A tooth broken at the gum line, typically classified as a subgingival fracture, represents a severe form of dental trauma requiring immediate professional attention. This injury is more than a simple chip, as the fracture line extends to or below the margin of the gingiva, the soft tissue surrounding the tooth. A break at this level suggests a significant loss of the tooth’s coronal structure, often compromising the underlying root, supportive bone, or internal pulp tissue. This separation of the visible tooth from its anchored structure creates an urgent situation where the tooth’s long-term viability is threatened. Successfully managing this fracture depends on a prompt and informed response.
Essential Immediate Care
The first step is to manage any bleeding by applying gentle, consistent pressure with a clean piece of gauze or a damp tea bag for up to fifteen minutes. Following this, rinse the mouth carefully with warm water or a mild saltwater solution to dislodge debris and clean the wound. Apply a cold compress or an ice pack wrapped in a cloth to the outside of the cheek near the injury for fifteen-minute intervals to reduce swelling and numb the pain.
Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can control discomfort until a professional examination. If the broken fragment is located, preserve it immediately, as it may be used in a reattachment procedure. Place the fragment in a small container of milk, a saline solution, or the patient’s saliva to maintain tissue viability. Contact an emergency dental office right away to schedule an urgent appointment, as timely care significantly improves the prognosis for saving the tooth.
Why Gum Line Breaks Are Complex
A fracture at or below the gum line is more complicated than a simple crown fracture because of its proximity to sensitive supporting structures. These breaks, known clinically as complicated crown-root fractures, often extend into the dentin and can expose the dental pulp, which houses the tooth’s nerves and blood vessels. When the pulp is exposed, it creates a direct pathway for oral bacteria to enter the inner chamber, leading to a high risk of infection, inflammation, and tissue necrosis.
The fracture line also poses a threat to the periodontium, the specialized tissues that anchor the tooth. A break extending significantly below the gingival margin can violate the “biological width,” a precise measurement of tissue attachment between the tooth and the surrounding bone. This violation can lead to chronic inflammation, bone loss, and difficulty achieving a stable, long-term restoration. To accurately assess the full extent of the damage, the dentist must take specialized dental X-rays to determine how deep the fracture extends into the root and supporting bone structure.
Restorative and Replacement Procedures
The professional treatment plan is determined by the severity of the subgingival fracture and the condition of the remaining root structure. If the root is deemed viable, the primary goal is to save the natural tooth through restorative procedures. An exposed pulp will necessitate root canal therapy to remove the damaged internal tissue, clean the canal, and seal the interior to prevent an abscess.
Restoring the Root
If the tooth lacks sufficient structure to support a crown, the dentist may use crown lengthening to surgically reshape the gum and bone, exposing more of the tooth above the gum line. Alternatively, forced orthodontic extrusion uses specialized appliances to slowly pull the root out of the socket, creating the necessary height for a stable restoration. Once the root is prepared, a dental post may be placed inside the canal for internal support. This is followed by a core buildup to create a platform for the final artificial crown, which encases the entire structure.
Replacement Options
If the fracture extends too far vertically into the root or if the remaining root cannot be salvaged, extraction becomes necessary. The tooth is removed, and a replacement is planned to maintain jawbone integrity and function. The preferred replacement option is a dental implant, which involves surgically placing a titanium fixture into the jawbone to serve as a stable artificial root. Other solutions include a fixed dental bridge, which uses adjacent teeth as anchors for a prosthetic tooth, or a removable partial denture.