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, chewing on ice or popcorn, trauma, grinding and clenching of teeth are all behaviors that place teeth under extra strain and render them more susceptible to cracking.
When tooth enamel is cracked, pain can become momentarily debilitating. When no pressure is exerted on the crack there may be no discomfort. However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack fuse back together, and pain subsides. If left untreated, 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
Sensitivity to warm and cold foods
Pain with no obvious cause
Difficulty pinpointing the location of the pain
Types of Cracks The specific type of crack will determine what type of treatment is viable. In many cases, if 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.
Craze Lines – These are tiny hairline cracks that only affect the outer enamel of the tooth. These cracks are more common in adults. They are typically only superficial and are usually of no concern. Fractured Cusp - When a cusp becomes weakened, a fracture may result. A fractured cusp rarely damages the pulp unless it fractures very close to the pulp, so root canal is typically not necessary. Your dentist will usually restore the tooth with a full crown. Cracked Tooth – This type of crack extends from the chewing surface of the tooth vertically towards the root end. In some cases, the crack may extend below the gum line. Damage to the pulp is commonplace. Root canal treatment is usually necessary, and your dentist will be better able to determine the extent of the crack once inside the root canal. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth. Therefore, early detection is essential. Vertical Root Fractures – A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Unfortunately, they show minimal symptoms initially and may go unnoticed until the fracture reaches the root canal. Treatment involves endodontic surgery if a portion of the tooth can be saved by removal of the fractured root. Otherwise the tooth will have to be extracted.
How are these cracks diagnosed and treated?: Some cracks can be exposed using routine dental radiographs or Cone Beam Computed Tomography (CBCT), a 3D image of the tooth and surrounding bone that may be affected by the crack, while others are clearly visible to the naked eye. In cases where the root canal is affected, root canal therapy is the most viable treatment option. The pulp, nerves, and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha. A crown or filling will be added to stabilize the tooth and it will continue to function as normal.
When the crack is too severe for the tooth to be saved, the dentist will perform an extraction. There are a number of restorative options in this case, such as bridges, dental implants, and partial dentures. All of these structures can restore biting, chewing and speaking functions.