Cracked Tooth Syndrome

aka fracture, split

A cracked tooth is a relatively common problem that most people will experience at some point in their life. Teeth can crack in various different ways, from superficial craze lines to deeper cracks that may leave your dentist with no other option but to extract the tooth. Superficial cracks in teeth can worsen, causing deeper cracks, over time.

How will I know if I have cracked my tooth?

One of the problems with cracked teeth, is that there are different types of cracks and they can be very hard to spot. For instance, if you crunch down on a boiled sweet and you feel a sharp pain in your tooth, it is highly likely that you have done some damage to your tooth and you need to see your dentist.

However, most cracks in your teeth do not happen so abruptly or obviously. In fact, you can have a tooth with a hairline crack that may not give you any pain at all. But what if that crack starts to grow? By the time you do start to notice the pain, it may be too late to save the tooth.

What causes teeth to crack?

There are multiple causes – biting on something hard like a boiled sweet, seed or granola is a common one. Sometimes grinding or clenching your teeth can lead to cracks; as can trauma, for example: accidentally being hit in the mouth with a ball.

Another common reason is large holes in teeth, even if these have had a filling, as the tooth structure has been weakened by the hole. Sometimes certain habits can lead to cracks, like biting nails or chewing pencils and pen lids. Sudden temperature changes can contribute to cracks, for instance hot food followed by a cold beverage.  At other times cracks seem to occur for no obvious reason and can just be part of the ageing process – we tend to get more cracks in our teeth the older we get.

How can I prevent a cracked tooth?

Although not all cracks can be prevented, there are measures you can take to minimise your risk:

1. Avoid chewing on hard objects, for example: pen lids, ice and hard foods

2. Avoid opening bottles with your teeth

3. Avoid biting your nails

4. Avoid excessive acid in your diet

5. Wear a mouthguard if you play contact sports or if you grind or clench your teeth

6. Avoid any trauma to your teeth

Which teeth are most likely to crack?

The teeth at the back of your mouth are more likely to crack, as these teeth are subject to much greater biting forces than your front teeth.

How will my dentist detect a crack in my teeth?

Cracked tooth syndrome is notoriously difficult to diagnose.

Cracks cannot be seen on x-rays, although your dentist may take some x-rays to exclude other causes of pain.

A diagnosis of Cracked tooth syndrome is often based on the history and symptoms you complain of.

Your dentist will look at your teeth carefully, sometimes magnification can help.

Bite pressure tests can help identify a crack in a tooth.

In some cases, identification of the causative tooth is not initially obvious, but usually issues with your teeth will ultimately reveal themselves, although this may take some time!

What kind of symptoms will I get if my tooth is cracked?

These are the following common signs, although these symptoms can be indicative of other dental issues and you will not necessarily suffer from all these symptoms:

1. Sharp pain or discomfort when biting or chewing, especially on release of pressure

2. Sensitivity to hot and cold

3. Pain when the tooth is exposed to temperature changes

4. Intermittent pain that comes and goes without an apparent cause

5. Swelling of the gum near the affected tooth

6. Difficulty locating the exact cause of pain

What happens if my dentist spots a crack in my teeth? What are my treatment options?

The treatment for a cracked tooth depends on the extent and location. There are various options, which include:

1. Composite Bonding – If a crack is very small and superficial and there are no symptoms, your dentist may fix your tooth with composite (tooth coloured filling material) to restore the tooth shape and prevent the crack from spreading.

2. Crown / Onlay – A crown or onlay, also known as a cap, may be recommended to hold the parts of the tooth together. The crown or onlay covers and protects the tooth, preventing propagation of the crack. There are risks associated with this treatment including a potential need for subsequent root canal treatment.

3. Root Canal Treatment – If the crack extends to the pulp (living part of the tooth) or there are significant symptoms then a root canal treatment may need to be undertaken. After the root canal treatment a crown or onlay is usually placed to protect the remaining tooth structure. There is an accepted failure rate associated with root canal treatment which can vary from 5-25% depending on which study you look at.

4. Extraction – this is sometimes the only option, especially for very deep cracks. There are various options to replace missing teeth.

What happens if I don’t treat my cracked tooth?

Often, if left untreated, the cracked tooth will split completely leading to a fracture. This normally leads to pain until the tooth is extracted as it is not possible to repair a split tooth.

If my tooth needs to be extracted, how can I replace it?

There are several options including placing a removable denture, a bridge or an implant. Some patients choose to accept and leave the gap too. The options available to you will depend and are best discussed on a case-by-case basis.