My tooth has broken: can it be saved?

From the outside in, a tooth has enamel, which is hard but does not flex; the softer dentine; the pulp, which carries the tooth's nerve and blood vessels; and the root, which is embedded in the jawbone. Which layer the break stops in decides what the treatment will be; that is why 'my tooth has broken' is not a diagnosis on its own, but covers four separate situations at once.

A break confined to the enamel and dentine is the most common type and the easiest to deal with. A corner or cusp of the tooth breaks off while you are biting on something hard; the rough surface catches your tongue and you feel slight sensitivity to cold, but there is no throbbing pain. Because the break has not reached the nerve, the tooth stays alive and a composite filling is enough; if the piece that broke off is a cusp that takes the load of chewing, a crown or an onlay is needed.

When the break reaches the pulp, that is, the nerve, the picture changes. A red spot or slight bleeding can be seen on the broken surface; cold and air cause sharp pain, and this pain carries on after the trigger has gone. The tooth can still be saved, but a filling is not enough: the exposed nerve tissue is covered with a special material or removed with root canal treatment. Waiting costs you the nerve, because the exposed pulp is in contact with bacteria.

When the break goes below the gum line, the problem is not the tooth itself but the lack of a sound wall for the crown to hold on to. If the edge of the crown sits inside the gum, that area cannot be cleaned and becomes permanently inflamed. The way out is to lower the level of the gum and bone, or to pull the root up orthodontically; the further down the break is, the lower the chances of either working.

A vertical root fracture is a separate category: the fracture splits the root along its length, from top to bottom. The reason it cannot be saved is not its size but its position. The line runs inside the bone, along the surface of the root, and opens up a direct pathway for bacteria; there is no filling that can seal this pathway, because there is no surface to work on. As the bacteria advance, the surrounding bone resorbs. The signs are easy to miss: a vague discomfort when you bite, a small bump on the gum at a single point, or a narrow pocket that keeps getting deeper. It is more common in teeth that have had root canal treatment and have a metal support (a post) placed inside them.

These four do not lead to the same outcome. The first two end with the tooth staying in place; with the third, it depends on how many millimetres down the break stops; with the fourth, what needs discussing is not saving the tooth but when it will be replaced and with what.

The breakdown below becomes clear after an examination and X-rays. Seeing yourself in the second list does not mean the tooth will be taken out today; it only means the option to discuss changes.

This sequence is for diagnosis, not treatment. At the end, you will know where the break ends and, based on that, which option is realistic for your tooth.

1. 1

   What to do in the first few hours

   Rinse your mouth with warm water, apply light pressure with a clean piece of gauze if there is bleeding, and hold something cold against your cheek from the outside. If you have found the broken piece, do not let it dry out: keep it in milk or your own saliva and bring it with you.

2. 2

   Several teeth affected: send us your X-ray

   If only one tooth is broken, your own dentist is the first place to go. If you have several missing teeth, or teeth that cannot be saved, send your panoramic X-ray through the form; the dentist who would carry out the treatment reads it and we write to you within 24 hours. This is a preliminary assessment; the final decision is made after an examination and a CBCT scan.

3. 3

   Clinical examination

   Your dentist asks how the break happened and whether that tooth already had a filling or root canal treatment; a sound tooth broken by a knock and a root-filled tooth that broke on its own are not read in the same way. Then the break line is traced: staining, shining a light through the tooth and a bite test on each cusp in turn show how far down the crack goes. A deep, narrow pocket measured with a probe is an early sign of a vertical root fracture.

4. 4

   X-rays and, if needed, a CBCT scan

   A standard X-ray does not always show a break; when the beam does not line up with the break line, the crack cannot be seen. If a root fracture is suspected, a cone beam CT (CBCT) scan is requested. This is where the decision becomes clear.

5. 5

   The nerve is assessed and the options discussed

   A cold test shows whether root canal treatment is needed; in teeth broken by a knock, the nerve goes into shock in the first few days, so the test is repeated at intervals. Finally, your dentist should explain openly how many visits each option needs and what is left if it fails.

None of them is better than the others; where the break is decides which one is right. The right order always starts with the least invasive.

We set these out so that you can ask the right questions whichever dentist you see. If a dentist does not tell you these things of their own accord, ask.

The course below applies when extraction and an implant are chosen. With a break repaired with a filling or a crown, there is no separate healing period; you go back to your normal life the same day.

1. The first 48 hours

   Some swelling and tenderness are normal. A cold compress and the painkiller your dentist recommends take care of this. You should take a break from smoking and hot drinks.

2. The first week

   The swelling goes down. Avoid hard and hot food and brush the area gently. If you have stitches, they are removed according to your dentist's follow-up plan.

3. The first three months

   During this period the implant's integration with the bone progresses, and you still need to be careful when chewing.

4. Once it has healed

   Care is no different from a natural tooth. If the break was caused by teeth grinding, a night guard also comes in at this point.

We do not give a single figure on this page, because the right figure can only be given once it is clear where the break ends, and the difference between a composite filling and an extraction plus an implant is very large. Ask the dentist who has seen the break for the figure in writing, item by item. These are the items that determine the price:

Where the break ends

A break confined to the enamel and dentine and a break that goes below the gum are not the same procedure; one involves a single-session filling, the other gum surgery and a crown.

Whether root canal treatment is needed

If the break has reached the nerve, root canal treatment is added to the plan; if not, this item does not come into it at all.

The type and material of the restoration

A composite filling, an onlay and a full crown mean different work and different materials. Ask at the outset, in writing, which brand of material will be used.

The number of teeth affected

If several teeth are at risk at once because of teeth grinding or old, large fillings, planning them all together means fewer visits.