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What is a tooth fracture? Symptoms and treatment

Dis Kirilmasi Nedir Belirtisi Ve Tedavisi

Tooth fractures mostly occur as a result of physical impacts. This condition can cause sudden and severe pain in the teeth. Sensitivity is also among the main symptoms. Individuals facing such a problem should be examined by a dentist immediately. If broken teeth are not treated, they can lead to more serious health problems. Especially fractures that affect the pulp can cause inflammation at the root of the tooth. Such conditions usually require root canal treatment. Therefore, tooth fractures should be addressed promptly and correctly.

Tooth Fractures: Treatment Process and Importance

Tooth fractures are a common health issue, especially among children and young people. These injuries usually occur during sports activities or traffic accidents. The state of the tooth fracture varies depending on the location and severity of the fracture. The tooth may partially or completely dislodge. Sometimes the tooth may even be ejected from the oral cavity. Therefore, tooth fractures are among the conditions that require immediate intervention. In such cases, dentists follow these steps:

  • Making an accurate diagnosis,
  • Preparing an effective treatment plan,
  • Regularly monitoring the patient’s condition.

This process is crucial to maintain the functionality and aesthetic appearance of the tooth. Quickly and effectively treating tooth fractures prevents serious complications that may occur in the future.

Factors Causing Tooth Fractures

Tooth fractures are a health issue caused by various factors. Physical impacts are usually the main cause of this condition. Accidents that an individual experiences can directly cause damage to the teeth. The structural characteristics of the tooth and surrounding tissues determine the impact of the trauma. This problem, which is particularly common during childhood and adolescence, continues for different reasons as age progresses.

  • Falls are the most common cause of tooth fractures and account for the majority of cases.
  • Injuries during sports activities,
  • Bicycle and motor vehicle accidents,
  • Physical violence incidents can cause tooth fractures.

Tooth decay also causes teeth to become more fragile. This condition can cause severe damage even from minimal traumas. In addition, certain anatomical features, such as a large overjet or insufficient lip structure, make the upper incisors more prone to trauma.

How Common Are Tooth Fractures?

Tooth fractures constitute a significant portion of oral injuries in all age groups. These injuries represent approximately 17% of all body injuries in children. Men experience these injuries more frequently than women. The majority of fractures occur in the upper jaw and typically affect the following teeth:

  • Central incisors
  • Lateral incisors
  • Canine teeth

These teeth are among the most frequently broken due to their position in the oral cavity. Single tooth fractures are more common than multiple tooth fractures. Permanent teeth are more sensitive to trauma compared to milk teeth. The prevalence of fractures in permanent teeth ranges from 6.1% to 58.6%, while this rate ranges from 9.4% to 41.6% in milk teeth.

Symptoms and Examination Methods

Tooth fractures occur due to traumatic impacts and show various symptoms. Firstly, enamel cracks are usually asymptomatic and contain micro-level traces on the surface of the tooth. These cracks can be detected using the transillumination method. On the other hand, enamel fractures appear more prominently and are usually seen on the cutting edges of the teeth. These fractures involve the breaking of the enamel layer but do not damage the pulp.

Enamel-dentin fractures involve both the enamel and dentin layers. These fractures occur without exposing the pulp and damage the deeper layers of the tooth. Dentists detect these fractures during clinical examination. Sensitivity or tooth mobility is usually not observed in these fractures. However, complicated enamel-dentin fractures affect the pulp and can cause sensitivity in the tooth as well as sensitivity to temperature and pressure.

Crown-root fractures can extend to the root of the tooth and cause serious structural damage to the tooth. These fractures are confirmed by both clinical examination and radiographic examinations. The broken pieces are usually mobile, and patients complain of pain and sensitivity related to these fractures.

Radiographic examinations play a crucial role in the diagnosis and treatment of tooth fractures. Recommended radiographic methods include:

  • Parallel periapical radiography
  • Two additional images taken from vertical and horizontal angles
  • Occlusal radiography.

If these radiographs do not provide sufficient information, a cone-beam computed tomography (CBCT) scan can be performed for more detailed imaging. This scan helps to more accurately determine the location and size of the fracture.

Especially when a tooth fragment is missing and the patient has soft tissue lesions, radiographs of the lips and cheeks can be taken to locate the missing fragment. This is important for locating and intervening in the fragment during the treatment process.

Treatment Approaches and Processes

The first intervention in tooth fractures is usually emergency treatment. Rapidly applying a cold pack to the injured area relieves pain and swelling. Dentists develop specific treatment protocols depending on the type and severity of the fractures.

  • Enamel Crack: If the crack deepens, it is sealed with etch and bonding resin to reduce the risk of bacterial contamination and prevent discoloration.
  • Enamel Fracture: The broken tooth can be restored with composite or, if necessary, the edges of the tooth can be adjusted. The first check-up is done after two months, followed by one year later.
  • Enamel-Dentin Fracture:
    • Binding agents and composite resin or glass ionomer are used to protect the exposed dentin.
    • Calcium hydroxide is preferred as a lining material when the dentin is close to the pulp.
    • The upper part is covered with glass ionomer.

If there is a broken piece, it is hydrated in water or saline solution 20 minutes before the procedure. This ensures tissue hydration and helps in repositioning the piece. Restorative options include direct composite restoration, indirect composite restoration, or ceramic restoration.

Enamel-Dentin Fracture with Exposed Pulp:

  • If the pulp is exposed, pulp capping or partial pulpotomy is performed depending on the situation.
  • Pulp capping is suitable if the exposure is short-term and the diameter does not exceed 1.5 mm.
  • Partial pulpotomy is ideal for young teeth with an open apex, especially if the exposure is large or long-term.

Pulp tests and X-rays are recommended 6 to 8 weeks, three months, six months, and one year after the treatment.

Crown-Root Fractures:

  • The first step is to remove the broken part to assess the extent of the fracture and the involvement of the pulp.
  • If the pulp is not exposed, the remaining dentin can be covered with glass ionomer or composite resin.
  • Treatment options include gingivectomy, orthodontic or surgical extrusion, and intentional reimplantation.

Root Fractures:

  • The main steps are repositioning the broken crown fragment and checking with X-rays.
  • The mobile segment is stabilized with a flexible and passive splint until the fracture heals.
  • The healing process is followed with check-ups after four weeks, six to eight weeks, four months, six months, one year, and then annually.

These processes aim to maximize the function and aesthetics of the tooth and improve the patient’s oral health.

Other Important Factors

There are some special conditions that need to be considered in the diagnosis and treatment of tooth fractures. Firstly, the evaluation of fractures in milk teeth should not be confused with the natural process of root resorption in these teeth. This situation is common in children and requires a different treatment approach. Sensitivity can occur for various reasons:

  • Luxation lesions
  • Root fractures

These symptoms are usually correctly diagnosed through a comprehensive clinical and radiographic examination.

Possible Complications

Tooth fractures can cause various complications. The most common issue is pulp necrosis, which results in the death of the living tissue of the tooth. In advanced cases, various reactions occur in the internal structure of the tooth:

  • Discoloration of the crown
  • Formation of periapical abscess
  • Pulpal obliteration

In addition, resorption of the tooth roots can be observed. There are two types of root resorption:

  • Internal root resorption
  • External root resorption

Fistula formation is another frequently encountered complication. These symptoms may indicate serious damage to the structure of the tooth.

Prevention and Patient Recommendations

Although there is no certain way to prevent tooth fractures, some strategies can reduce the risk. Custom-made mouthguards are of great importance for those who participate in contact sports. These mouthguards reduce the severity of impacts and can prevent traumatic injuries. Additionally, parents and school teachers should be equipped with first aid knowledge for emergencies.

Contact Sports and Precautions:

Custom-made mouthguards minimize trauma during contact sports.

These protectors should be made mandatory for athletes.

Education Programs:

  • First aid courses for parents and teachers.
  • Practical information on dental first aid after trauma.

These measures can reduce the frequency of tooth fractures and ensure proper intervention in case of emergencies.