With
their more sophisticated procedures,
dentists are helping people keep their teeth
longer. Because people are living longer and
more stressful lives, they are exposing
their teeth to many more years of
crack-inducing habits, such as clenching,
grinding, and chewing on hard objects. These
habits make our teeth more susceptible to
cracks.
How do I know if my
tooth is cracked?
Cracked teeth show a variety of symptoms,
including erratic pain when chewing,
possibly with release of biting pressure, or
pain when your tooth is exposed to
temperature extremes. In many cases, the
pain may come and go, and your dentist may
have difficulty locating which tooth is
causing the discomfort.
Why does a cracked
tooth hurt?
To understand why a cracked tooth hurts,
it helps to know something about the anatomy
of the tooth. Inside the tooth, under the
white enamel and a hard layer called the
dentin, is the inner soft tissue called the
pulp. The loose pulp is a connective tissue
that contains cells, blood vessels and
nerves.
When the outer hard tissues of the tooth
are cracked, chewing can cause movement of
the pieces, and the pulp can become
irritated. When biting pressure is released,
the crack can close quickly, resulting in a
momentary, sharp pain. Irritation of the
dental pulp can be repeated many times by
chewing. Eventually, the pulp will become
damaged to the point that it can no longer
heal itself. The tooth will not only hurt
when chewing but may also become sensitive
to temperature extremes. In time, a cracked
tooth may begin to hurt all by itself.
Extensive cracks can lead to infection of
the pulp tissue, which can spread to the
bone and gum tissue surrounding the tooth.
Why have I been
referred to an endodontist?
All dentists receive basic training in
the diagnosis and treatment of cracked teeth
in dental school. However, some cracked
teeth can be especially difficult to
diagnose, and treatment may involve root
canal treatment. That’s why you have been
referred to an endodontist.
Endodontists are dentists with at least
two additional years of education that
include the diagnosis and treatment of
unusual dental pain. Cracked tooth pain
often comes from damage to the inner soft
tissue of the tooth, the pulp. Endodontic
treatment, also known as root canal
treatment, can relieve that pain.
Early diagnosis is extremely important.
Like cracks in a windshield, cracks in teeth
often start small and progress slowly. The
sooner a crack is detected and treated, the
better the chance of saving your tooth. The
endodontist’s special training and
experience can be valuable when a cracked
tooth is suspected.
How will my cracked
tooth be treated?
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 enamel. These cracks are
extremely common in adult teeth. Craze lines
are very shallow, cause no pain, and are of
no concern beyond appearances.
Fractured Cusp
When a cusp (the pointed part of the
chewing surface) becomes weakened, a
fracture sometimes results. The weakened
cusp may break off by itself or may have to
be removed by the dentist. When this
happens, the pain will usually be relieved.
A fractured cusp rarely damages the pulp, so
root canal treatment is seldom needed. Your
tooth will usually be restored with a full
crown by your dentist.
Cracked Tooth
This crack extends from the chewing surface
of the tooth vertically towards the root. A
cracked tooth is not completely
separated into two distinct segments.
Because of the position of the crack, damage
to the pulp is common. Root canal treatment
is frequently needed to treat the injured
pulp. Your dentist will then restore your
tooth with a crown to hold the pieces
together and protect the cracked tooth. At
times, the crack may extend below the
gingival tissue line, requiring extraction.
A nontreatable tooth is shown in the graphic
above.
Early diagnosis is important. Even with
high magnification and special lighting, it
is sometimes difficult to determine the
extent of a crack. A cracked tooth that is
not treated will progressively worsen,
eventually resulting in the loss of the
tooth. Early diagnosis and treatment are
essential in saving these teeth.
Split Tooth
A split tooth is often the result of the
long term progression of a cracked tooth.
The split tooth is identified by a crack
with distinct segments that can be
separated. A split tooth cannot be saved
intact. The position and extent of the
crack, however, will determine whether any
portion of the tooth can be saved. In rare
instances, endodontic treatment and a crown
or other restoration by your dentist may be
used to save a portion of the tooth.
Vertical root fractures are cracks that
begin in the root of the tooth and extend
toward the chewing surface. They often show
minimal signs and symptoms and may therefore
go unnoticed for some time. Vertical root
fractures are often discovered when the
surrounding bone and gum become infected.
Treatment may involve extraction of the
tooth. However, endodontic surgery is
sometimes appropriate if a portion of the
tooth can be saved by removal of the
fractured root.
After treatment for a
cracked tooth, will my tooth completely
heal?
Unlike a broken bone, the fracture in a
cracked tooth will not heal. In spite of
treatment, some cracks may continue to
progress and separate, resulting in loss of
the tooth. Placement of a crown on a cracked
tooth provides maximum protection but does
not guarantee success in all cases.
The treatment you receive for your
cracked tooth is important because it will
relieve pain and reduce the likelihood that
the crack will worsen. Once treated, most
cracked teeth continue to function and
provide years of comfortable chewing. Talk
to your endodontist about your particular
diagnosis and treatment recommendations.
S/he will advise you on how to keep your
natural teeth and achieve optimum dental
health.
What can I do to
prevent my teeth from cracking?
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.
- Don't clench or grind your teeth.
- If you clench or grind your teeth
while you sleep, talk to your dentist
about getting a retainer or other
mouthguard to protect your teeth.
- Wear a mouthguard or protective mask
when playing contact sports.
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