Because people are living longer and dentists are helping keep teeth longer, teeth are being exposed to years of crack inducing habits. Particularly, clenching, grinding, and chewing hard things such as ice can result in teeth cracks and fractures in teeth. Hence, cracked and fractured teeth can especially be difficult to locate.
When the outer hard tissues of a tooth are fractured or cracked, chewing can cause movement of the pieces and the pulp becomes irritated. Often this results in a momentary, sharp pain which eventually progresses to include thermal sensitivity. In time the cracked or fractured tooth, similar to other teeth with pulp degeneration, can begin to hurt on it’s own.
Cracked tooth syndrome is one of the most difficult diagnoses in dentistry. The patient generally presents with sharp pain on chewing in a certain area of his mouth, but he frequently cannot tell which particular tooth hurts. It is generally a back tooth, and it becomes plain which tooth it is when the dentist has the patient bite on piece of wood placed on top of the correct tooth. Cracked tooth syndrome is a very common problem that affects teeth that have large fillings in them.
Teeth can crack in several different ways
- Cracked tooth – this is when a crack runs from the biting surface of the tooth down towards the root. Sometimes it goes below the gum line and into the root. A cracked tooth is not split into two parts but the soft, inner tissue of the tooth is usually damaged.
- Craze lines – these are tiny cracks that affect only the outer enamel of the tooth. They are common in all adult teeth and cause no pain. Craze lines need no treatment.
- Cracked cusp – the cusp is the pointed part of the biting surface of the tooth. If a cusp becomes damaged, the tooth may break. You will usually get a sharp pain in that tooth when biting.
- Split tooth – this is often the result of an untreated cracked tooth. The tooth splits into two parts. Vertical root fractures are cracks that begin in the root and go up towards the biting surface.
Causes of Cracked Tooth
Teeth can develop fractures for a number of reasons. From repetitive chewing on your teeth, day after day, teeth may develop dental cracks. Each time you chew on your teeth they flex slightly from the chewing force. This flexing over time can cause teeth to develop fine cracks (stress fractures).
A history of clenching or grinding (bruxing) teeth can result in cracks. Chewing on hard substances or foods such as ice, popcorn kernels or candy. Trauma to the mouth such as a blow below the chin or lower jaw.
Large fillings that are deep or that involve the contacts between teeth (inter proximal contacts), can weaken the teeth resulting tooth fracture.
It has be suggested that bone loss associated with periodontal disease can predispose a tooth to root fracture because of decreased support.
Symptoms of Tooth Crack
You may experience pain in the tooth upon biting or chewing. However, it probably will not happen all the time. The tooth may be painful only when you eat certain foods or when you chew in a specific way. You will not feel a constant ache, as you would with a decay-induced toothache or abscess. The tooth may be more sensitive to cold temperatures. If the crack worsens, the tooth may be loose.
Many people with cracked tooth syndrome have symptoms for months, but it’s often difficult for them to explain what’s wrong because the symptoms are not consistent.
Diagnosis Of Cracked Tooth
Diagnosis of cracked tooth syndrome is often difficult, because the crack cannot be seen. Your dentist will do a thorough examination of your mouth and teeth, focusing on the tooth in question. He or she may use a sharp instrument called an explorer to feel for cracks in the tooth and will probe the gum around the tooth to feel for irregularities. Your dentist also may take X-rays, although X-rays usually do not show the crack. However, cracks that have widened may show up as shadows.
If a dentist suspects that a tooth is cracked, he or she may use a special instrument to test the tooth for fractures. One instrument looks like a toothbrush, but has a plastic cup-shaped structure on the end instead of bristles. The structure fits over one cusp of the tooth at a time and you bite down several times. If you feel pain, the cusp being tested most likely has a crack affecting it.
Prevention of Tooth Crack
If you grind or clench your teeth (a condition called bruxism), talk to your dentist about treatment: Bruxism can increase your risk for cracked tooth syndrome.
Tooth Crack Treatment
Treatment depends on the location, direction and extent of the crack. Cracks vary from superficial ones in the cusp of a tooth to deep splits in the root of a tooth. Some affect only the enamel, or outer layer of the tooth; others may affect the dentin (a softer, inner layer) or the pulp (the center of the tooth, which contains the nerves and blood vessels.)
If the crack affects one or more cusps of a tooth, the tooth can be restored with a crown (also called a cap). If a crack affects the pulp, you will probably need root-canal treatment (endodontic treatment). About 20 percent of teeth with cracked tooth syndrome require root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure. This means that some people still may have intermittent symptoms. If you felt pain upon biting before the root canal, you probably will not feel it as intensively or as often, but you may feel it occasionally.
In some cases, the tooth may need to be extracted. Some cracks extend into the root of the tooth under the bone and there’s no way to fix the tooth. In some cases, the crack has worsened to the point where other treatments will not help or have been ineffective. If your dentist decides the tooth needs to be extracted, you can have it replaced with an implant or bridge.
Treatment of cracked tooth syndrome is not always successful. Your dentist should fully inform you about the prognosis. In some people, a restoration with a crown will relieve all symptoms. In others, root-canal treatment solves the problem. Some people continue to have occasional symptoms after treatment or need to have the tooth extracted.