A broken tooth can range from a minor chip in the enamel to a severe fracture that extends deep into the tooth structure. Regardless of the severity, any break compromises the tooth’s protective layers. The hard outer layers, the enamel and dentin, shield the inner, soft tissue. When this defense is breached, the living components become vulnerable to the constant onslaught of oral bacteria. Ignoring this injury transitions the problem from a structural issue to a serious biological one, setting the stage for infection, pain, and damage beyond the tooth itself.
Progression of Internal Damage
The immediate biological consequence of a fracture is the exposure or irritation of the dental pulp, the soft tissue housed at the center of the tooth. This pulp contains the tooth’s nerves, blood vessels, and connective tissue. Bacteria from the mouth gain entry through the crack, leading to inflammation of this inner tissue, a painful condition known as pulpitis.
The initial inflammation causes extreme sensitivity to temperature changes and can lead to intense, throbbing pain. Swelling increases pressure inside the tooth, constricting the blood flow and depriving the nerves and blood vessels of oxygen. If the bacteria are not removed, this reduced blood supply eventually causes the death, or necrosis, of the pulp tissue. Once the nerve dies, the tooth may temporarily stop hurting, but it has become a site of dead tissue highly susceptible to infection.
The Development of Dental Abscesses
The dead internal tissue becomes an ideal environment for bacteria to multiply, transitioning the injury into a full-blown infection. This bacterial colony eventually produces pus, which forms a pocket at the root tip, known as a periapical abscess. This accumulation of pus is the critical intermediate stage of infection.
Symptoms of an abscess typically include persistent throbbing pain, facial swelling, and sometimes a fever. If the infection is left untreated, the pressure from the pus buildup begins to erode the bone and tissue surrounding the tooth. The localized infection can spread to surrounding facial tissues, potentially causing conditions like cellulitis, or tracking into deeper spaces in the neck.
Structural and Jawbone Deterioration
Neglecting a broken tooth and the resulting infection leads to long-term physical and functional consequences, often starting with the necessity of extraction. If the crack extends below the gum line or the infection has destroyed too much supporting bone, the tooth cannot be saved and must be removed. Once the tooth is lost, the jawbone begins to deteriorate because it no longer receives the necessary stimulation from chewing forces.
This loss of alveolar bone density, or resorption, is a gradual process that is most rapid within the first 18 months following tooth loss. The resulting structural gap can cause adjacent teeth to shift out of alignment, leading to problems with bite and function (malocclusion). Furthermore, the lack of bone can severely complicate future restoration options, as dental implants require a strong foundation and may necessitate complex bone grafting.
Connection to Overall Health
The most severe risks arise when the chronic oral infection and inflammation enter the body’s circulation. Bacteria from the abscess can breach the localized area and travel through the bloodstream, leading to systemic infection and inflammation throughout the body. This bacteremia can contribute to the exacerbation of serious pre-existing health conditions.
There is growing evidence linking chronic dental infections to cardiovascular disease, as the inflammation caused by the bacteria can contribute to the narrowing of arteries (atherosclerosis). Bacteria from the mouth can travel to the heart and cause endocarditis, a life-threatening infection of the heart’s inner lining. Additionally, chronic oral infections can make it significantly more difficult for people with diabetes to control their blood sugar levels. The bacteria can also be aspirated into the lungs, potentially leading to respiratory infections like pneumonia.