Cracked and Fractured Teeth

Cracked and fractured teeth are increasingly common as people retain their natural teeth longer thanks to advances in dental care. Teeth can crack for a variety of reasons, including biting on hard foods or objects, trauma, or chronic grinding and clenching. These stresses weaken the tooth structure and make it more susceptible to fractures.

How Cracks Affect the Tooth

When enamel cracks, pain may be intermittent. There may be no discomfort when the tooth is at rest, but biting or chewing can cause the crack to widen, exposing the pulp and inner tissues. This exposure triggers sharp pain. Once the pressure is released, the crack closes, and the pain subsides. Untreated cracks can lead to pulp infection, which may affect surrounding bone and soft tissue, resulting in persistent pain and potentially permanent damage.

Symptoms of a cracked tooth include:

  • Unexplained pain while eating
  • Sensitivity to hot or cold foods and drinks
  • Pain without a clear cause
  • Difficulty identifying the exact location of the pain

Types of Cracks

The type and severity of the crack determine the best treatment option. Some teeth can be saved with root canal therapy, while others may require extraction. Common types of cracks include:

Crazes:
Tiny vertical surface cracks that usually pose no health risk. These are considered normal and typically only require cosmetic treatment if desired.

Oblique supragingival cracks:
These affect only the crown of the tooth and do not extend below the gum line. The affected section may eventually break off, but pain is minimal since the pulp remains unharmed.

Oblique subgingival cracks:
These extend below the gum line and often into the jawbone. Pieces may remain attached until removed by a dentist. Treatment may involve periodontal surgery and endodontic therapy, followed by a crown or other restoration.

Vertical furcation cracks:
These cracks occur where the tooth roots separate and typically affect the nerve. Root canal therapy and a crown can often save the tooth.

Oblique root cracks:
These occur below the gum line and jawbone, with little or no visible damage to the tooth surface. Depending on the fracture location, root canal therapy may be possible, though extraction is often required.

Vertical apical root cracks:
These cracks occur at the tip of the root. While the tooth may not need extraction from a dental perspective, pain can be severe. Root canal therapy can relieve discomfort temporarily, but extraction is often ultimately necessary.

Treatment Options

Root canal therapy:
For cracks involving the pulp or tooth root, root canal therapy removes the damaged pulp, nerves, and vessels. The space is filled with gutta-percha, and a crown or filling is placed to stabilize the tooth, restoring normal function.

Extraction and restoration:
Severely damaged teeth that cannot be saved are extracted. Restorative options include dental implants, bridges, or partial dentures, all of which restore biting, chewing, and speaking functions.