Are you always looking for “something crunchy and hard to bite on’ when you are reading, watching TV or spending time with family? If you are, it is probably a good idea to check for yourself every so often whether any of your teeth have cracks or fractures!
What is a cracked tooth?
According to American Association of Endodontists (AAE), a cracked tooth means a crack that extends from the chewing surface of your teeth vertically towards the root. The crack can either be just on the crown or extend onto the root from the crown. [1]
Many people confuse crack line with craze line and fractured tooth. Most adult teeth have craze line. It is a very shallow crack that only limits to the outermost layer of teeth, so it does not cause pain and is of no concern except for its appearance. On the other hand, a tooth is cracked when the tooth is separated into 2 parts incompletely, which can be painful especially when chewing. This is different from completely chipped off or fractured tooth in which the fractured part is totally separated from the tooth. [1,2]
By author.
By author.
By author.
Cracked tooth most commonly happens to lower back teeth [3] because they absorb a great deal of chewing force. [4]
How to recognize cracked tooth?
It can be difficult to identify the existence and extension of a crack on the tooth.[1]
Patients with cracked tooth often complain of pain which is irregular and unpredictable. It can range from mild to severe, and can happen at various times, such as when chewing food, when releasing from bite, or when having something hot or cold. Sometimes, crack can extend to the pulp (innermost layer of the tooth that contains nerves and blood vessels). It is through this crack that bacteria can enter the tooth and cause infection. The infection may then spread to the underlying bone and surrounding gums. [1,4] When left untreated, these can result in serious infections that can spread to other parts of the body.
Frequently, cracks on tooth are invisible to the naked eye and may not even show up on dental X-rays. This poses difficulty to the dentists to find the source of pain, and patients often say that they have had the condition for a long time without knowing what caused it.
In addition, people with one cracked tooth are more likely to have others at the same time or in the future.[5]
Therefore, it you suspect that you have a cracked tooth, you should see your dentist as soon as possible. Dentists can use some special tools such as a bright light, special dye, dental operating microscope [6] or 3D x-ray to confirm the condition.
Coronation Dental Specialty Group, CC BY-SA 3.0 , via Wikimedia Commons
What causes a tooth to crack?
A tooth could crack if the force exerted on it exceeds the limit. A tooth is more prone to cracking if it suffers severe loss of tooth structure due to decay, tooth wear or root canal treatment. These teeth usually have large fillings on it.
Shaimaa Abdellatif, CC BY-SA 4.0, via Wikimedia Commons
However, crack can also happen to a tooth which is totally fine. A tooth that that have not undergone any dental treatment, have not lost any tooth structure, or have never had a filling can also crack.
There are various reasons for a normal, healthy tooth to crack:
- Trauma e.g. blow to the mouth, unexpected biting on a hard object.
- Bad habits e.g. grinding and clenching of teeth, pen biting, ice chewing
- Chewing on hard food/ objects e.g nuts, ice, hard candy
- Uneven biting pressure
Preventing cracked tooth
It is always better to prevent cracked teeth than to treat them, because some cracks may persist despite treatment. [2] When the crack extends deeper into the root, the treatment options are limited, and removal of the tooth is often the only option.
A cracked tooth can be prevented by avoiding the causes listed in the previous section, e.g:
- Don’t chew on hard food and hard objects
- Don’t grind or clench your teeth
- Wear a protective mouthguard when playing contact sports
- Seek help from dental professional for adjustment of uneven biting pressure
Treatment for cracked tooth
Treatment for cracked tooth depends on the direction, location and extent of the crack. [2]
Superficial crack is easier to be managed compared to deep crack that involves the dental pulp. [7] You should not wait further if there is a crack on your tooth because it can progress deeper. It is therefore wise to consult your dentist as soon as possible if you suspect your teeth have cracks.
The goal of treatment is to prevent the crack from progressing and to improve comfort while chewing.[8] This can be achieved by placing a tiny ring called premolar/ molar band around the tooth immediately, followed by appropriate treatment.
Often, your dentist will remove the old filling of the cracked tooth, if there is any, to visualize the extent of the crack properly. A small and shallow crack might be treated with a dental filling or coverage with dental crown, but a deep crack that affects the dental pulp might require root canal treatment, followed by a dental crown. On the other hand, a tooth with extensive crack may need to be removed. Thus, a proper examination by your dentist is important to decide the appropriate treatment.
Last but not least, in order to prevent new cracks from forming on other teeth, the cause of the cracked tooth must be identified and eliminated.
Can a cracked tooth heal after treatment?
The outcome of cracked tooth is not certain even after with treatment, because some cracks may continue to grow, and separate the tooth into two pieces completely.
Coronation Dental Specialty Group, CC BY-SA 3.0, via Wikimedia Commons
It is important to treat a crack as soon as possible because a small crack, if treated early, has a better chance of lasting a long time. [2]
Conclusion
It is possible to get a cracked tooth for no apparent reason, but chewing on hard objects or food is often what causes it. Therefore, people with one cracked tooth are likely to have more if they don’t break this bad habit.
A cracked tooth cannot always be saved, so it is best to prevent it from occurring rather than fix it after it has already happened.
Reference
- Rivera, E. and Walton, R. Cracking the cracked tooth code: Detection and Treatment of Various Longitudinal Tooth Fractures. [Internet] Chicago. American Association of Endodontists; 2022. Available at: <https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/ecfesum08.pdf>
- American Association of Endodontists. Cracked Teeth – American Association of Endodontists. [Internet] Chicago. American Association of Endodontists; 2022. Available at: <https://www.aae.org/patients/dental-symptoms/cracked-teeth>
- Lubisich, E., Hilton, T. and Ferracane, J. Cracked Teeth: A Review of the Literature. Journal of Esthetic and Restorative Dentistry. 2010; 22(3), pp.158-167.
- PORTAL MyHEALTH. Cracked Tooth Syndrome – PORTAL MyHEALTH. [Internet] Available at: <http://www.myhealth.gov.my/en/cracked-tooth-syndrome/> [Accessed 29 June 2022].
- Mathew, S., Thangavel, B., Mathew, C., Kailasam, S., Kumaravadivel, K. and Das, A. Diagnosis of cracked tooth syndrome. Journal of Pharmacy and Bioallied Sciences. 2012; 4(6), p.242.
- Mamoun, J. and Napoletano, D. Cracked tooth diagnosis and treatment: An alternative paradigm. European Journal of Dentistry. 2015; 09(02), pp.293-303.
- Hasan, S., Singh, K. and Salati, N. Cracked tooth syndrome: Overview of literature. International Journal of Applied and Basic Medical Research. 2015; 5(3), p.164.
- Hargreaves K, Berman L, Rotstein I. Cohen’s pathways of the pulp. 1st ed. South Asia: Elsevier Inc.; 2016.
