As we live longer and more stressful lives, we are exposing our teeth to many more years of potentially damaging habits such as clenching, grinding, and chewing on hard foods. These habits make our teeth more susceptible to cracks. 

Cracked teeth may not show visible signs of damage, but can exhibit a variety of symptoms, including erratic pain to chew, as well as sensitivity to heat and cold. In many cases, the pain may come and go, making it difficult for your doctor to locate the source.

Why Cracked Teeth Hurt

When the outer hard tissues of the tooth develop a crack, chewing can cause movement of the segments, which in turn irritates the pulp tissue. In many cases, patients report pain on release of biting pressure, which can result in a brief, sharp pain, especially to bite hard foods. Irritation of the dental pulp can be cumulitive over time, and cracked teeth will often exhibit intermittent symptoms over several months or even years. 

Eventually, the pulp can become inflamed to the point where it no longer has potential for repair. In these cases, root canal treatment is necessary to remove the inflamed pulp tissue and evaluate the extent of the crack under the microscope.  

Types of Cracked Teeth

There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.

Craze Lines

Craze lines are tiny cracks that affect only the outer surface of the enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearance.

Fractured Cusp

When a cusp (the pointed part of the chewing surface) becomes weakened, a crack or fracture can develop under that cusp. The weakened cusp may break off by itself, in which case the pain will usually be relieved. A fractured cusp does not necesarily damage the pulp of the tooth, so root canal treatment may not be needed. However, a crown is often necessary to protect the outer surface of the remaining tooth structure.

Cracked Tooth

Some cracks extend vertically down the wall of the tooth, propogating towards the root surface. These cracks often extend into the pulp of the tooth, resulting in inflammation or infection of the pulp tissue. In these cases, root canal treatment is necessary to remove the damaged pulp tissue and to evaluate the true depth of the crack under the microscope. 

If the crack does not extend onto the root surface and has not separated the tooth into two distinct segments, root canal treatment followed by the placement of a crown can allow the tooth to be saved. However, the outcome can be more unpredictable when treating teeth with cracks of this nature, so it is important to make an informed decision with your doctor on a case by case basis. 

In the event that the crack is found to propogate onto the root surface, your doctor will likely advise that the tooth must be extracted. 

Split Tooth

A split tooth exhibits a crack with distinct segments that can be separated from one another. These teeth generally have a hopeless prognosis and require extraction.  

Vertical Root Fracture

Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They are often asymptomatic and may therefore go unnoticed until the surrounding bone and gum become infected. Extraction is usually the only treatment option, but in certain cases, a portion of the tooth can be saved by removal of the fractured root (known as root amputation). 

Preventing Cracked Teeth

While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

  • Don't chew on hard objects such as ice, unpopped popcorn kernels, or pens.
  • Take every effort to avoid clenching or grinding your teeth. If you grind your teeth at night, speak to your dentist about having a custom nightguard made to protect your teeth while you sleep
  • Wear a mouthguard and/or protective mask when playing contact sports.

Early diagnosis is important. Even with high magnification and special lighting, it can be challenging to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, and eventually result in the loss of the tooth. Early diagnosis and treatment are essential to saving cracked teeth.

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