 | This article includes a list of references, related reading, or external links, but its sources remain unclear because it lacks inline citations .(May 2024) |
An enamel fracture is when the outermost layer of the tooth is cracked, without damaging the inner layers including the dentine or pulp.
An enamel fracture occurs when the outer layer of the tooth, known as enamel, is fractured without directly impacting the underlying dentine and pulp. This phenomenon typically arises from external forces impacting the tooth to induce enamel breakage. These fractures are often characterised by irregular breaks on the occlusal surface, in contrast to the smoother surfaces associated with typical tooth degradation. Enamel fractures can vary in severity, ranging from minor cosmetic issues to more significant structural problems. An enamel fracture typically doesn’t cause any noticeable symptoms such as tenderness or an increase in mobility. However, if sensitivity and mobility are present, it may indicate an enamel-dentine fracture, with the dentine being exposed.
Enamel fractures commonly result from direct impacts to the tooth, often occurring due to a variety of accidents. These accidents encompass a broad spectrum of situations, including sports-related injuries, cycling mishaps, motor vehicle collisions, and physical altercations. Notably, falls stand out as a major factor, responsible for a significant 65% of dental trauma cases. The severity of the damage inflicted on the tooth correlates directly with the energy, magnitude, shape, and direction of the impacting force.
Enamel fractures can also arise from malocclusion which is when the teeth do not align properly as they should. This can result in excessive pressure on some areas of the teeth, particularly during chewing or grinding, which increases the risk of enamel fractures occurring.
Various terms and classifications are used to differentiate types of tooth fractures; however, a limited number applies exclusively to enamel fractures. This limitation arrives from the sole effect on the outer tooth layer in enamel fractures, independent from the underlying dentine or pulp.
According to the Ellis Classification System for Enamel Fractures, a fracture involving only the enamel is categorised as a Class I fracture. Class I fractures can be further described as either vertical or horizontal, and as complete or incomplete. Patients affected by such fractures do not typically experience pain in response to temperature, air, or tapping (percussion) on the fractured tooth.
The term “craze lines” is also used to describe minute cracks exclusive to the enamel surface.
Early detection plays a pivotal role in curbing fracture progression. Various diagnostic techniques are available to localise and assess fracture planes, including clinical examinations, transillumination and bite tests. Moreover, recent advancements in diagnostic methods, such as optical coherence tomography (OCT) and near-infrared imaging, offer potential diagnostic tools for improved detection and evaluation.
Clinical examination with visual inspections can help dentists localise potential defects in the tooth. Magnifying loupes might be required for enhanced visualisation. Limitations include the limited accessibility to severity and depth of fracture planes. Old restorations and staining are advised to be removed for clearer visualisation. additionally, the dentist may test for pain on percussion or palpation. This may include sensibility testing, such as electrical pulp testing or thermal testing. IADT
Transillumination aids in locating the fracture plane by diffracting light from the LED light source . Studies have suggested using yellow or orange light may enhance diagnostic accuracy . It is advised to remove former restorations before assessment and diagnosis. Recent advances in transillumination including infrared laser technology have been proposed by recent studies, highlighting the ability of targeting in fracture diagnosis. Transillumination will show the enamel fracture to appear darker compared to the rest of the tooth due to the light not passing through.
The following technology is still being researched and is not available for general dental practice.
Optical coherence tomography (OCT) is a non-invasive and non-destructive imaging technology. It uses infrared light waves to provide high-resolution images of internal structure . Studies have suggested swept-source optical coherence tomography (SSOCT) as a potential diagnostic tool, given the high image -producing speed and the high sensitivity in detecting fracture planes and caries within the enamel layer.
In cases of a simple enamel fracture, the recommended approach is to reattach the broken tooth fragment, if it is possible. Following reattachment, smoothing of the edges is undertaken. Depending on the extent of the fractured portion, a choice is made between a glass ionomer or permanent restoration, such as composite resin, to ensure structural integrity and good aesthetics.
If the enamel fracture is mild, there is no advisement for subsequent follow-up appointments. However, if the fracture is large the dentist may want to review the restoration and monitor the tooth for any potential complications, including pulp necrosis, which represents an extreme outcome of an enamel fracture characterized by the death of the tooth pulp. Early detection and intervention are pivotal in ensuring optimal outcomes and maintaining oral health following dental trauma.
Dentin or dentine is a calcified tissue of the body and, along with enamel, cementum, and pulp, is one of the four major components of teeth. It is usually covered by enamel on the crown and cementum on the root and surrounds the entire pulp. By volume, 45% of dentin consists of the mineral hydroxyapatite, 33% is organic material, and 22% is water. Yellow in appearance, it greatly affects the color of a tooth due to the translucency of enamel. Dentin, which is less mineralized and less brittle than enamel, is necessary for the support of enamel. Dentin rates approximately 3 on the Mohs scale of mineral hardness. There are two main characteristics which distinguish dentin from enamel: firstly, dentin forms throughout life; secondly, dentin is sensitive and can become hypersensitive to changes in temperature due to the sensory function of odontoblasts, especially when enamel recedes and dentin channels become exposed.
Dental restoration, dental fillings, or simply fillings are treatments used to restore the function, integrity, and morphology of missing tooth structure resulting from caries or external trauma as well as to the replacement of such structure supported by dental implants. They are of two broad types—direct and indirect—and are further classified by location and size. A root canal filling, for example, is a restorative technique used to fill the space where the dental pulp normally resides.
Toothache, also known as dental pain or tooth pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.
The pulp is the connective tissue, nerves, blood vessels, and odontoblasts that comprise the innermost layer of a tooth. The pulp's activity and signalling processes regulate its behaviour.
In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. Some dentists will also finish root canal treatment by covering the exposed tooth with a crown. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.
The enamel organ, also known as the dental organ, is a cellular aggregation seen in a developing tooth and it lies above the dental papilla. The enamel organ which is differentiated from the primitive oral epithelium lining the stomodeum. The enamel organ is responsible for the formation of enamel, initiation of dentine formation, establishment of the shape of a tooth's crown, and establishment of the dentoenamel junction.
Pulpitis is inflammation of dental pulp tissue. The pulp contains the blood vessels, the nerves, and connective tissue inside a tooth and provides the tooth's blood and nutrients. Pulpitis is mainly caused by bacterial infection which itself is a secondary development of caries. It manifests itself in the form of a toothache.
Dentinogenesis imperfecta (DI) is a genetic disorder of tooth development. It is inherited in an autosomal dominant pattern, as a result of mutations on chromosome 4q21, in the dentine sialophosphoprotein gene (DSPP). It is one of the most frequently occurring autosomal dominant features in humans. Dentinogenesis imperfecta affects an estimated 1 in 6,000-8,000 people.
A dental emergency is an issue involving the teeth and supporting tissues that are of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source. Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.
Dentin hypersensitivity is dental pain which is sharp in character and of short duration, arising from exposed dentin surfaces in response to stimuli, typically thermal, evaporative, tactile, osmotic, chemical or electrical; and which cannot be ascribed to any other dental disease.
Dens invaginatus (DI), also known as tooth within a tooth, is a rare dental malformation and a developmental anomaly where there is an infolding of enamel into dentin. The prevalence of this condition is 0.3 - 10%, affecting males more frequently than females. The condition presents in two forms, coronal involving tooth crown and radicular involving tooth root, with the former being more common.
Dens evaginatus is a rare odontogenic developmental anomaly that is found in teeth where the outer surface appears to form an extra bump or cusp.
Dentin dysplasia (DD) is a rare genetic developmental disorder affecting dentine production of the teeth, commonly exhibiting an autosomal dominant inheritance that causes malformation of the root. It affects both primary and permanent dentitions in approximately 1 in every 100,000 patients. It is characterized by the presence of normal enamel but atypical dentin with abnormal pulpal morphology. Witkop in 1972 classified DD into two types which are Type I (DD-1) is the radicular type, and type II (DD-2) is the coronal type. DD-1 has been further divided into 4 different subtypes (DD-1a,1b,1c,1d) based on the radiographic features.
Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. Tooth wear is a physiological process and is commonly seen as a normal part of aging. Advanced and excessive wear and tooth surface loss can be defined as pathological in nature, requiring intervention by a dental practitioner. The pathological wear of the tooth surface can be caused by bruxism, which is clenching and grinding of the teeth. If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity. It is best to identify pathological attrition at an early stage to prevent unnecessary loss of tooth structure as enamel does not regenerate.
Cracked tooth syndrome (CTS) is where a tooth has incompletely cracked but no part of the tooth has yet broken off. Sometimes it is described as a greenstick fracture. The symptoms are very variable, making it a notoriously difficult condition to diagnose.
Vertical root fractures are a type of fracture of a tooth. They can be characterized by an incomplete or complete fracture line that extends through the long axis of the root toward the apex. Vertical root fractures represent between 2 and 5 percent of crown/root fractures. The greatest incidence occurs in endodontically treated teeth, and in patients older than 40 years of age.
Dental pulpal testing is a clinical and diagnostic aid used in dentistry to help establish the health of the dental pulp within the pulp chamber and root canals of a tooth. Such investigations are important in aiding dentists in devising a treatment plan for the tooth being tested.
Enamel infractions are microcracks seen within the dental enamel of a tooth. They are commonly the result of dental trauma to the brittle enamel, which remains adherent to the underlying dentine. They can be seen more clearly when transillumination is used.
Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.
Root fracture of the tooth is a dentine cementum fracture involving the pulp.