Facts About Cracked Teeth

With their more sophisticated procedures and equipment, including the use of operating microscopes, endodontists 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?

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 tissue called the dentin, is the inner soft tissue called the pulp. The pulp is a loose connective tissue that contains cells, blood vessels and nerve fibers.

When the outer hard tissues of the tooth are cracked, chewing can cause movement of the fractured segments, 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 repair itself. The tooth will not only hurt when chewing, but may also become sensitive to temperature extremes. With time, a cracked tooth may begin to hurt spontaneously. 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. They have special training in the diagnosis and treatment of unusual dental pain, especially problems involving the dental pulp. Cracked tooth pain often comes from damage to the pulp. Endodontic treatment can relieve that pain.

Early diagnosis is extremely important. Like cracks in a windshield, cracks in teeth often begin as small hair-line fractures and become progressively larger. The sooner a crack is detected and treated, the better the chance of saving the tooth.The endodontist's special training and experience can be valuable when a cracked tooth is identified or 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 Cusps

When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture can result. The weakened cusp may break off by itself, or it 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 dentist can usually restore the tooth with a full crown.

Cracked Teeth

This crack usually extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is rarely 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 fractured portion of tooth together and prevent further damage.

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 develop a complete fracture or split eventually resulting in tooth loss.

At times, the crack may extend below the gingival attachment also requiring extraction.

Split Teeth

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 usually cannot be saved. The position and extent of the crack, however, will determine whether any portion of the tooth can be salvaged. 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. This procedure is called a root amputation or hemisection and may also be performed by an endodontist.

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 over 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. 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, popcorn kernels or pens.
• Try to avoid clenching or grinding your teeth.
• If you clench or grind your teeth at night, talk to your dentist about a retainer or night guard to protect your teeth while you are sleeping.
• Wear a mouth guard or protective splint while participating in vigorous sports activities.