Cracked, fractured, loose or displaced tooth fragments and restorations
Brief description of the condition
Lost, chipped, fractured or loose filling; cracked, chipped, fractured or split tooth or part of tooth; loose or displaced crowns, bridges or veneers.
Key signs and symptoms
Typically may include:
- Pain (general and localized; tenderness to bite)
- Sensitivity to hot, cold and sweet and chewing of food
- Open cavity
- Section of tooth or filling missing
- Sharp edge on tooth
- Mobile section of tooth or teeth
- Mobility or loss of restoration
- Trauma to the soft tissues of the tongue, lips or cheek from sharp edges of the fracture site
- Gingival (gum) inflammation
- Recurrent caries
Initial management
If it is known or suspected that the patient has inhaled a piece of tooth, filling or restoration, send the patient immediately to emergency care via NHS 24.
If the patient has an open cavity or fractured tooth, either provide a temporary dressing or advise the patient to use an emergency temporary repair kit which can be purchased at a pharmacy.
Recommend optimal analgesia (see Appendix 2).
If painful symptoms have not been relieved with optimal analgesia, advise the patient to seek urgent dental care.
If pain is relieved or is not a significant component, advise the patient to seek non-urgent dental care.
Subsequent care
If tooth fragments or fillings, consider:
- Smoothing any rough edge, removing any loose or displaced tooth fragments or defective fillings.
- Providing a temporary palliative dressing or permanent filling.
- Pulp therapy (direct pulp cap, pulpotomy or root canal treatment) if fracture involves the pulp.
- Extracting if the tooth is not restorable.
If crowns, bridges and veneers, consider:
- Recementing the restoration with a temporary or permanent cement, depending on the integrity of the tooth beneath and whether a new restoration is needed.
- Providing temporary coverage.
- Making permanent replacements.
- Providing a new crown for a primary tooth.