I thought I'd broken two of my teeth. I was rushing out the door with a mouthful of muesli when I heard—and felt—a big crrruNnch. It felt exactly like it sounded: What else could it be other than cracked teeth, because how many other types of injuries can a little block of calcium suffer? But after two days, the pain started to dissipate. After another three, it was totally gone, which wouldn't have happened if I'd exposed a nerve or caused a crack. It turns out that I'd very likely sprained my tooth—one of the most common and least serious tooth injuries many people have never heard of.
“Most people when they come in here say, 'I think I've cracked a tooth or broken something',” says Sally Cram, a Washington, DC-based dentist. “People don't come in and say 'I think I have a tooth sprain.' I think if you ask most people what a tooth sprain was, they probably couldn't tell you.”
"Tooth sprain," it's worth noting, isn't really a clinical term most dentists use. “Trauma from occlusion” is the technical term for an injury that results from biting, but it's also a clumsy one to use in normal conversation, so "tooth sprain" has caught on as a layman's way of explaining the little-known injury. In short, it's an inflammation injury to the ligaments supporting the teeth, and everybody's familiar with the idea of spraining the ligaments in a wrist or knee, even though the ligaments in a complicated joint like the knee are much different.
“We know it's not the same as a sprain in a joint,” Cram says. “The periodontal ligament is very different from the ligaments surrounding the knee joints and hip joints, because those ligaments are helping to hold one bone to another one.”
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Mounting the tooth into the jaw bone is a rubbery, thin ligament that, when you chew, gives way a little so that the two hard body parts don't bang together. “It's like a little shock absorber around the whole root of the tooth,” Cram says. When you bite down too hard on something and the force is too great for the ligament to absorb, it can be stretched, broken, or crushed, says Phillip Richards, a dentist and professor at the University of Michigan School of Dentistry.
Because the inflamed ligament has nowhere to expand into—just hard bone to one side and hard tooth on the other—it can be incredibly painful. Injuries around teeth are more localized, self-contained, and hidden, Richards says, and that makes them hard to diagnose. So because very few people have heard of tooth sprains, it's reasonable for somebody to bite down on a piece of gristle or a seed, feel a sharp pain, and assume they've cracked a tooth.
How do you tell a sprain from a cracked tooth, exposed nerve, or decay? The first step is generally to wait it out. “Typically, if it's juts a little pinching of that ligament, it's going to self-resolve itself in three to five days,” Cram says. Cracks, exposed nerves, and decay don't heal on their own, so if a few days' rest soothes your tooth, it was likely just a sprain. In the meantime, stick an ice pack against your face near the tooth, avoid hard food and chewing gum, and take an anti-inflammatory painkiller such as ibuprofen, Richards says. If the pain sticks around longer than five days, go to a dentist. It doesn't rule out a sprain, because you might just be continually hurting it and not allowing it to heal, but it may be something more serious or more chronic.
“It could be any trauma to a tooth that'd cause a tooth sprain,” Cram says, adding that it's not always caused by biting down on something hard. Grinding your teeth at night, clenching your jaw during the day, and biting your nails can traumatize tooth ligaments, and having a misaligned bite pattern can also make you more susceptible to recurring ligament injuries, she says. Chronic inflammation is more serious and can lead to gum recession and loss of bone around the tooth's root over the long-term, Cram says. Tooth ligaments aren't built to take constant low-level punishment any more than a single high-impact trauma. If you keep getting tooth sprains, go see a dentist, who may correct your bite pattern or give you a bite guard to wear at night.
The good news is that tooth sprains are typically minor, and an isolated incident won't lead to everlasting harm, Cram says. Biting down on a chicken bone or a seed, or having a too-high filling or crown that leads to a sprain won't likely be hard enough to permanently injure a tooth's ligaments. The supportive tissues around teeth have a high capacity for healing, Richards says, so it may hurt for a while, but as long as you take up a temporary diet of mush to give your tooth some rest, it should heal fine. The next time you crunch into something and feel a pang, wait it out a few days if the pain is bearable. You just might save yourself half an afternoon—and an expensive trip to the dentist.
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