A tooth fractured down to the gum line represents a serious dental emergency. This type of severe break, often called a subgingival fracture, means the structural damage extends below the visible crown and into the root area. Immediate professional assessment is necessary to determine if the tooth can be saved or if extraction is the only viable option for preventing infection and preserving jawbone health. Understanding the immediate steps to take and the clinical factors guiding treatment will help you navigate this unexpected situation.
Immediate Steps for Managing the Injury
Manage discomfort and control bleeding immediately while preparing for a dental visit. You can gently rinse your mouth using warm salt water to clean the area and remove loose debris, which also helps soothe irritated gums. If there is active bleeding, apply gentle but firm pressure to the site using a clean piece of gauze or a damp tea bag, as the tannins in tea can help promote clotting.
For pain management, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce both pain and swelling. Avoid aspirin, however, as it acts as a blood thinner and could worsen bleeding. If you locate the broken tooth fragment, store it in a clean container with milk or saliva to keep it moist, as the dentist may need to examine it.
Contact your dentist or an emergency dental clinic immediately, explaining the severity of the injury, as a fracture extending to the gum line requires immediate attention. Even if the pain is minimal, the exposed inner tooth structure is vulnerable to bacterial contamination that can quickly lead to infection. Avoid chewing on the injured side to prevent further trauma to the remaining tooth structure and surrounding gum tissue.
Understanding the Clinical Severity of the Fracture
A fracture reaching the gum line, known as an oblique subgingival fracture, is complex because it involves both the visible crown and the hidden root structure. The extent of the fracture below the gum line determines whether the tooth can be successfully restored or must be extracted. Damage extending deep below the bone level makes restoration technically difficult.
A significant factor in determining restorability is pulp involvement (the tooth’s nerve and blood vessels). If the fracture exposes the pulp, bacteria can easily enter the inner tooth, leading to infection and the formation of an abscess at the root tip. This pulp exposure necessitates root canal therapy to remove the infected tissue and prevent the spread of bacteria.
Biological width refers to the space required between the edge of a dental restoration and the underlying jawbone to maintain healthy gum tissue. If the fracture violates this space, any restoration placed will cause chronic gum inflammation, bone loss, and eventual failure of the treatment.
Treatment Pathways for Tooth Preservation
If the root is viable and the fracture does not extend too far apically, the dentist will focus on preserving the tooth structure. This often involves root canal therapy if the pulp chamber has been exposed or infected. The procedure removes damaged nerve and blood vessels, sterilizes the internal space, and seals the root to prevent future infection.
Once the internal structure is treated, the dentist must address the lack of visible tooth structure above the gum line, often referred to as a lack of “ferrule” or retention. To rebuild the tooth, a post may be placed into the root canal space for retention, followed by a composite core build-up to create a stable foundation. This core acts as the platform for the final restoration.
A surgical procedure called crown lengthening is frequently required to expose enough sound tooth structure above the gum line to place a stable crown margin without violating the biological width. This involves the surgical repositioning of the gum tissue and, often, the careful removal of a small amount of supporting bone.
Alternatively, orthodontic extrusion can be used, where a small orthodontic force gently pulls the root segment out of the bone over several weeks to expose the fracture line. After the necessary structure is exposed and rebuilt, the tooth is prepared to receive a full-coverage dental crown. The crown provides strength and protection to the remaining tooth structure, restoring function and appearance. This multi-step process aims to convert a complicated subgingival fracture into a successfully restored tooth.
Replacement Options Following Extraction
When a fracture is too deep, involves a vertical root split, or severe damage to the surrounding bone, the tooth is considered unrestorable, and extraction becomes necessary. Leaving a severely fractured or infected root risks significant damage to the jawbone and adjacent teeth. Following extraction, three main options exist for replacing the missing structure to prevent shifting and preserve the jawbone.
Dental Implants
A dental implant is widely regarded as the most complete and long-lasting replacement option, functioning as an artificial tooth root. A titanium screw is surgically placed into the jawbone, where it fuses with the bone over several months in a process called osseointegration. Once healed, a custom-made crown is attached to the implant, providing a stable, independent restoration that feels much like a natural tooth.
If the fracture resulted in significant bone loss, bone grafting may be required before implant placement to support the titanium post. This adds time to the treatment but is necessary for long-term success. Implants are the only restoration that prevents bone resorption, which naturally occurs after a tooth root is lost.
Fixed Bridges
A fixed bridge replaces the missing tooth by using the two adjacent teeth as anchors. The anchor teeth are prepared for crowns, and a prosthetic tooth, called a pontic, is suspended between them. This option is non-removable, but it requires altering the structure of the healthy adjacent teeth.
Removable Partial Dentures
A third, more economical option is a removable partial denture, which uses replacement teeth attached to a gum-colored base with clasps that attach to the remaining natural teeth. While less stable than an implant or bridge, a partial denture is easier to clean and a good option for replacing multiple missing teeth.