When a tooth gets chipped or fractured, the first consideration must be whether the pulp - the vital, living portion of the tooth - has been damaged. I f a fracture is sensitive, painful or uncomfortable, it may be because the pulp is exposed. Ultimately, the condition of the pulp and the amount of remaining tooth structure will determine the choice of treatment.

• Minor Fracture                                                         Small chips off the biting edges of the teeth, are usually simple to repair. If the chipped tooth is of sufficient length so that shaping it with a sandpaper disc won't harm the smile line, it may be cosmetically contoured. Often, the neighboring teeth are also contoured so that no one tooth stand out from the rest. Or, an acid - etch bonding technique may be used to "fill out " the defect. Avoid crowning in cases of minor fracture whenever possible. Remember that it is always best at least initially to try simple therapies that preserve the color, shape and health of the tooth.

• Serious Fracture                                                        Often caused by accidents, usually are best treated with the least amount of additional stress possible. Your dentist may choose to bond some teeth and crown others, especially when he needs time to determine whether the nerves in the teeth can be saved. If you experience a serious fracture, see your dentist immediately, even if you aren't experiencing any pain. Often, the only sign of pulpal damage is tooth discoloration. In such cases, the first step is to replace the damaged nerve structure with root canal filling. Then, because much of the natural tooth structure is gone, full crowns typically are placed.

• Vertical Root Fracture                                                There may be no practical way to save the tooth, making extraction the only answer. However, all possibilities should be considered before any tooth is extracted. The function of dentistry is to maintain the integrity of the dental arch and to preserve the natural tooth as much as possible.

Cosmetic contouring is an ideal treatment for small fractures and chips because anesthesia is not required and the amount of tooth reduction involved is minimal - just enough to " smooth out " the rough edges. Once treatment is complete, no replacements or touch - ups are necessary. The cost and time involved are minimal, as well.