Fracture of the tooth crown is a problem with which a huge number of people come to the dentist's appointment. It means getting injured in which the bone tissue of the molar is destroyed. Typically, tooth fractures (ICD S02.5) are found in children and people involved in extreme sports. However, such injuries can also be encountered by ordinary people as a result of mechanical damage, for example, during a fight, fall, or due to a strong bite during meals, when strong pressure is created on the molar with metal cutlery.
Features and localization
In dental practice, a tooth fracture is one of the most difficult cases, since it often violates the anatomical structure of the alveoli. With very strong mechanical damage, a fracture of the entire jaw in its weakest spot can even occur.
Depending on how severe the fracture was, this type of injury is divided into the following types:
- spallation - enamel damage;
- damage to bone tissue, in which there is no exposure of the pulp;
- dentin fracture, accompanied by exposure of soft tissues;
- trauma to the area of the tooth root.
In addition, the classification divides fractures into two main categories:
If the molar is damaged, a crack forms on it, affecting all its important parts. Moreover, it can be not only longitudinal, but also transverse, or even go along the diagonal of the crown. In some cases, the root can be damaged simultaneously on both sides. In dentistry, such a case is called comminuted fracture of the tooth. Most often, the integrity violation is localized in the middle of the molar or in its upper part. Much less often - in the central region and near the root neck.
Main reasons
Let's dwell on them in more detail. As mentioned earlier, tooth fractures in children and adults most often occur as a result of mechanical stress. In this case, cracks can be multidirectional. It is generally accepted that vertical ones pose virtually no threat to the integrity of the molar, but only worsen its aesthetics. However, in the absence of proper treatment, they can gradually grow and as a result lead to complete tooth decay. Therefore, it is better not to postpone the visit to the dental clinic.
In addition to injury, among the main causes of fractures are the following:
- the provision of unskilled medical care;
- low-quality surgery to extract the tooth from the alveoli;
- strong blow to the jaw area;
- prolonged lack of therapy for various pathologies;
- abnormalities and congenital pathologies in the development of molars.
There are some other reasons behind the violation of the integrity of the dental crown, however, they occur in isolated cases and are the exception to the rule rather than a significant factor.
Clinical manifestations
It is very difficult to independently determine the presence of a fracture, since pronounced symptoms are not observed as such. Therefore, if you suspect damage to the molar, then you should go to the hospital. However, there are several factors that can help diagnose a tooth root fracture.
Symptoms in this case may be as follows:
- severe pain that occurs during palpation of the gums or with food;
- mobility and gradual loosening of the molar;
- swelling of the soft tissues in the area of the damaged tooth and periodic discharge of blood;
- a change in the normal color of enamel, it acquires a pinkish tint.
It is worth noting that the severity and intensity of symptoms depends on the severity of the fracture, as well as on the location of the fracture. But, as a rule, even with a slight injury, a person begins to experience discomfort when opening and closing his mouth. This is due to damage to the pulp and the onset of the inflammatory process. It is worth noting that if a person has a tooth fracture, the symptoms make themselves felt immediately, so this problem will not go unnoticed.
Diagnostics
What is she like? With a high degree of probability, only a qualified dentist can tell whether there is a fracture of the tooth crown or not, since the clinical manifestations and their form can be very different. They depend on a number of factors, among which there are individual anatomical features of the structure of the jaw and bite of each person. Therefore, if you suspect a fracture on the basis of the symptoms described above or due to various other reasons, then you should immediately go to the hospital.
When examining patients, the doctor pays attention to the following factors:
- degree of soft tissue damage;
- fracture severity;
- violation of occlusion;
- whether there is damage to the alveoli;
- tooth enamel color;
- the intensity and degree of violation of the structure of the injured area.
The main and most effective diagnostic method is palpation performed using a special tool.
It allows the dentist to determine the following:
- the presence of mobility of the tooth or its individual parts and its degree;
- bulging;
- molar displacement level;
- swelling.
If the feeling of the injured area of the gum does not allow to make an accurate diagnosis, and in some other cases, an electroodontometric or transillumination examination can be prescribed. They allow the doctor to determine the viability of the loose fibrous connective tissue located under the molar. Both types of laboratory tests are based on tooth highlighting, which makes it possible to determine the presence of even microcracks.
In addition, an x-ray of the jaw is mandatory . This is one of the most accurate diagnostic methods, providing a complete picture of the health status of the human oral cavity.
Therapy
If the dentist confirms a tooth root fracture, treatment begins immediately. Regardless of the severity of the injury, if the molar root was not damaged, then in almost all cases, doctors manage to save the tooth without prosthetics.
The treatment features are as follows:
- In a fracture, when the pulp was not exposed, the doctor puts the patient a filling made of special material.
- If hard dental tissue is exposed, then first an insulating pad is placed on the molar, and after that, the filling and installation of the pin is performed.
- If the blow was of great strength, as a result of which the tooth crumbled and the pulp was exposed, then it is removed surgically. Further, the channels are cleaned and sealed. For very severe injuries, a crown may be required.
- If the molar is completely destroyed and cannot be restored, then in this case a prosthesis is installed in its place.
It is worth noting that if the treatment of tooth fractures involves the installation of a crown, then in this case, therapy should be performed as soon as possible. Procrastination can cause a shift in the dentition, which is a very difficult case, requiring a long and expensive treatment.
Poorly treatable in violation of the integrity of the incisor in which the root was damaged. To get to it, the doctor will have to remove the molar, even if the crack is insignificant. This is due to the fact that the root is no longer able to perform the function of a support, so it is impossible to install a pin on it. After extraction, it takes time to completely heal the gums, after which the prosthesis is already placed. This should also not be delayed, since the dentition may shift.
In some cases, splinting of the teeth with a broken jaw may be required. It involves the installation of a special orthopedic apparatus on molars, combining them into a single monolithic design. This procedure allows you to maintain the chewing function and attractiveness of a smile.
Crown fracture
What he really is? This tooth fracture is classified as transverse and is very common in medical practice. For its diagnosis, no examination is required, since it is visible even with the naked eye. The treatment program for crown injury is selected based on the clinical picture of the patient. If only the enamel enamel is damaged, when the bone tissue remains intact, filling will be sufficient.
If the damage has also affected the dentin layer, then in this case the doctor cleans the canals, puts an insulating pad, and then restores the anatomical shape of the molar using modern composite materials. In very severe cases, in which the tooth roots were damaged, a pin is installed that acts as the basis for the prosthesis.
A fracture of the neck of the molar is also very often diagnosed. The elimination of this problem does not require surgical intervention, since the root remains intact and can be used to install the pin and subsequent prosthetics.
Root fracture
When making this diagnosis, the treatment program is selected based on where the root was damaged. Localization can be located in the neck, between the middle and upper part of the molar or at the very base. Most often, the crack has a transverse direction, but it can also be at a slight angle.
Such a fracture of the lower tooth is also determined very easily. It is accompanied by pain when feeling, in the process of chewing food or when closing the jaws. In addition, the molar, as a rule, staggers from side to side. Very often, injury is accompanied by rupture of blood vessels, which is why the enamel acquires a pinkish tint. When radiography on the picture, cracks are clearly visible.
Alveolar bone fractures
Such injuries occur when a direct blow to the jaw during a fight, when it occurs simultaneously on several molars. In addition to the violation of the integrity of the tooth, wounds also form on the mucous membrane of the oral cavity in the area of the damaged area. The process becomes mobile, since only soft tissues hold it.
Fractures of the alveolar processes occur exclusively with a very strong blow, so they are often accompanied by craniocerebral injuries. The main symptoms are nausea, migraine and dizziness. The main diagnostic method is x-ray, which allows you to really assess the condition of the patient. If the viability of the root is maintained, the most effective treatment program is selected. In critical injuries, the only way out is to completely remove the broken tooth.
Possible complications
In dentistry, it is critically important to timely determine damage to the integrity of the tooth and begin treatment. The only way to minimize the likelihood of developing various complications.
Otherwise, a person may begin the following pathological processes:
- purulent inflammation of the soft tissues ;
- phlegmon;
- periodontitis;
- pulpitis;
- root displacement.
In addition to all of the above, if teeth splinting is not completed in time during a fracture accompanied by their strong mobility, then there is a high risk of molars falling out.
In what cases can a tooth be saved?
In most cases, dentists manage to save the molar in violation of its integrity. However, in some cases, fractures of a high degree of complexity may require surgery to extract the tooth from the alveoli. Therefore, it is very important not to delay the trip to the clinic.
Removal is performed under anesthesia, so the patient will not experience any pain or perceptible discomfort. Most often, the procedure does not last too long, but with a severe fracture, when there is practically nothing left of the molar and the doctor has nothing to grab at, the operation may be delayed. In this case, the gum is first cut with a scalpel and the remains of the root are tucked away, after which sutures are applied. When the tooth fracture is completely cured and the rehabilitation period ends, they are removed and an implant is installed. If necessary, the dentist can prescribe a set of physiotherapeutic procedures.
What to do if the fracture is accompanied by severe pain?
As you might guess, the most appropriate solution for pain is to go to the hospital for qualified medical care. Self-medication is not recommended, since the longer you delay, the higher the risk of infection entering the soft tissues. This is dangerous not only because the molar cannot be saved, but various serious pathologies can also develop. Therefore, if you had an injury, you need to immediately make an appointment with the dentist to undergo an examination and, in case of a problem, start treatment on time.