Your son has fallen and hit his face against a hard surface. Not only is he in pain but now there is also a chip missing from his front tooth. He is worried that his smile will never be the same. What should you do?

Answer: If you can find that missing chip, sometimes we can bond the fragment back on to the tooth. The tooth should be evaluated and repaired as soon as possible, although in the absence of other signs and symptoms of injury, and if your child is not in acute pain, it can probably wait up to 12 hours.

If the fragment can't be found, then the tooth can be restored with tooth-colored filling materials, which are also physically bonded to the natural tooth. Done well, these “composite resin” fillings can last for years and look perfectly natural. They may eventually need to be replaced with something more permanent.

If the chipped tooth is a child's primary (baby) tooth rather than a permanent (adult) tooth, the treatment will be similar.

However, a blow to a tooth can cause damage to the pulp — the living tissue within the tooth, which can become infected and die. If the damage to a primary tooth is too extensive it may be better to remove it to avoid damage to an underlying and developing permanent tooth. A place-holding appliance called a space maintainer may be used. If it is a permanent tooth it may need root canal treatment.

If a tooth is not chipped but is loosened or tender to the touch, it may require temporary stabilization, called splinting, until it has healed. Sometimes no treatment is required. If there has been a fracture to the tooth's root (the part below the gum line) it may heal by itself, or it may require further treatment especially if it is a permanent tooth, depending on the individual situation.

It is important to evaluate teeth that have been hit or damaged as a result of injury to ensure that they remain healthy and functional. We will keep track of the tooth or teeth, with observation, x-rays when necessary and monitoring over time to make sure no permanent damage has been done.

Contact us today to schedule an appointment or to discuss your questions about repairing a chipped tooth. You can also learn more by reading the Dear Doctor magazine article “The Field-Side Guide to Dental Injuries.”

Damaging the crown of a tooth (the part of the tooth that is visible above the gums) is the most common type of dental injury. The tooth may be broken or chipped. It is good to be prepared by knowing how such cases should be treated.

What is the first thing to do if my tooth is chipped or broken?
If fragments broke off the tooth, try to find and save them. They can probably be reattached to the tooth by bonding.

Does a chipped or broken tooth hurt?
The tooth may be sensitive to touch, hot and cold. Depending on the type of injury and how much of the tooth's inner surface is exposed, there may also be pain.

How long can I wait before getting treatment?
Get treatment right away, within 12 hours if possible. Teeth with crown fractures can be treated within 12 hours without affecting long-term outcomes.

What types of treatment may be used?
The treatment recommended depends on the tooth and the type and severity of the injury. Exposure of a tooth's inner pulp can be treated by a pulpotomy (partial pulp removal) technique. Front teeth can be temporarily restored with special cements, or the original tooth fragments may be reattached by bonding. Composite resin bonding may be used to restore the tooth's original appearance and function. Composites can be made in a wide range of tooth colors and can match the original tooth almost exactly.

Is treatment different if the damaged tooth is a primary (baby) tooth?
Chipped or broken primary teeth are generally treated similarly to permanent teeth. The treatment depends on the extent of the injury and damage to the tooth. Treatment of fractured primary teeth also depends on the proximity of the injured tooth to the permanent tooth beneath it, which will ultimately replace it. If a fractured primary tooth cannot be saved, it may be removed.

What if my tooth is loosened but not broken?
If the tooth is loosened but not cracked, broken or chipped, no dental treatment may be required. However, we will collect baseline clinical and x-ray information and keep an eye on the tooth or teeth in the future. We will need to check the tooth during recall visits to see whether the dental pulp is still living or whether it has died as a result of its injury. The latter condition can lead to a variety of problems and will require treatment.

Contact us today to schedule an appointment to discuss your questions about repairing a chipped tooth. You can also learn more by reading the Dear Doctor magazine article “The Field-Side Guide to Dental Injuries.”

When choosing among different ways to solve a problem, knowledge is power. In the case of selecting the best repair for a dental problem, count on your team of dental professionals to advise you. But you as the patient make the final decision, and it helps to thoroughly understand the different options, their advantages and disadvantages. If you have a chipped or broken front tooth, your likely repair options are composite resin or porcelain veneer.

Composite resins are synthetic materials that can be colored to match your natural teeth. The material is bonded to the tooth surface using adhesives that become part of the tooth structure, strengthening the original tooth. The repair looks as good as, or even better than, your original tooth. Such repairs can be used to restore small to large chips and other damage caused by decay or trauma.

Since the composite resin repair is applied directly to the tooth in the dental office, the repair can be made in a single appointment. You do not need to use a temporary repair while waiting for the final replacement to be made at a dental laboratory. This also means that the repair will cost less.

Another advantage of composite resin is that less of the healthy tooth needs to be removed to prepare the tooth to receive the replacement, since it bonds directly to the original tooth structure.

Porcelain veneers are very thin layers of tooth-colored porcelain that are also bonded to the tooth. They are usually recommended in situations with more serious injury or risk to the tooth, such as teeth that have been fractured, treated for root canal, or injured in contact sports.

Application of porcelain veneers may require more tooth preparation (in which more of the original tooth material must be removed) before the restoration can be bonded in position. Bonded porcelain veneers are likely to be longer-lasting than composite resins. They must be fabricated in a laboratory, so they require more than one visit and cost more.

All of the above are factors to consider in choosing composite resin or porcelain veneer to restore your chipped or damaged tooth. As usual in making such decisions, the final choice will depend on your individual situation.

Contact us today to schedule an appointment to discuss your questions about bonding to repair chipped teeth. You can also learn more by reading the Dear Doctor magazine article “Artistic Repair of Front Teeth with Composite Resin.”

Your son just crashed his skateboard and cracked a tooth, or maybe your daughter fell off the monkey bars at school and now has a chipped front tooth. For children, and some adults, repairing chipped or damaged teeth with tooth-colored restorative materials directly bonded to the teeth may be the perfect solution to restore their smiles.

What is Involved: Composite bonding is a technique that has been developed to correct chipped teeth and other minor dental imperfections. It may also be used to correct mild crookedness or gaps between teeth. The procedure requires the application of a tooth-colored composite resin material to the surfaces of teeth, which is then sculpted to the desired shape. It can be performed in a single visit for one or multiple teeth. The procedure usually takes between one and two hours, and the end result is a beautiful, natural-looking smile.

Advantages for Kids and Adults: Composite resin bonding is a good choice for kids and teens since their jaws are still growing and developing, and they may still be engaged in high-risk activities. After your child's teeth and jaws are fully developed, we can discuss options for more permanent restorations such as porcelain veneers or crowns. These require removal of more tooth structure, which could compromise the long-term health of your child's teeth if done too soon. Composite resin restorations, which bond straight to the teeth and require little to no tooth preparation or drilling are therefore a good option for fixing chipped teeth, and they're less expensive than choosing veneers.

Disadvantages: The longevity of composite resin restorations is related to how well you maintain your teeth. Many people can go for ten or fifteen years before they need to have the bonded resins repaired or replaced. Others will tend to stain and wear after only one or two years and will need some touch-up work.

Contact us today to schedule an appointment to discuss any questions you may have regarding dental bonding. Read more about this topic in the Dear Doctor magazine article “Repairing Chipped Teeth.”