Fractured teeth are a common dental problem. Many wonder if a broken tooth can heal itself, much like a broken bone. However, teeth have a limited capacity for self-repair after a significant fracture, differing from other tissues due to their distinct biological makeup.
Why Teeth Don’t Heal Naturally
Teeth have a limited ability to repair themselves due to their distinct composition and lack of a robust blood supply compared to bones. The outermost layer, enamel, is the hardest substance in the human body. It is entirely inorganic and lacks living cells, blood vessels, and nerves. Once damaged, enamel cannot regrow or repair itself, unlike bone tissue which contains living cells and a rich blood supply.
Beneath the enamel, dentin contains living cells and has a poor blood supply, allowing for some limited, microscopic repair in minor damage. However, this internal repair mechanism is insufficient to “knit” together a true fracture that extends through the tooth structure. The innermost part of the tooth, the pulp, contains nerves and blood vessels. Its blood supply is also limited and constrained by the surrounding hard tissue, making effective inflammation and repair difficult if bacteria penetrate this area.
Understanding Different Fractured Tooth Types
The impact of a tooth fracture, and its required treatment, is largely determined by the type and severity of the crack.
Craze lines: Superficial hairline cracks, known as craze lines, affect only the enamel. They are generally harmless, common in adults, and often require no treatment beyond aesthetic considerations, as they typically do not cause pain.
Fractured cusp: A fractured cusp involves a portion of the chewing surface breaking off, either completely or partially, sometimes extending below the gum line. This type of fracture commonly occurs in teeth with large fillings.
Cracked tooth: A cracked tooth refers to a fracture that starts on the chewing surface and extends vertically towards the root, potentially reaching below the gum line. While the tooth does not split into two distinct pieces, the crack can irritate the pulp and often causes sensitivity or pain.
Split tooth: A split tooth is a more severe form where a cracked tooth has progressed to the point of separating into two distinct segments. This type of fracture often extends from the crown all the way to the root.
Vertical root fractures: Vertical root fractures are particularly challenging as they originate in the root of the tooth and move upwards toward the chewing surface. They often remain undetected until significant pain or infection in the surrounding bone and gum occurs.
Treating Fractured Teeth
Given the limited natural healing capacity of teeth for significant fractures, dental interventions are necessary to restore function, prevent further damage, and alleviate pain.
Dental bonding or filling: For minor chips or fractured cusps, dental bonding or a filling can be used. This involves the application of a tooth-colored composite resin to the damaged area. This resin is then shaped, hardened with a special light, and polished to match the tooth’s natural appearance.
Dental crown: If a larger crack or fractured cusp is present, a dental crown is often recommended. A crown is a custom-made cap, typically porcelain or ceramic, that fits over the entire remaining tooth structure, protecting it from further damage and restoring its shape and function. The process usually involves two visits, with a temporary crown placed initially.
Root canal therapy: When a crack extends into the tooth’s pulp, causing infection or significant sensitivity, root canal therapy becomes necessary. This procedure involves removing the infected or damaged pulp, cleaning and disinfecting the inner tooth, and then filling and sealing it. After a root canal, a crown is often placed to protect the treated tooth.
Extraction: For severe fractures, such as vertical root fractures or split teeth where the tooth cannot be saved, extraction is often the only viable option. Following extraction, dental implants or other prosthetic solutions can be considered to replace the missing tooth.