A sudden, sharp pain while chewing or a jagged edge felt by the tongue can signal a fractured tooth. Dental fractures, which range from tiny surface imperfections to severe breaks, are common occurrences that compromise both the function and structure of a tooth. The urgency of a fractured tooth depends entirely on the depth and location of the break. Understanding the severity of a fractured cusp is the first step toward effective care, and this article provides guidance on determining the seriousness of the injury and the necessary steps to take while awaiting professional dental treatment.
Defining Cusp Fractures and Assessing Urgency
A cusp is one of the pointed projections on the chewing surface of molars and premolars, the back teeth responsible for grinding food. A fractured cusp occurs when a piece of this chewing surface breaks away, often near an existing, large dental filling that has weakened the tooth structure over time. Unlike a true cracked tooth, where the break runs vertically from the crown toward the root, a fractured cusp typically involves a lateral break that separates the cusp. This distinction is important because a fractured cusp is often less severe than a full crack.
The decision of whether a fractured cusp constitutes a true dental emergency rests on whether the fracture has reached the tooth’s innermost layer, the pulp. The pulp contains the nerves and blood vessels, and its exposure to the oral environment invites bacterial infection. If the fracture is shallow, affecting only the enamel and outer dentin, it is considered an urgent matter requiring prompt repair but not an immediate life-threatening emergency. However, if the break is deep and exposes the pulp, indicated by intense, lingering pain or visible pink tissue, it is a complicated fracture that requires immediate professional attention to prevent infection from spreading. Even a minor cusp fracture can cause sensitivity to hot or cold temperatures or pain when releasing biting pressure, which signals that a visit to the dentist is necessary soon.
Immediate Steps for Pain Relief and Protection
While waiting for a dental appointment, you can take several immediate steps to manage the discomfort and protect the soft tissues inside your mouth. Gently rinsing your mouth with warm water helps clean the area and remove any debris that may have lodged in the fracture site. Rinsing with a warm salt water solution is also beneficial, as it can help to reduce bacteria and soothe irritated gum tissue surrounding the fractured area.
To manage the pain, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be effective in reducing both pain and any potential swelling. If the remaining tooth structure has a sharp or jagged edge, cover this edge with a piece of dental wax or a small, sugarless piece of gum. This provides a temporary protective barrier against irritation to the tongue, cheek, or lip. Avoid chewing on the side of the mouth with the damaged tooth and refrain from consuming very hot, cold, or sticky foods, which can increase sensitivity.
Professional Diagnosis and Repair Methods
Upon visiting the dentist, a comprehensive examination is performed to accurately diagnose the extent of the damage. The dentist will typically begin with a visual inspection, often using magnification, and will gently probe the tooth’s surface. Diagnostic tools like dental X-rays are taken, which are useful for assessing the pulp’s health and looking for bone loss, even though X-rays may not always show the full extent of a vertical crack.
A key diagnostic method involves having the patient bite down on a specialized instrument, like a bite stick, to pinpoint the location and severity of the pain, especially the characteristic sharp pain upon releasing biting pressure. Another technique, called transillumination, involves shining a light through the tooth; the light will not pass through the fracture line, making the break more visible. Based on the depth of the fracture, the dentist will recommend a specific repair method.
Restoration and Coverage
If the damage is minor and does not extend deep into the dentin, a simple restoration using a tooth-colored filling material may be sufficient to seal and restore the tooth’s shape. When the fracture is more extensive, affecting a large portion of the tooth structure, the tooth will need more comprehensive coverage to prevent future breaks. In these cases, an onlay or a full-coverage crown is often necessary. An onlay covers one or more cusps, while a crown encases the entire tooth above the gum line, providing maximum support and strength.
Severe Damage and Extraction
If the fracture has extended to the pulp, causing irreversible damage or infection, the dentist must perform root canal therapy to remove the diseased tissue and save the tooth. Following a root canal, a crown is placed to protect the now-brittle tooth. In the most severe cases, where the fracture extends too far below the gum line or splits the tooth into separate, irreparable segments, extraction may be the only viable option.
Strategies for Avoiding Future Fractures
Preventing future tooth fractures focuses on protective measures and mindful habits, particularly for teeth that have already been weakened by large fillings or previous trauma. For individuals who participate in contact sports, wearing a custom-fitted mouthguard is highly effective at absorbing impact and dramatically reducing the risk of a new fracture. Similarly, those who grind or clench their teeth, a condition known as bruxism, should wear a night guard to protect their teeth from the intense, constant forces applied during sleep.
Avoid chewing on non-food items, such as pens, ice, or hard candies. These hard objects can create sudden, concentrated forces that easily cause a weakened cusp to break. Furthermore, it is beneficial to proactively address large, older metal fillings, which can weaken the cusps they are meant to restore. Replacing these restorations with modern, bonded materials or covering the tooth with a crown can often strengthen the tooth structure and prevent a catastrophic fracture from occurring later. Regular dental check-ups are also important, as they allow the dentist to identify and treat small cracks or weakened areas before they progress into a painful fractured cusp.