Recently I had an 11 year old patient who was running and fell and broke off a portion of his tooth. We at The Gentle Dentist take care of emergency broken teeth. In this case he and his mom came into our office with the missing piece. It was important in this case to recover the missing tooth fragment and keep it hydrated in water. At our Shelby Twp. dental office we can bond the tooth fragments together with an extremely thin bonding agent that holds the tooth together. The bonding strength of this can come close to the strength of the tooth. As you can see (photo below), the color and characteristics of the tooth would be almost impossible to match next to the remaining tooth structure if it were to be built up with the resin composite materials we have. It is like trying to hand paint a piece of torn print wall paper and match every aspect of the wall covering to perfection-an almost impossible ask. To match the color, opacity and texture is extremely difficult.
With a simple break in the tooth we could do this even without numbing up the patient. The fracture line was above the level of where the nerve is and therefore we could bond the pieces together. If the break involved the nerve then a root canal would be necessary to reduce the risk of an infected tooth. A root canal is a painless procedure where the nerve is removed and replaced with a rubber type of root canal filler. This will actually save the tooth and at the same time reduce any pain in the future.
To follow up in this case we will keep an eye on the tooth to see if it gets sensitive to hot or cold or to see if it turns dark. If the tooth gets dark that is a sign that the nerve is in the process of dying out. The reason why a tooth that is traumatized turns dark or grey over time is that the circulation that provides nutrients to the inside of the tooth is severed and the blood vessels die out creating a “bruise”. In other areas of the body if you get a bruise the circulating blood around the bruise will heal the area and wash the dying blood cells away. In a tooth, since there is only one entrance (through the tiny opening at the end of the tooth) new fresh blood can not enter the inside of the tooth and the “bruise” can’t be washed away.
It is best to treat a tooth that is turning dark as soon as possible before the dying blood cells and byproducts penetrate into the remaining pulp area and stain it permanently. If a tooth turns gray in color then a root canal will be needed to remove the dead nerve and after this is done an internal bleaching technique can be done which will whiten the internal aspect of the tooth. This is difficult to do especially if the tooth has been darkened over time. There is the possibility of crowning a dark tooth with an all porcelain crown if the internal bleaching technique fails in an attempt to match it with the adjacent teeth.
About The Author:
Dr. Robert Antolak is a Michigan Dentist located in Shelby Township (Macomb County).