I see cracked teeth all the time. Research suggests that the majority of adults have at least one posterior (molar or premolar) cracked tooth. Crack progression and related symptoms are a common concern in every dental practice.
ABOUT CRACKED TEETH
Cracked teeth can be caused from injury, excessive chewing forces (chewing really hard things like ice, Jolly Rancher type candies, beef jerky) or from clenching or grinding habits. They can cause symptoms that range from mild sensitivity to hot and cold, to the feeling of sudden erratic, sharp pain with the release of biting force. You may also experience pain when your tooth is exposed to extreme temperatures, like ice cream or coffee. In many cases, this is difficult to diagnose, because the pain can come and go and the cracks are sometimes very hard to see, even on a regular dental x-ray. CBCT scans have a better potential to detect fractures; particularly root fractures. We have a CBCT Scan here in our office. These scans help us locate and assess tooth fractures so we can provide an accurate and prompt diagnosis.
WHY DOES IT 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 pulp contains the tooth’s nerves and blood vessels.
When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. Eventually, the pulp will become damaged to the point that it can no longer heal itself.
Extensive cracks can lead to an abcess or other infection of the pulp tissue, which can spread to the bone and gum surrounding the tooth.
WHAT CAN BE DONE TO FIX IT?
The treatment and outcome for a cracked tooth depends on the TYPE of crack, LOCATION of the crack and the SEVERITY of the crack. This is where the training, experience and competence of the dentist diagnosing the problem is CRUCIAL: in getting the correct diagnosis! This is often something that is either misdiagnosed or not diagnosed at all. If it’s not found at all, the patient continues living with pain and not knowing which tooth is causing it.
If it is improperly diagnosed and the wrong treatment recommended, the result can be thousands of dollars spent and months of treatment (Example: Root Canal, Post & Core, Crown) that ultimately fails anywhere from a few months to a few years later. So. Proper diagnosis and treatment is the key.
UNDERSTANDING DIFFERENT TYPES OF CRACKS AND WHY SOME CANNOT BE REPAIRED
Craze lines are tiny little cracks you may see on teeth if you look up close up in a mirror. These are tiny cracks that are not deep and only affect the outer ENAMEL layer of the tooth. Other than possibly being concerned about the esthetics of this, these types of cracks do not cause concern and do not cause pain.
A FRACTURED CUSP
When just the cusp of a tooth cracks, it usually doesn’t cause much discomfort and can typically be repaired with either a new filling or crown, depending on the size, location and extent of the crack lines.
TREATABLE vs NON-TREATABLE CRACKS
If the crack has extended into the pulp, the tooth can sometimes be treated with a Root Canal and Crown to correct the crack from spreading.
However, if the crack extends below the gum line, it is no longer treatable, and the tooth cannot be saved and will need to be extracted. That’s why early treatment is so important. 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.
PREVENTING CRACKED TEETH
Here are some steps you can take to protect your teeth from cracking:
- Don’t chew on hard objects (ice, popcorn kernels, pens, etc)
- Wear an athletic mouthguard if you play contact sports
- Don’t grind or clench your teeth
- If you ARE someone who does this at night, speak with your dentist about having an occlusal guard/ nightguard made to wear while you sleep – and then WEAR IT!
It is imperative that cracked teeth get diagnosed as soon as symptoms appear. If they aren’t, over time the crack can get bigger and render the tooth unrestorable, in which case, it will need to be extracted. This is what we want to prevent. So, next time we see you, we will be checking out those teeth for any cracks!