Broken Teeth, Decayed Teeth

There are many options for fixing broken and decayed teeth

Scroll down to read about tooth repair.

Here are two broken front teeth. The big break will need a crown. The small chip can be simply polished away, or if the patient prefers, restored with a white filling.

The small chip and small cavity

What is a chip?

It is a very slightly broken tooth or filling.

What is a ‘cavity’?

It is an infection in a tooth. A cavity is called ‘caries’ by a dentist. A cavity is repaired by a filling (white or silver). When a cavity is left untreated, the infection deepens and a root canal or extraction is needed.

How to fix small chips and cavities

• A small chip on the edge of a tooth can easily be polished to look esthetic, and no filling is needed. A drill is used to polish the chip. Remember that no shot and no filling is needed.

• Small cavities, and small broken fillings can also be repaired relatively painlessly without the need for a shot. Sometimes a white filling (called a ‘composite’) is placed.

• White spots can be gently removed with the light touch of a dental drill and placing a white filling. If the white spot is large or there are many spots, a porcelain crown or porcelain laminate may be necessary in order to restore your smile.

• What is the downside to white fillings? They are prone to breaking and staining. Also the dentist may also need to drill on the back of the tooth to help hold the white filling in place so it doesn’t fall out.

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Causes of white spots:

• teeth that contain low

  levels of minerals due to

  genetics

• new cavities

• over-use of fluoride when

  young

• a dry mouth - which allows

  cavities to grow

• tetracycline stains (usually

  more yellow to brown in

  color)

How to fix a not so tiny chip or cavity

• Veneers versus white fillings. In the front teeth, after the dentist polishes and smooths a chipped tooth, you must decide if the esthetics is acceptable. If not, then a white filling or porcelain veneer is needed. Porcelain veneers are often more pleasing to the eye than white fillings and they last longer. A small porcelain veneer called, a partial porcelain veneer, is a thin, small, glass-like covering over the tooth and is an extremely esthetic choice. On average, according to one study, white fillings on a front tooth last about five years. A veneer should last longer. Don’t be shy to ask your dentist about a guarantee.

• When is a veneer is possible

For a front tooth, only if sufficient tooth remains, will it be possible to place a porcelain veneer. This is a thin cosmetic facing that is bonded (‘glued’) to the tooth. If too much tooth is missing, then a crown may be necessary.

• White fillings on the back teeth

White fillings for back teeth are made of stronger material than white fillings made for front teeth. The back filling is able to withstand the force of the patient’s bite. What is the esthetic difference between back and front white fillings? The back filling is slightly less ‘shiny’ than the front white filling. The difference, however, is minor.

Following a root canal, the root may be restored with a post cemented inside the center of the root (pictured above). On top of the post, a crown is cemented. The post is reliable but…sometimes loosen and have to be recemented.

A significantly broken, or decayed

tooth

When a tooth is damaged by breakage or deep decay, the dentist must decide if the nerve inside the tooth is infected or permanently damaged (non-functional or a ‘dead nerve’), both of which means a root canal is needed. After root canal therapy (see image) either a thin pin or thick post might be placed in the tooth to help hold a crown in place.

The decision to do a root canal is made by three factors:

• Visually, where the dentist can see the nerve which means root canal must be started

• X-rays, show if the cavity or tooth fracture goes into the nerve. If the cavity or fracture is in the nerve a root canal is needed.

• Symptomatically, which means your pain never goes away and it hurts for days.

A porcelain veneer is a reliable restoration composed of a thin color matched film of porcelain bonded or ‘glued’ to the tooth.

The white crowns

The all-white crowns are commonly made either from zirconia (a type of ceramic crown) or lithium-silicate (a glass ceramic). Lithium-silicate crowns have a superior, natural look. Zirconia is stronger but not as esthetic as lithium-silicate. Therefore, a porcelain coating is painted over the zirconia, which makes these crowns quite attractive.

A porcelain fused to metal crown (PFM) is a traditional and highly reliable restoration. The thin edge of the crown is very gum friendly and prevents inflammation.

Some white crowns can be made in one visit

In some offices, lithium-silicate or zirconium crowns are made in one visit while the patient waits. This is called the ‘CAD CAM’ system. CAD CAM systems remain under active investigation with particular interest focusing on the accuracy of the crown’s fit. Many dental offices currently report satisfaction with the system. CAD CAM is used for crowns, veneers, dentures and braces.

A PFM crown

The older, but very reliable PFM crown

An older type of crown, the porcelain fused to metal crown (PFM), has a metal interior or ‘core’ with a porcelain coating. It is strong and reliable. Porcelain fractures are uncommon with PFM. For cemented bridges on back teeth where the chewing is hardest, the PFM has proven more reliable and less likely to break than zirconium crowns.

In summary, when discussing choices in restorations (filling, crown, or bridge) with your dentist, consider these issues:

• How much tooth is remaining and what options do I have for long-lasting success?

• What are the esthetic considerations?

• How strong is my bite and what is the chance that the new work will break?

• How comfortable is the restoration. Can I eat with it comfortably?