What causes a cracked tooth & how do I know it’s cracked?

Habits such as grinding, clenching, chewing on hard objects make teeth susceptible to cracks. Predominant symptoms include erratic pain when chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes. Patients sometimes remember biting down on something hard that initiated these painful episodes. In many cases, the pain may come and go, and patients may have difficulty locating which tooth is causing the discomfort.

When the outer hard tissues of the tooth (enamel & dentin) 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. Continuous irritation due to biting forces can result in irreversible damage to the pulp with time. 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.

Fractured Cusp

fractured-cuspSometimes a tooth cusp gets weakened & may fracture with time.

It 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. You may however need a full coverage restoration such a crown to restore the tooth back to function.


Cracked Tooth

cracked-teethThis crack extends from the chewing surface of the tooth vertically towards the root. In such a situation, pulp is most often damaged & needs Root canal treatment. After RCT, the tooth needs to be restored with a crown ASAP to hold the cracked pieces together & protect the tooth. At times, the crack may extend below the gingival tissue line or the fracture is through & through across the tooth requiring extraction. Early diagnosis is the key. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth.

It is sometimes difficult to determine the extent of a crack even with high magnification & special lighting or the crack may progress deeper after the treatment. This may cause the treatment to fail needing a extraction of the tooth.

Split Tooth

split-toothA split tooth is often the result of the long term progression of a cracked tooth wherein the crack has progressed to deeper parts of the root. Treatment mainly involves extraction of the tooth. However, in some cases, it is possible to remove only the fractured part of the tooth by a surgical procedure & save the rest of the tooth.



Vertical Root Fracture

vertical-root-fracture1Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. Treatment mainly involves extraction of the tooth. It is possible to remove only fracture root by a surgical procedure & save the rest of the tooth.




After the treatment for a cracked tooth, will my tooth completely heal?

Unlike a broken bone, a cracked tooth will not heal by formation of new layers of tooth tissues to close the fractured segments. In spite of treatment, some cracks may continue to progress and worsen with time, leading to loss of the tooth. Hence there is no guarantee of success in these cases. Depending of the extent of crack progression with time, the tooth may serve you for several years or fail within a short time after the treatment. The treatment is however needed to relieve pain & reduce the likelihood of further crack progression.

* Pictures reproduced with permission from the American Association of Endodontists