Teeth break in ordinary ways. An olive pit, a stale crust, a fall on the back step, a nightly grinding habit that finally finds the weak spot in a twenty-year-old filling. Almost nobody breaks a tooth doing anything interesting.
The question everyone asks is the same: does this need dealing with tonight, or can it wait? Here is how we think about it.
The quick triage
Look at the broken surface, and pay attention to what you feel.
Enamel only, no sensitivity. A small chip on an edge, still white all the way across, no reaction to cold or air. This can usually wait a few days. Ring for a normal appointment.
Sensitive to cold or air. The break has gone through the enamel into the dentine underneath, which contains thousands of microscopic tubes running toward the nerve. That is why air across it makes you wince. Worth being seen within a few days, sooner if it is getting worse.
A pink or red spot in the middle of the break. That is the nerve, exposed. This one is same day. An exposed nerve becomes infected quickly, and the difference between treating it today and treating it next week is often the difference between a filling and root canal treatment.
Broken at or below the gum line, or the tooth is loose or moved. Same day. There may be a root fracture or damage to the socket, and that changes what can be saved.
Bleeding that will not settle, or a knock that also split the lip or jaw. If it followed an accident and there is a facial injury, a suspected broken jaw, or bleeding you cannot control with firm pressure, go to a hospital emergency department rather than waiting for a dental appointment.
What to do tonight
Keep the piece. Put it in milk, the same as for a knocked-out tooth. Fragments from front teeth can sometimes be bonded straight back on, and a real piece of your own tooth matches in colour and translucency in a way filling material can only approximate.
Rinse with warm salty water. Gently. It clears debris and settles the gum.
Cover the sharp edge. Orthodontic wax from the chemist works well. Sugar-free chewing gum pressed over the edge is a reasonable substitute at 11pm. A sharp enamel edge will shred the side of your tongue overnight and that ulcer often hurts more than the tooth by morning.
Stay off that side, and off temperature extremes. Cold especially, if the dentine is exposed.
Pain relief if you need it. Ibuprofen or paracetamol at the doses on the packets. Check with your pharmacist if you take other medication.
What not to do
Do not file it down yourself. People do try this, usually with a nail file. Enamel does not grow back, and the underlying dentine is much softer, so a home smoothing job tends to expose more of the sensitive layer, not less.
Do not superglue it. Not the fragment, not a broken denture, not anything. Household adhesives are not safe in the mouth and they contaminate the surfaces we need to bond to, which can turn a repairable fragment into an unusable one.
Do not ignore a break because it does not hurt. More on this below, because it is the common one.
Why a break that does not hurt still matters
A break that does not hurt feels like a cosmetic problem you can schedule around a busy month. Two things tend to happen while you wait.
The first is decay. A fracture creates a rough, retentive surface and often a ledge that a toothbrush cannot clean. Bacteria colonise it. Because the break is not painful, nobody looks closely for months, and by the time it is examined the decay has run deeper than the original fracture.
The second is propagation. A crack in a tooth behaves like a crack in a windscreen. Every chewing cycle loads it, and it tends to extend. There is a meaningful difference between a crack confined to the crown, which is usually restorable, and one that has run down into the root, which frequently is not. Cracks travel in one direction only, and treating one early is the whole game.
What we do about it
A short examination, a check of how the tooth responds to cold, and usually an X-ray to see how deep the fracture runs and whether the nerve or the surrounding bone is involved.
The repair depends on how much tooth is left and what is exposed:
A composite filling for a small to moderate break. Tooth-coloured material bonded directly, generally in one visit.
Bonding the original fragment back on where you kept it and it fits. Not always possible, and worth trying for a front tooth.
A crown where too much of the tooth is gone for a filling to hold. A crown covers the whole tooth and takes the chewing load off a weakened wall.
Root canal treatment then a crown where the nerve is exposed or has already died. Cleaning and sealing the inside, then protecting the outside.
Removal where the fracture runs too far below the gum to restore. If it comes to that, we will talk through what replaces it, whether that is an implant, a bridge or a denture, rather than leaving you with a gap and no plan.
You get an itemised quote before treatment starts, so you can decide with the numbers in front of you.
If it keeps happening
People who break more than one tooth in a couple of years usually have a reason, and it is worth finding rather than repairing the same problem repeatedly.
Common causes are night grinding, which flattens and eventually splits teeth and is often noticed first by a partner; large old amalgam fillings, which act like a wedge in the remaining walls of a back tooth; and untreated decay hollowing a tooth from the inside. A nightguard for a grinder is far cheaper than the sequence of crowns that follows if it is left.
Getting seen
We are open Monday to Friday, 8:00am to 5:00pm, at Level 1, Tweed Arcade, 2 Queen Street in Murwillumbah. Ring (02) 6672 1980 as early in the day as you can, because emergency slots fill from the morning onwards.
You do not need to be an existing patient. We see people from Uki, Pottsville, Kingscliff and across the Tweed Valley.
For the full picture on other dental emergencies, see our emergency dentistry page.
Frequently asked questions
Is a chipped tooth an emergency? +
It depends on what is exposed. A small chip in enamel with no sensitivity can usually wait a few days. A chip that is sensitive to cold or air has exposed the dentine underneath, and one showing a pink or red spot in the middle has exposed the nerve. That last one should be seen the same day.
Should I keep the broken piece? +
Yes. Keep it in milk and bring it in. Front tooth fragments can sometimes be bonded back on, which often gives a better colour and shape match than any filling material.
My tooth broke but it does not hurt. Do I still need to come in? +
Yes, though not necessarily today. A break with no pain can still have opened a path for bacteria into the tooth, and the sharp edge tends to cut the tongue or cheek. Getting it smoothed and sealed early is far simpler than treating decay under a fracture later.
What can I do about a sharp edge tonight? +
Orthodontic wax from a chemist, or a small piece of sugar-free chewing gum pressed over the edge, will protect your tongue until you are seen. Avoid chewing on that side.
Can a cracked tooth heal by itself? +
No. Unlike bone, tooth structure does not repair itself. A crack stays there and tends to propagate with normal chewing, which is why an early small restoration often prevents a much bigger one.