A fractured tooth is a fairly common occurrence. While teeth are incredibly strong, the day-to-day wear and tear of using our teeth can lead to cracking, chipping, and even breaking. Sometimes, the chipping of a tooth can be so small that you may not even notice it. Other times, the fracture is large enough to be visible, or jagged enough to feel with your tongue. In extreme cases, by damaging your tooth you may have exposed the nerve inside the tooth, which can cause pain.

Endodontists are the dental professionals who specialize in the root and pulp of our teeth–the layers beneath the enamel. In addition to performing root canals, they are able to diagnose and treat fractured teeth, as cracks that reach beneath the surface of the tooth can have serious implications for the inner layers.

If you experience a minor chip in your tooth, make a non-emergency appointment with your dentist to have it treated. A broken or cracked tooth is an urgent matter, and you should try to see your dentist as quickly as possible. Some dentists have in-house endodontists on staff, but if yours does not, ask to be referred to a specialist. Unfortunately, fractured teeth do not heal, but dental solutions can seal or cover the tooth to prevent the fracture from deepening or spreading to the root of the tooth.

Causes and Symptoms of a Fractured Tooth

A common cause of fracturing a tooth is biting down on a hard object. You may chip or fracture a tooth when chewing ice or hard candy, or when using your teeth in improper ways, like to open or loosen something. A hard impact to the face can be dangerous for many reasons, and this includes damaging your teeth. For those who play contact sports, a mouth guard should always be worn. If you fall while walking, or are about to collide with another hard surface, try turning your face away to prevent a direct impact.

Cavities and old amalgam fillings that don’t support the entire tooth can weaken your enamel and may lead to cracks in your teeth. People who clench or grind their teeth are also prone to fractures, and if you have a history of grinding your teeth at night, you may consider consulting your dentist about using a mouth guard.

The severity of your symptoms depends on the size and location of the fracture. A small chip on the surface may very well cause no pain or discomfort. When a tooth cracks completely, the sides can move against each other during chewing, and this leads to discomfort and irritation in the layers beneath (the pulp). If left untreated, the pulp will become irritated enough to cause pain. By this point, the pulp–which contains the nerves and blood vessels–can no longer heal itself. Sometimes, a crack can be large enough that it strikes right down to the nerves and you may experience pain immediately.

When exposed, the nerves in our teeth are extremely sensitive. Pressure and movement from chewing, biting down, and even releasing your bite can cause varying degrees of discomfort or pain. Extreme temperatures can irritate the tooth, as can very sweet or sugary foods. The pain can be constant, or it may come and go. Eventually, an untreated fracture can lead to tooth decay or infection of the pulp.

Treatment and Procedures for Fractured Teeth

Dentists and endodontists determine the proper treatment for a fractured tooth depending on the extent and location of the crack. There are actually several different kinds of fractures in teeth, some of which require more intensive treatment than others, and your dental professional must diagnose your fracture before they proceed. In most cases where the tooth has not decayed or become infected, restoring the tooth and preventing further damage is an entirely feasible and routine procedure.

Chipped teeth: A
surface-level chip in your tooth will rarely need treatment. These are
considered minor fractures, and your dentist will more than likely use filling
material only if there appears to be a risk of the chip getting worse. For
aesthetic appearances, your dentist can file down and polish the tooth.

Craze lines: Craze
lines are also surface-level fractures. In this case, they are minor cracks on
the enamel that don’t reach below the surface. Your dentist may decide that
treatment isn’t necessary, or they may polish the area to smooth out the

Fractured cusp: Fractured
cusps occur when a piece of the tooth’s chewing surface breaks off. They often
occur around fillings, but are generally considered to be minor fractures. It
is rare that a fractured cusp damages the pulp, and it usually does not cause
pain. Dentists often place a new filling or crown over the area to protect the
fracture from deepening.

Cracked tooth: A
cracked tooth involves the entire tooth–a
fracture that reaches from the enamel down to the nerve. While the tooth is not
broken into pieces, the crack will gradually spread. It is at this stage when
you may need to consult with a specialist for treatment. Sometimes, cracks can
be repaired with filling material, but more often than not, a crown is
necessary to prevent it from worsening. If the pulp becomes damaged, an
endodontist may need to perform a root canal. A serious break exposes the nerve
and will almost always cause pain or bleeding. In this case,a root canal is
critical to remove the exposed nerve.

Split tooth: A
split tooth often results from the prolonged spreading of a cracked tooth, and
causes a completely vertical break that splits the tooth into two separate
parts. An endodontist will likely perform a root canal and cover the root with
a crown. Molars have more than one root, and when they split, it is sometimes
possible to save one of the roots. The endodontist will remove the roots that
cannot be saved and cover the remaining piece with a crown. When no roots can
be saved, the tooth must be removed.

Vertical root
These fractures begin in the root of the tooth and move upward
toward the surface. They can often go unnoticed because they show minimal
symptoms until the surrounding bone and gum become infected. Extraction of the
tooth is the most common treatment, but if the tooth can be saved by removing
the fractured portion, endodontic surgery may be performed. 

Even in cases when a fractured tooth must be removed, there are still options available to preserve your smile and overall oral health. Dental technology has advanced in leaps and bounds; innovations like dental implants allow dentists to anchor and reinforce prosthetic teeth that look and function like natural teeth. No matter how severe the fracture in your tooth, consulting your dentist as soon as possible and determining the appropriate treatment can effectively resolve the issue.

Topical anesthetics, or “numbing gels” as you may hear them called in the dental office, are basically just that. They are liquids or gels that can be applied to mucous membranes, such as inside the mouth, to cause surface numbness.

In dental offices, these gels are typically applied prior to an injection of anesthesia in order to numb the gumbs and lessen the pain of the injection.

Topical anesthetics belongs to a group of medicines known as topical local anesthetics (an-ess-THET-iks ) . In addition to dentistry, they are used to relieve pain and itching caused by conditions such as sunburn or other minor burns, insect bites or stings, poison ivy, poison oak, poison sumac, and minor cuts and scratches.

Topical anesthetics deaden the nerve endings in the skin. They do not cause unconsciousness as do general anesthetics used for surgery.

Most topical anesthetics are available without a prescription; however, your doctor may have special instructions on the proper use and dose for your medical problem.

These medicines are available in the following dosage forms:


  • Benzocaine
    • Cream (U.S.)
    • Ointment (U.S.)
    • Topical aerosol (U.S.)
    • Topical spray solution (Canada)
  • Benzocaine and Menthol
    • Lotion (U.S.)
    • Topical aerosol solution (U.S. and Canada)
  • Butamben
    • Ointment (U.S.)
  • Dibucaine
    • Cream (U.S.)
    • Ointment (U.S. and Canada)
  • Lidocaine
    • Film-forming gel (U.S.)
    • Jelly (Canada)
    • Ointment (U.S. and Canada)
    • Topical aerosol (Canada)
    • Topical spray solution (Canada)
  • Pramoxine
    • Cream (U.S. and Canada)
    • Lotion (U.S.)
  • Pramoxine and Menthol
    • Gel (U.S. and Canada)
    • Lotion (U.S.)
  • Tetracaine
    • Cream (U.S.)
  • Tetracaine and Menthol
    • Ointment (U.S.)

Before Using This Medicine

If you are using this medicine without a prescription, carefully read and follow any precautions on the label. For topical anesthetics, the following should be considered:


Tell your doctor if you have ever had any unusual or allergic reaction to a local anesthetic, especially when applied to the skin or other areas of the body. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes, especially aminobenzoic acid (also called para-aminobenzoic acid [PABA]), to parabens (preservatives in many foods and medicines), or to paraphenylenediamine (a hair dye).


Although studies on effects in pregnancy have not been done in humans, topical anesthetics have not been reported to cause problems in humans. Lidocaine has not been shown to cause birth defects or other problems in animal studies. Other topical anesthetics have not been studied in animals.


Topical anesthetics have not been reported to cause problems in nursing babies.


Benzocaine may be absorbed through the skin of young children and cause unwanted effects. There is no specific information comparing use of other topical anesthetics in children with use in other age groups, but it is possible that they may also cause unwanted effects in young children. Check with your doctor before using any product that contains a topical anesthetic for a child younger than 2 years of age.

Older adults

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of topical anesthetics in the elderly with use in other age groups.

Other medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other medical problems

The presence of other medical problems may affect the use of topical anesthetics. Before using a topical anesthetic, check with your health care professional if you have any other medical problems, especially:

  • Infection at or near the place of application or
  • Large sores, broken skin, or severe injury at the area of application—The chance of side effects may be increased

Proper Use of This Medicine

For safe and effective use of this medicine:

  • Follow your doctor’s instructions if this medicine was prescribed.
  • Follow the manufacturer’s package directions if you are treating yourself.
  • Unless otherwise directed by your doctor,do not use this medicine on large areas, especially if the skin is broken or scraped. Also, do not use it more often than directed on the package label, or for more than a few days at a time. To do so may increase the chance of absorption through the skin and the chance of unwanted effects. This is especially important when benzocaine is used for children younger than 2 years of age.

This medicine should be used only for problems being treated by your doctor or conditions listed in the package directions.Check with your doctor before using it for other problems, especially if you think that an infection may be present. This medicine should not be used to treat certain kinds of skin infections or serious problems, such as severe burns.

Read the package label very carefully to see if the product contains any alcohol. Alcohol is flammable and can catch on fire.Do not use any product containing alcohol near a fire or open flame, or while smoking. Also, do not smoke after applying one of these products until it has completely dried.

If you are using this medicine on your face,be very careful not to get it in your eyes, mouth, or nose. If you are using an aerosol or spray form of this medicine, do not spray it directly on your face. Instead, use your hand or an applicator (for example, a sterile gauze pad or a cotton swab) to apply the medicine.


The dose of a topical anesthetic will be different for different patients.Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change itunless your doctor tells you to do so.

For benzocaine and for benzocaine and menthol combination

  • Fortopicaldosage forms (aerosol solution, cream, lotion, ointment, and spray solution):
    • For pain and itching caused by minor skin conditions:
      • Adults and children 2 years of age and older—Apply to the affected area three or four times a day as needed.
      • Children younger than 2 years of age—Dose must be determined by your doctor.

For butamben

  • Fortopicaldosage form (ointment):
    • For pain and itching caused by minor skin conditions:
      • Adults—Apply to the affected area three or four times a day as needed.
      • Children—Dose must be determined by your doctor.

For dibucaine

  • Fortopical creamdosage form:
    • For pain and itching caused by minor skin conditions:
      • Adults and children 2 years of age and older—Apply to the affected area three or four times a day as needed.
      • Children up to 2 years of age—Dose must be determined by your doctor.
  • Fortopical ointmentdosage form:
    • For pain and itching caused by minor skin conditions:
      • Adults—Apply to the affected area three or four times a day as needed. The largest amount that may be used in a twenty-four-hour period is 30 grams, but much smaller amounts are usually enough.
      • Children 2 years of age and older—Apply to the affected area three or four times a day as needed. Do not use more than 7.5 grams in a twenty-four-hour period.
      • Children up to 2 years of age—Dose must be determined by your doctor.

For lidocaine

  • Fortopicaldosage forms (aerosol solution, film-forming gel, jelly, ointment, and spray solution):
    • For pain and itching caused by minor skin conditions:
      • Adults—Apply to the affected area three or four times a day as needed.
      • Children—Dose must be determined by your doctor.

For pramoxine and for pramoxine and menthol combination

  • Fortopicaldosage forms (cream, gel, and lotion):
    • For pain and itching caused by minor skin conditions:
      • Adults and children 2 years of age and older—Apply to the affected area three or four times a day as needed.
      • Children younger than 2 years of age—Dose must be determined by your doctor.

For tetracaine and for tetracaine and menthol combination

  • Fortopicaldosage forms (cream and ointment):
    • For pain and itching caused by minor skin conditions:
      • Adults and teenagers—Apply to the affected area three or four times a day as needed. The largest amount that may be used in a twenty-four-hour period is 30 grams (a whole tube of the medicine), but much smaller amounts are usually enough.
      • Children 2 years of age and older—Apply to the affected area three or four times a day as needed. Do not use more than 7 grams (about one-fourth of a tube of the medicine) in a twenty-four-hour period.
      • Children younger than 2 years of age—Dose must be determined by your doctor.

Missed dose

If your doctor has ordered you to use this medicine according to a regular schedule and you miss a dose, use it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and use your next dose at the regularly scheduled time.


To store this medicine:

  • Keep out of the reach of children.
  • Store away from heat and direct light.
  • Keep the medicine from freezing.
  • Do not puncture, break, or burn aerosol containers, even when they are empty.
  • Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

After applying this medicine to the skin of a child,watch the child carefully to make sure that he or she does not get any of the medicine into his or her mouth. Topical anesthetics can cause serious side effects, especially in children, if any of the medicine gets into the mouth or is swallowed.

Stop using this medicine and check with your doctor:

  • If your condition does not improve within 7 days, or if it gets worse.
  • If the area you are treating becomes infected.
  • If you notice a skin rash, burning, stinging, swelling, or any other sign of irritation that was not present when you began using this medicine.
  • If you swallow any of the medicine.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

  • Less common
    • Large swellings that look like hives on the skin or in the mouth or throat 
  • Symptoms of too much medicine being absorbed by the body–very rare
    • Blurred or double vision;  confusion;  convulsions (seizures);  dizziness or lightheadedness ;  drowsiness;  feeling hot, cold, or numb;  headache;  increased sweating;  ringing or buzzing in the ears ;  shivering or trembling;  slow or irregular heartbeat;  troubled breathing;  unusual anxiety, excitement, nervousness, or restlessness;  unusual paleness;  unusual tiredness or weakness 

Also, check with your doctor as soon as possible if any of the following side effects occur:

  • Burning, stinging, or tenderness not present before treatment ;  skin rash, redness, itching, or hives 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Oil pulling, or oil swishing is a traditional folk remedy that has recently re-gained popularity.  The process involves swishing, or pulling, for 3-15 minutes with a natural oil such as sesame, sunflower, olive, coconut, and others.  It is said to cure/help with all kinds of health issues including whitening teeth, plaque buildup on teeth, hormonal issue, digestion.  Now spreading across the web, claims about oil pulling are begging the question, is this for real?

Let me start by saying, as a dentist, that in my 5+ years of dental education I have never heard of oil pulling.  The closest thing to it is that some mouthwashes, namely Listerine, use essential oils to help kill bacteria, freshen breath, and keep the mouth healthy.  So this idea of keeping an oil in your mouth for up to 20 minutes is certainly not involved in a core dental education.

Oil Pulling Claims

Oil pulling enthusiasts make 3 general claims about the practice that I will address one at a time:

1. Pulls Toxins: 

Unless you have a high level of toxins in your cheeks and tongue, the claim of pulling toxins is extremely far-fetched. There is no scientific evidence to show that toxins can be pulled from your body by swishing with oil.

2. Clean Mouth: 

Some claims, such as killing oral bacteria and reducing plaque, seem more plausible.  Doing a quick search on PubMed, the go-to scientific article search engine, one finds a scant dusting of articles on this ancient practice.  Basically, every relevant study was done by one man, a faculty member at a dental school in India.  The studies do show reduced plaque, improved health, and decreased bacterial loads in oil pulling patients.  However, the studies lack strength and do not compare oil pulling to common solutions like mouthwash, or Chlorhexidine (Peridex), the gold-standard in oral rinses.

3. Tooth Whitening: 

Now, we get to the last, and possibly most tantalizing claim about oil pulling. Whiter teeth!  A quick Google search results in numerous before-and-after shots, which as a dentist I know are completely useless unless done with the exact same lighting, F-stop, flash, etc.  None of the photos I found met my criteria for actual whitening as a result of oil pulling.  In addition, no scientific article can be found about the whitening effects. The placebo effect often drives people to perceive treatments as successful, when in fact they are not.  And any whitening effects of Oil Pulling appear to be purely placebo.

Oil pulling is an ancient practice that is being rejuvenated by young, easily persuaded individuals around the country, however there is virtually zero scientific evidence backing it up.

Do yourselves a favor! Go buy a bottle of mouthwash at the store. Use that once a day for the same effect as oil pulling without wasting 20 minutes of your life and making yourself feel sick.

Brush twice a day, everyday.  Use a pea-to-chickpea size amount of toothpaste, and make sure it has fluoride which is essential in preventing cavities.

How to Brush Your Teeth

Angle the soft bristles of your brush towards the gums as to remove as much plaque as possible.  Don’t scrub, this can damage the enamel and cause your gums to recede. 

Remember, 2 minutes of brushing twice a day = a healthy smile!

Check out www.pearlinbrite.com for our Aloe Vera Fluoride Toothpaste and Nano-Silver Soft Toothbrush.