Endodontics
Cracked Tooth

Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example, biting on hard objects, trauma, grinding and clenching of teeth, especially teeth with large fillings. All of these behaviors place the teeth under extra strain and render them more susceptible to cracking.

When a tooth is cracked, pain can become momentarily debilitating. In the absence of pressure on the crack, there may be no discomfort.  However, as the cracked tooth performs a biting action, the cracked pieces move.  The pulp  of the tooth then become instantly stimulated and painful irritation occurs. As pressure is released again, the two parts of the crack move back together, and pain may reoccur.  If left untreated, bacteria invade the crack and the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth.

Symptoms of a cracked tooth may include:

  • Unexplained pain when eating (biting).
  • Sensitivity to warm and cold foods.
  • Pain with no obvious cause (in Xray).
  • Acute pain described as "electric shock in tooth".
What kind of cracks can affect the teeth?

There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In cases where the crack is not too deep, root canal therapy can be performed, and the natural tooth can remain in the mouth.  In other situations, the tooth is too badly damaged and requires extraction.

Here is a brief overview of some of the most common types of cracks:

Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.

Oblique supragingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. The exposed area may be sensitive to air or cold water. result.  Generally,  the tooth pulp (that contains the nerves and vessels) will remain unaffected.

Oblique subgingival cracks – These cracks extend below the gum line and often beyond where the jawbone begins.  When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the fracture line) and a crown or other restoration.

Vertical furcation cracks – These cracks occur when the root(s) of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can save the tooth HOWEVER these fractures can also be mortal and require extraction.

Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the bone level.  Root canal therapy may be possible, depending on how close the fracture is to the tooth surface.  However, extraction is almost always the only option after sustaining this classification of fracture.

Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.

How are cracks in the teeth treated?

There are many different types of cracked teeth. Some fractures are visible using X-ray machines and transillumination while others are clearly visible to the naked eye. In cases where the tooth root is affected, root canal therapy/crown or extraction/implant replacement are the most viable treatment options. 

When the crack is too severe for the tooth to be saved, the situation requires extracting the fragments. There are two common restorative options in this case, fixed bridges and dental implants . 

If you have any questions or concerns about cracked teeth, please contact our office.



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