to be avoided. The tooth could also be painful to chew on. It is usually best to wait until your dental visit to rule out root fractures before attempting to chew on a traumatically chipped tooth. The teeth could also ache so a pain reliever with anti-inflammatory properties would be most helpful. Ibuprofen tends to work the best. Over-the-counter preparations come in 200mg tablets, so an adult could take as many as four tablets, for a total of 800mg per dose to stay comfortable. Once at the dental office, the dentist will x-ray the teeth, check for root fractures, and check for loose or displaced teeth.
X-ray of Root Fractures
If the root is fractured, the tooth may or may not need to be removed. It depends on where the fracture is. The closer to the end of the root, the better the chance that the tooth could be saved. If there are any teeth that are loose, they may need to be splinted in place. This would be just like placing a cast on a broken arm to allow for undisturbed healing.
Whenever a tooth is injured in a fall, there are certain steps that one must take. First and foremost, a head injury must be ruled out. When one has fallen or received a blow to the mouth, it is not uncommon to also incur trauma to the head. Especially when a tooth has been chipped and there is blood in the mouth, the focus of attention can be on the oral cavity. If there are any symptoms such as dizziness or loss of consciousness, a physician should be consulted. Once head injury has been ruled out, then the focus can be placed on the mouth. If a front tooth was chipped, look for a small red dot toward the center of the tooth.
Exposed nerve/ "red dot" after trauma
This should be checked after any blood has been rinsed away. The red dot is the tooth’s nerve. If it is exposed, there is a fairly high likelihood that it would need root canal treatment. A dentist should be consulted as soon as possible in that situation. The next thing to look at is to see if any teeth are loose or displaced. Again, if either of those conditions are present, a call to your dentist would be in order. Otherwise, it would be best to see your dentist at your earliest convenience so that he can x-ray the tooth to make sure that there are no fractures under the gums.