You're in the middle of a meal and your tooth just broke off at the gum line but miraculously there is no pain at all. What should you do about this cracked tooth and also why doesn't it hurt? It certainly looks painful but somehow isn't, almost as if it defies the laws of this world.
What's going to happen to this tooth? We all know that we're going to have to see the dentist but wouldn't it be nice to know what to expect beforehand? Well, that's what this article is all about.
Table of Contents:
What should you do first?
Since you are not in pain from the broken tooth, it is an urgent situation but not an emergent one where you have to drop everything that you're doing to take care of it. Do not panic because you have time to address this so try to remain as calm and collective as possible.
Here is what you should do in regards to a tooth breaking off at the gum line but feels painless:
Secure the piece of broken tooth in a resealable zipper bag or coin pouch to give to your dentist.
Examine in the mirror to see which tooth broke off so you know what to tell your dentist.
Clean the area around the broken tooth by brushing and flossing so that food particles don't get trapped around it. That may cause swelling and inflammation if you don't keep it clean.
Avoid chewing on the affected side as much as possible. Also try to avoid hard crunchy foods that may potentially cause more damage to the already chipped tooth at the gum line!
Schedule an appointment with your dentist as soon as possible so that you can have the tooth fixed. There is absolutely no way you're going to be able to repair a broken tooth at home. So, don't even try!
If this situation happens to you, you may consider yourself one of the fortunate ones since you're not in pain. Most of the time if your molar broke off at the gum line, you would be in pain and that would make it an emergency where you would have to pause everything that you're doing and seek medical help immediately.
However, since you're not in pain you do have more wiggle room and shouldn't have to panic. You should still try to see your dentist as soon as possible because the cracked tooth will not fix itself. Only a dentist will be able to repair a tooth that has broke.
Definitive signs that your tooth broke off at the gum line
You can tell that your tooth broke off by verifying these three pieces of information.
Does the hard piece that came out look like a tooth?
Do you see a missing tooth when you look in the mirror?
Do you feel a gap when you run your tongue over the affected area?
If the answer is yes to all three, you most likely fractured your tooth.
What does it look like?
In case you needed more information to confirm what a broken tooth with the retained root still left in the gums look like:
It basically looks like a large piece of the tooth is missing like you only have a small piece of it remaining.
If you look in the mirror, it would look like you have a black hole in your mouth since you can see through the gap where the tooth use to be.
It can also look sharp and jagged because it is usually not a clean break.
What does it feel like?
For this particular situation, you actually wouldn't feel anything at all because there is no pain. Surprisingly it doesn't hurt so there would be zero sensations coming from the tooth. Although the broken tooth root still in the gum may feel sharp to your tongue because it could be jagged.
The tooth itself shouldn't hurt you but the jagged edges of the cracked tooth root may irritate or scratch your tongue.
Why doesn't it hurt?
If the broken tooth does not hurt you, it most likely means that the nerve has already died from the impact of the fracture. Alternatively, the tooth could have already been dead or it was a root canal treated tooth that already had the nerve removed.
Nerve dies from fracture
If you bit down on something really hard, the force of the impact could kill the nerve immediately and if the nerve is dead, you wouldn't feel any pain. It all depends on how much force was used to cause the tooth to break off at the gum line.
Even though you may not feel pain at the moment, you should still get it treated because that broken tooth root that is left in the gums can become infected. Once it gets infected, you will start to have pain. Then the situation will change from urgent to emergent.
Tooth was already dead
If your tooth was already dead and you fractured it, chances are it probably wouldn't hurt you. Since the nerve was dead previously, there is no healthy nerve to sense any pain.
Dead teeth tend to look discolored and they don't feel any sensitivity to temperature nor pain. Therefore if you cracked a tooth like this, you most likely wouldn't have felt any tooth pain at all.
Tooth had a root canal already
If a root canal tooth broke off at gum line, you will definitely not feel any pain because it already had the nerve removed. During a root canal procedure, your dentist deliberately separates the nerve from the tooth so that it wouldn't feel any pain. Therefore if you crack a root canal tooth, you'll most likely feel nothing at all.
Treatment options for a tooth broken below gum line
In order to prepare you for what to expect at the dentist, we will review all of the available treatment options for a tooth with this condition. There are two categories of treatment available for a broken tooth and it all depends on whether or not the tooth should be restored or extracted.
A filling, bonding, or attempting to reattach the broken tooth fragment will not work. Those methods only work for minor chips but for a tooth that broke down to the gums, that is far too severe for it to work.
Tooth can be restored
Despite the tooth breaking down to the gum line, if your dentist deems the tooth restorable, you may not need the rest of the tooth removed. This means that the tooth root can remain in the mouth and can be saved by putting a dental crown on top of it.
This is only an option if your dentist thinks that there is enough tooth structure left for a crown. The procedures required to save this broken tooth is as follows:
Root canal. The tooth nerve has already died and that is why you no longer feel pain. Your dentist will need to finish the job by performing a root canal, where they remove the dead nerve from the tooth and then fill back in the canal. This ensures that the nerve does not rot and turn into an infection later on. You agree that it is not healthy to leave dead matter in your body right?
This is what a tooth before and after a root canal looks like on an x-ray.
Core buildup. After the root canal, you will need a core build up which basically fills back in the hole created by a root canal. It also builds the tooth back up so that there is enough tooth to put a crown on it.
Dental crown. Once the core is done, your dentist can make the crown for it. The crown will cover the entire tooth to prevent it from fracturing in case you bite into anything hard. It will also provide the aesthetics that you want because it'll look just like your natural tooth.
Here is what a completed crown looks like in your mouth.
This entire process from root canal to core buildup to crown will take approximately four separate visits. Two of the visits may be needed for the root canal procedure. Then another two will be for doing the core build up and crown on one visit with the second visit to glue in the final crown.
Additional procedures to improve the prognosis
If your dentist wants to save the tooth but doesn't think there is quite enough tooth left to put a crown on, he can perform additional procedures to increase the success rate of a crown. These two procedures are called crown lengthening and orthodontic extrusion of the tooth.
Both of these additional treatments attempt to create more tooth structure so that the crown can fit. The reason is because you can't put a crown on if there is no tooth above the gum line to put it on. The reasoning is the same as why the headless horseman cannot wear his own head.
Crown lengthening
A crown lengthening procedure is where your dentist will shave away the bone surrounding the tooth so that there can be more tooth above the gum line. The consequence of this would be a longer looking tooth.
A negative consequence is that the bone you have to shave away cannot regrow back so it is an irreversible procedure. Another side effect is that it may make the adjacent teeth more sensitive especially if they happen to have gum recession as a result of this procedure.
If you opt for this additional procedure, you will need this completed prior to making the crown. It can be done before or after the root canal, the order for that does not make a difference.
Orthodontic extrusion
This procedure is when your orthodontist attaches a bracket to the broken tooth and then extrude the tooth above the gum line. This essentially serves the same purpose as crown lengthening, in that it creates more tooth above the gums and also a longer looking tooth.
The downside to choosing this option is that it takes a lot longer to extrude a tooth when compared to crown lengthening. The former can take months while the later can be completed within a day.
The pro to this technique is that it is more conservative in that you do not need to shave away bone. Therefore it does not cause irreversible damage.
Tooth needs to be extracted
If the tooth is so severely broken that it can no longer be saved or be used to put a crown on, it would need to be extracted. The entire tooth along with the tooth root will need to be removed. This is usually the case if there is not enough tooth left or the fracture is so unfavorable that it is not worth pursing saving the tooth.
Options to replace an extracted tooth are as follows:
Dental implant. After the tooth is extracted, the oral surgeon can place a dental implant, which is a titanium screw into the socket where the tooth use to be. Afterwards, your general dentist can put an implant crown on top of the implant. This whole process may take 8-12 months.
Dental bridge. Alternatively your dentist can make a bridge for you where it is three connected crowns. The middle crown will be a pontic or dummy tooth with nothing underneath of it. The con to this technique is that you need to shave down the adjacent teeth on both sides to fit the bridge on. The pro is that this procedure can be done in about a month.
Maryland bridge. This is similar to a bridge except it is two connected crowns. It is more conservative in that you don't need to shave down two teeth and only need to shave down one. The con is that it is usually not as stable as a dental bridge since it has less teeth to anchor it.
Partial dentures. The worse case scenario if you can't get an implant nor a bridge, you can always get a partial denture. This is a prosthesis that is like a denture except it only replaces one tooth. The con is that the appliance tends to be bulky and that you can take it in and out. You do have to remove it before going to bed.
Overall, if the broken tooth near the gum line cannot be saved and must be extracted you can expect the entire treatment length to take longer. The reason is because after the tooth gets removed, you still have to wait for it to heal before you can proceed to the next step.
On the other hand if the tooth can be saved, you do save yourself quite a bit of time because you don't have to wait for the post-extraction healing time. Nonetheless, it all depends on how bad the crack was and that's completely out of your control.
Possible causes for teeth to break at the gum line
Teeth don't break down to the gum line for no reason so there is always a cause for it. We will review what some of the potential causes are that can break teeth.
Eating hard foods
If you've a habit of eating hard foods, you will be at a greater risk to cracking your teeth. Despite the fact that your enamel is the hardest substance in your body, it is very brittle to blunt trauma. It is scratch resistant and can handle scratches well but it fairs poorly against forceful impact
Here are some common foods that our patients have broken their teeth on while eating:
Ice cubes
Olive pits
Hard bread
Crab legs
Using their teeth as a beer bottle opener
It happened before
If your molar broke off to the gum line once before and you restored it with a crown, it does not make it immune to happening again. In fact, after you break it the first time, the second time is easier to break.
The reason is because a natural virgin tooth is one piece which makes it very strong.
A restored tooth is actually three separate pieces (natural tooth, core buildup and a crown). These separate layers where each piece joins is a natural weak point.
Therefore, if this happened to you once before, you better be extra careful the second time around! Most of the time, there ARE NO SECOND CHANCES. This means that the second time it happens, it will have to progress towards the tooth extraction treatment option.
Teeth Grinding
If you're stressed out and grind your teeth at night, you can cause some serious damage to your mouth. Aside from the fact that the teeth start to get worn down and look shorter and shorter, there is the possibility that it can crack teeth.
Traumatic Injuries
Once again, your teeth does not sustain blunt force trauma very well so if anything hard hits your tooth, it can break. Depending on how much force the impact was, will determine how bad the fracture will be.
Some common situations where teeth get damaged are as follows:
Sports injuries
Motor vehicle collisions
Tripping and falling face first
Altercations with other individuals
How do you prevent teeth from breaking like this?
The vast majority of time, your tooth will break unexpectedly but here are a couple of tips that you should follow that can decrease the chances of that happening.
Minimize or avoid eating hard foods. If you do, try to chew slowly or cut up the foods.
Wear a night guard if you grind your teeth.
Wear a sports guard if you play sports!
Eat a nutritious diet that is full of calcium and vitamin D so that your teeth and bones can be as strong as possible.
Takeaway
If your tooth broke all the way to the gum line and you're not in pain, you should still try to get an appointment with an emergency dentist as soon as possible. A tooth that is broken that badly cannot self heal and only your dentist can fix it. The sooner you can do it the better because there is always the chance that it CAN get infected and start causing you pain.
Aside from the fact that you don't want to be in pain, missing a tooth will affect the way you eat and chew. Therefore it would be in your best interest to see your dentist and get it addressed.
Author: Written by Dr David Chen, a long island city dentist.
