Broken tooth: what to do in the first few hours

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Broke a tooth? Here's what to do now: rinse your mouth with water, store the broken piece in a little milk, saline solution or your own saliva, don't use any kind of glue and avoid chewing on the side of the fracture. If you see a red dot or blood in the center of the tooth, if the pain is severe or if the tooth is loose, get care the same day. A small chip with no pain can wait a few days — but not weeks.

In clinical practice, most fractures happen when biting something hard, in falls and blows, or in teeth already weakened by large fillings and old root canals. What changes the course of the case is how deep the break goes — and that's what this article helps you recognize before you get to the dental office.

Below, Dr. Cléo Salustiano (CRO-SP 170844), a dentist in Mooca, São Paulo, explains how to identify the type of fracture, what to do in the first few hours, when it's truly urgent and how each situation is usually treated.

This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the general dentistry page to learn how the treatment is done here and book your assessment.

Step by step

1. Rinse your mouth and look at the tooth calmly. Warm water or saline solution clears debris and blood so you can see how big the break is. If your gum is bleeding, press a clean piece of gauze on it for a few minutes.
2. Keep the piece that broke off. Put the fragment in milk, saline solution or a small container with your own saliva. Don't let it dry out or wrap it in paper: in many cases the dentist can bond the original piece back on, and that only works if it's kept moist and intact.
3. Don't glue, file or "fix" it yourself. Contact cement, super glue and similar products burn the tooth tissue, contaminate the fracture and get in the way of the final repair. Don't file the edge either: the dentist does that adjustment with the right instrument.
4. Protect your tongue and cheek. If the edge is sharp, a piece of orthodontic wax (from a pharmacy) over the tip prevents sores until your appointment. Sugar-free gum works for a short while, but it comes off easily.
5. Manage pain and swelling. A cold compress on the outside of your face helps with swelling after a blow. Take only a pain reliever you already use, and never put a pill directly on the tooth — it burns the gum. Avoid very hot, cold or sweet foods, which trigger sensitivity.
6. Book an assessment — today, if there's a warning sign. A red dot or blood in the center of the tooth, severe pain, a loose or displaced tooth, or a blow followed by dizziness or vomiting are reasons for same-day care (for the last two, go to a medical emergency room before the dentist).

What kind of break is it? How to gauge severity at home

Small enamel chip: the edge feels rough or uneven, with no pain, at most mild sensitivity. It's the most common and least serious fracture. It can wait a few days, but book soon: a rough edge irritates your tongue, and chipped enamel no longer protects the layer underneath.

Break exposing the dentin: the tooth hurts when you breathe in cold air, drink cold water or eat something sweet, and you may see a yellowish color in the center of the break. Dentin has tiny channels that carry stimuli straight to the nerve, hence the sensitivity. It needs a filling within a few days to prevent decay and nerve inflammation.

Fracture exposing the pulp: a red or pinkish dot, or bleeding, appears in the center of the tooth, and the pain is usually intense and constant. Here the break has reached the nerve. It's urgent: the sooner the tooth is treated, the better the chance of solving it with a simpler treatment instead of losing the tooth.

Loose, displaced or pushed-in tooth: this suggests a root fracture or injury to the bone and ligament that hold the tooth. Don't force the tooth back and don't chew with it. This is also urgent, and sometimes imaging is the only way to see how extensive the problem is.

Tooth knocked out whole (avulsion): this is the only case where time is counted in minutes. Hold it by the crown, never by the root. If it's dirty, rinse it quickly in saline or milk without scrubbing. If you can, put it back in place with gentle pressure and bite on gauze; if not, carry it in milk or saline. The chance of successful reimplantation is highest within the first hour.

A tooth with a root canal or large filling that broke: these teeth are more fragile, and the break is usually bigger than it looks from outside. Even without pain — a treated tooth can't feel — get it checked soon, because the fracture may have reached the root.

How does the dentist fix a broken tooth?

For chips and small breaks, treatment is usually a composite filling done on the spot, rebuilding the missing part in the tooth's color. When the piece was saved and is intact, bonding the original fragment back may be an option — which is why you shouldn't let it dry out.

For larger breaks that compromise a lot of the tooth, a filling may not be enough for the tooth to withstand biting forces. Options then include a veneer, when the loss is on a front tooth, or a crown, which covers the whole tooth and distributes the force. The choice depends on how much healthy tooth is left.

When the fracture has reached the nerve, root canal treatment usually comes before the rebuild. It removes the exposed pulp, relieves the pain and allows the tooth to be restored afterward. Done early, the outlook is good; if delayed, infection can set in and complicate things.

For a root fracture, the approach depends on the height and direction of the fracture line. Some allow the tooth to be kept with monitoring. A vertical fracture, which splits the root from top to bottom, usually leads to extraction and planning a replacement, such as an implant.

After the repair, a few habits protect the work: avoid biting very hard objects and foods with the restored tooth, wear a night guard if you grind your teeth and keep your check-ups, when the restoration is polished and checked.

No dentist can guarantee that a broken tooth will last forever once treated. What the assessment does is choose the solution most likely to work in your case and explain clearly what to expect from it.

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Broken or Chipped Veneer: What to Do Now

Toothache: When Is It a Dental Emergency?

When do you need a root canal?

Sensitive teeth: causes and what to do

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