Firstly, if the tooth is completely out (an avulsed tooth), pick it up and put it in milk. Bring it to a dentist who will take an emergency call and meet you. The faster that tooth is replaced, the more likely it will reattach properly. In very traumatic situations we may need to prepare for an implant, but that is another post.
If the tooth is just broken, try to find the piece that broke off. This can help with shape reference or possibly rebonding it. If you can’t find it, don’t worry — it will have to be bonded anyway. Again, the faster you can see your dentist, the better.
A broken tooth raises two main concerns: Has it moved in the socket? Has the nerve been damaged by the trauma or exposed by the break? It is possible that the tooth will need a root canal.
To test the nerve, the dentist will place ice on an intact portion of the tooth. This helps determine the status of the nerve inside. If this is not addressed, the tooth can develop a rotten nerve due to the trauma.
The dentist will stabilize the tooth to prevent movement. This is often done by bonding a metal wire to the neighboring teeth — sort of like putting a cast on a broken arm. Less movement allows the bone to reform properly around the tooth.
A post should be placed, preferably on a front tooth. This is usually made of a slightly flexible material such as fiberglass or titanium. After this is completed, the dentist will discuss the esthetics. The tooth may need a porcelain veneer or crown. In these cases we usually make decisions based on symmetry. If this is the center right tooth, it may be wise to consider a matching restoration on the left center tooth as a mirror image.
If the tooth is vital: At times the break is small enough that a smaller composite bonded repair is sufficient.
The case below is a little on the larger side, but there was no damage to the pulp and no exposure of the nerve. We were able to bond and repair it. After the past 12 years, the tooth has remained stable and our bond has survived successfully.
Of course this is always a concerning situation. The patient has been traumatized and it is difficult to make choices while in pain. The dentist would love to have all the answers, but at times we have to make educated estimations.
In any event, the proper evaluation would be to replace an avulsed tooth. Stabilize it if moving. A root canal may be needed, followed by restoration of the broken area. If the break is small, bonding may be all that is needed. In larger breaks we may have to be more encompassing and place a porcelain restoration to rebuild the tooth strong enough to survive for many years.