Chipped or Broken Tooth: What to Do in the First Few Hours

Maybe it was a crunch that wasn't the food, and then your tongue found a sharp edge where a smooth one used to be. If you've broken a tooth, here is what to do first. Call us, keep the broken piece in water, cover the sharp edge, and hold something cold on your cheek. After that, the thing to know is how deep the break goes, because depth decides how urgent it is and how we fix it.

Broken tooth: what should I do until I can be seen?

1. Call the office first. Tell us what happened, whether it hurts and what you can see, and we'll tell you how soon you need to come in.

2. Rinse gently with warm water. That clears out grit and small fragments so you can get a good look at the tooth.

3. Save the piece, and keep it wet in a small container of water. The International Association of Dental Traumatology guidelines list bonding the original piece back on as an option when it's intact. They also say a piece that has dried out should soak in water or saline for 20 minutes before it's bonded.

4. Press on any bleeding. Bite gently on clean gauze or a folded cloth for several minutes.

5. Put something cold on your cheek. A cold pack wrapped in a towel, held on the outside of your face, helps keep swelling down after a knock.

6. Cover the sharp edge. Dental wax from the pharmacy, or a small piece of sugar-free gum, stops the edge from cutting your tongue or the inside of your cheek.

7. Chew on the other side. Skip hard, sticky, very hot and very cold foods until we've looked at it.

For pain, an over-the-counter pain reliever, taken the way the label directs, can help until you're seen.

What should I not do with a broken tooth?

Don't glue the piece back with a household glue. It isn't made for the inside of a mouth, and we'd have to remove it before a real repair can bond.

Don't hold an aspirin against the gum next to the tooth, which the American Dental Association's emergency advice also warns against. Aspirin is an acid, and resting it on soft tissue can burn the gum.

Don't file the edge down yourself. You can't see how far the break runs, and grinding takes away tooth structure we may want to keep.

And don't decide it can wait just because it doesn't hurt, for reasons the next two sections explain.

How can I tell how deep the break goes?

A tooth is built in three layers, and each one behaves differently once the layer above it breaks away.

Enamel is the hard white outer shell. It has no nerves, so a chip that stays in enamel usually doesn't hurt, even when it feels sharp against your tongue.

Dentin sits under the enamel and looks slightly more yellow. It's full of tiny tubes that run inward toward the center of the tooth, and those tubes hold fluid. When cold air or a cold drink hits exposed dentin, the fluid in the tubes shifts. Nerve endings at the inner end read that movement as a sharp, quick pain. So if a broken tooth stings with cold, with sweet food or when you breathe in, the break has probably reached dentin.

The pulp is the soft center, where the tooth's nerve and blood supply live. A pink tint in the middle of the break, with no bleeding, means the pulp is very close. The trauma guidelines read that pink as less than half a millimeter of dentin left. A bleeding red spot means the break has reached the pulp. Either way, call us right away.

Why does a chipped tooth that doesn't hurt still need a look?

The same tubes that carry fluid inward also give bacteria a route toward the pulp. Enamel normally seals them off, but once it breaks away, saliva and bacteria sit directly on the dentin. That's why the guidelines say exposed dentin should be covered, with a bonded layer or a filling material.

Once the pulp is exposed, bacteria reach it directly, and the longer it stays open to saliva, the more likely it becomes inflamed or infected.

A break can also hide damage, because a knock hard enough to break a tooth can loosen it in the bone or crack the root. The guidelines call for checking both, especially if the tooth is tender when you bite, so we usually take an X-ray.

The pulp can also react weeks later. For a break into dentin, the same guidelines recommend rechecks at 6 to 8 weeks and at one year. The rechecks look for a pulp that has quietly died, which can happen in a tooth that felt fine on the day it broke.

How is a chipped or broken tooth repaired?

The repair follows the depth of the break, and the exam decides which of these usual paths fits your tooth.

A chip in enamel only. A small rough edge can sometimes just be smoothed. A bigger chip is usually rebuilt with composite bonding, a tooth-colored resin we shape right on the tooth. It's done in one appointment, with no lab, and usually without drilling or numbing. I covered how long it holds in how long tooth bonding lasts.

A break into dentin. We seal the exposed dentin and rebuild the missing part, often with bonding or a composite filling. When a large part of the tooth is gone, a filling alone won't hold up to chewing for long. The tooth then needs a crown, which is kind of like a hard hat for a tooth. We take a digital scan and place a temporary crown, an outside lab makes the final crown, and we fit it at a second visit.

A break into the pulp. The exposed pulp has to be treated before anything is rebuilt on top of it. Depending on how large the exposure is and how long it has been open, that can mean root canal therapy. We numb the tooth, then clean, shape and seal the canals inside it. A crown usually follows, because a tooth that has lost this much structure breaks more easily under a hard bite.

If the break runs below the gumline or splits the root, the options narrow, and we talk them through with the X-ray on screen.

What if the tooth breaks on a day the office is closed?

We're open Monday through Thursday, 8:00 AM to 4:30 PM, and closed Friday through Sunday. When you call during those hours, we do our best to see urgent patients the same day. Our emergency visits page and our earlier post on emergency dental care in Munhall cover the other problems we see.

If a tooth breaks later in the week, the steps above keep it protected, and a chip that only feels sharp can usually wait. Swelling in your face, a fever, trouble swallowing or breathing, or a hard blow to the head can't wait. Those need an emergency room.

If the whole tooth came out, root and all, the clock is shorter. The ADA says to keep it moist without touching the root, and to set it back in the socket if you can. Otherwise keep it between your cheek and gum or in milk, and get to a dentist right away. If we're closed, that means the nearest dentist who is open.

Ready to have it looked at?

Call us at (412) 462-3095 and tell us what happened, or reach us through the contact page. Bring the piece with you in its container of water.