A Cracked or Chipped Tooth

A cracked or chipped tooth is rarely an emergency in the medical sense, but it is usually time sensitive in the dental sense. Cracks tend to travel, and a tooth that could be saved with a crown this week can need a root canal or an extraction if it is left for months.

Here is what to do in the first hour, how dentists judge which cracks are serious, and the specific situations where an emergency room is the right place rather than a dental office.

Go to an emergency room, not a dentist, if any of these apply

Most broken teeth are handled by a dental practice. A small number of situations are beyond what any dental office can safely manage, and delay in those is dangerous. Go to an emergency room or call emergency services if you have any of the following, whatever the tooth looks like.

• Swelling that is spreading towards your eye or down your neck
• Difficulty breathing or swallowing, or a swollen tongue or floor of the mouth
• Fever alongside facial swelling, especially if you feel unwell with it
• Bleeding that will not stop after twenty minutes of firm, unbroken pressure
• A blow to the head or face, a suspected jaw fracture, or loss of consciousness

The first hour: keep the pieces, protect the tongue, call somebody

Rinse your mouth with warm water to clear any fragments and see what you are dealing with. Save any broken pieces in a container of milk or saliva rather than throwing them away, because a clean fragment from a front tooth can sometimes be bonded back on. If the gum or lip is bleeding, press with clean gauze for ten to fifteen minutes.

A sharp edge will cut your tongue and cheek within hours, so cover it with a piece of sugar free gum or dental wax from a pharmacy until you are seen. Use a cold compress on the outside of the cheek for swelling, chew on the other side, avoid very hot and very cold things, and take the ordinary painkillers you would take for a headache. Never hold aspirin against the gum, which burns the tissue. Then call a dental practice and describe what happened and when.

Not all cracks are the same, and the name changes the plan

Craze lines are hairline cracks in the enamel only. They are extremely common in adults, do not hurt, and need nothing beyond an occasional look. A chipped cusp, where a corner of a back tooth breaks off, often causes little pain and is usually restored with a filling, an onlay or a crown.

A cracked tooth proper is one where the crack runs from the biting surface downwards but the tooth is still in one piece. These are the ones that hurt on chewing and that get worse if ignored. A split tooth is a crack that has separated into segments, and a vertical root fracture starts in the root and is often found only on an x ray. The last two frequently end in extraction of part or all of the tooth.

• Craze lines: enamel only, common, usually no treatment
• Chipped cusp: restored with a filling, onlay or crown
• Cracked tooth: needs treating promptly before it splits
• Split tooth or root fracture: often ends in extraction

How a dentist judges how urgent yours is

The strongest clue is pain when you release a bite rather than when you press down. That release pain is close to a signature of a crack that is flexing, and it usually means the tooth needs stabilizing soon. Lingering pain from cold or any pain from heat suggests the nerve is already inflamed, which points towards a root canal being part of the answer.

Other things that raise urgency are a visible pink or red spot in the middle of the break, which can mean the nerve is exposed, a tooth that has been pushed out of position or feels loose, an injury in a child where an adult tooth is involved, and any swelling of the gum or face. A tooth that is simply chipped, not sensitive and not sharp can usually wait for a normal appointment within a week or two.

What treatment usually involves, and roughly what it costs

Small chips are smoothed or bonded with composite, commonly around 150 to 500 dollars per tooth. A cracked back tooth is most often crowned to hold it together, and crowns commonly run from about 900 to 2,500 dollars depending on the material, the city and the practice. If the nerve is involved, a root canal is done first and typically adds around 700 to 1,800 dollars, more on molars.

Where the crack has split the tooth or run into the root, extraction is often the only option, commonly 150 to 400 dollars for a simple case and more if it is surgical. Replacing that tooth later with a bridge or an implant costs several times more than saving it would have, which is the real argument for being seen early. All of these ranges vary by city, by practice and by how complicated your case turns out to be, so ask for a written estimate.

• Bonding a small chip: roughly 150 to 500 dollars
• Crown for a cracked back tooth: roughly 900 to 2,500 dollars
• Root canal if the nerve is involved: roughly 700 to 1,800 dollars extra
• All of these vary by city, practice and case, so get an estimate in writing

Finding somebody today when your own dentist is closed

Call your own practice first even outside hours, because many have a recorded message with emergency arrangements. If you cannot reach anyone, our directory searches every dental practice in the United States by town or ZIP code and shows the closest first, free and with no account, which makes it quick to work down a list of numbers.

When you get through, say what broke, when it happened, whether there is any swelling, and whether it hurts when you bite or when you let go. Those four facts are what a practice uses to decide whether you are seen today or on Thursday.

Frequently asked

This is general information to help you ask better questions, not a diagnosis. Anything happening in your own mouth needs a dentist who can look at it.