Cracked Tooth Crisis: Your Complete Guide to Types, Causes, Symptoms & Treatment

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Cracked Tooth Crisis

Your teeth are designed to last a lifetime, but they endure significant stress and force over the years which can sometimes lead to damage like cracks and fractures. While the outer enamel layer is the hardest substance in the human body, once a crack extends through the enamel, the tooth can’t repair itself. However, by working closely with dental professionals, you can develop an effective treatment plan to restore the tooth and prevent further damage.

In this comprehensive guide, we’ll cover everything you need to know about cracked teeth, including:

  • The 5 main types of tooth cracks
  • Common causes and risk factors
  • Typical symptoms to watch out for
  • Diagnosis and treatment options
  • Prevention tips to avoid cracks

By the end, you’ll be well-equipped to identify and deal with any potential cracked tooth crisis. Let’s dive in!

The 5 Main Types of Cracked Teeth

According to the American Association of Endodontists, there are five main classifications of cracked teeth:

1. Craze Lines

Craze lines are superficial hairline cracks that only affect the outer enamel. They appear as thin vertical lines, most commonly on the front teeth. Craze lines are very shallow, painless, and usually don’t cause any major issues beyond cosmetic concerns. Over time, craze lines can accumulate stains and plaque.

Craze Lines
Craze Lines

Common causes of craze lines include:

  • Normal wear and tear
  • Prolonged clenching or grinding (bruxism)
  • Regularly eating hard foods like popcorn kernels
  • Chewing on ice
  • Trauma to the mouth
  • Using teeth as tools to open things
  • Biting fingernails
  • Tongue piercings
  • Previous dental procedures on the tooth
  • Sudden extreme temperature changes

Since craze lines are largely a cosmetic issue, treatment isn’t always necessary. In some cases, dental veneers made of composite resin or porcelain can be used to cover the lines for aesthetic purposes. But the craze lines can’t be removed entirely.

2. Fractured Cusp

A fractured cusp occurs when a weakened cusp (the raised points on the biting surface) breaks off, often on its own. This most frequently happens on the inner cusps of lower back teeth and outer cusps of upper back teeth. Fractured cusps rarely damage the pulp and typically don’t cause much pain.

Fractured Cusp
Fractured Cusp

Fractured cusps can result from:

  • Prolonged excessive biting forces
  • Severe tooth decay that weakens the cusp
  • Chronic teeth grinding and clenching
  • Mouth trauma
  • Failed dental restorations
  • Biting down on something hard

Symptoms of a fractured cusp may include:

  • Pain when biting down
  • Discomfort that is relieved after releasing bite pressure
  • Sensitivity to hot and cold
  • Sharp pain when chewing on that tooth
  • Irritation of surrounding gum tissue
  • Feeling a sharp edge on the tooth with your tongue

Treatment for a fractured cusp typically involves placing a dental crown over the tooth to protect it. In some minor cases, a filling may be sufficient. If the fracture extends deeper, a root canal may be needed first before restoring the tooth. Catching cusp fractures early, before the cusp actually breaks off, allows for less invasive treatment like dental onlays.

3. Cracked Tooth

A cracked tooth features an incomplete fracture line that starts on the chewing surface and extends vertically towards the root. The crack causes movement that irritates the pulp. With enough pulpal damage over time, the tooth may struggle to recover, leading to erratic pain that ranges from mild temperature sensitivity to severe constant discomfort. Excessive biting forces are a leading cause of cracked teeth.

Cracked Tooth
Cracked Tooth

Cracked teeth are categorized as either treatable or untreatable depending on the severity and depth:

  • Treatable cracks can often be saved by placing a crown to prevent the crack from progressing further. Early diagnosis is key.
  • Untreatable cracks have progressed too far for the tooth to be salvaged. Extraction is usually necessary at this stage.

4. Split Tooth

A split tooth represents the end stage of an untreated cracked tooth. The crack extends from the surface down to below the gumline, often from one side of the tooth to the other. The tooth segments become completely separated and may feel loose. A tooth can split suddenly after a crack has been developing for some time.

Split Tooth
Split Tooth

Split teeth frequently result from long-term habits like clenching, grinding, chewing on ice or hard objects, or using teeth as tools. Treatment depends on the extent and location of the split:

  • If only a portion of the tooth is salvageable, the damaged segment may be removed and the remaining part restored with a crown after root canal therapy.
  • If the split is too severe and extends below the bone, extracting the entire tooth is often the only option.

5. Vertical Root Fracture

Vertical root fractures start in the root of the tooth and extend upwards towards the chewing surface. The fracture line may involve only a portion of the root or extend along its entire length. Vertical root fractures are often only discovered when the surrounding bone and gum tissue become infected.

Vertical Root Fracture
Vertical Root Fracture

Most vertical root fractures occur in teeth that previously had root canal treatment. Dental professionals can usually diagnose them by spotting a deep, narrow periodontal pocket along the affected root on dental x-rays.

Unfortunately, vertical root fractures have a very poor prognosis and are generally untreatable. Extraction of the tooth is the most common outcome. In rare cases, if the fracture only involves one root of a multi-rooted tooth, that root may be amputated in a procedure called a root resection or hemisection.

Other Types of Tooth Fractures

In addition to the above five categories, there are a couple other types of tooth fractures worth mentioning:

Chipped Tooth

Chipped teeth are very common, especially for patients who grind their teeth. Classic signs of bruxism are small chips randomly breaking off the enamel. Chips can also occur from biting on something hard, mouth trauma, or accidents. Front teeth are prone to small chips from things hitting them, like utensils, glass bottles, or using teeth to open packages.

Chipped teeth often feel jagged or rough to the tongue. Chips on front teeth are also usually quite noticeable in the mirror or photos. Treatment depends on the size of the chip:

  • Minor chips can be smoothed and left alone
  • Moderate chips can be repaired with dental bonding or veneers
  • Severe chips may require a dental crown

Fractured Root

Tooth roots can fracture due to a variety of causes, such as:

  • Traumatic dental injury
  • Pathologic resorption of the root structure
  • Occlusal overload from excessive biting forces
  • Weakening of the root from prior root canal treatment

Depending on how far the fracture extends, the tooth may be savable with stabilization and a crown, or require extraction. Prompt treatment is essential to avoid infection.

Cracked Tooth Syndrome

Cracked tooth syndrome refers to a cluster of symptoms associated with an incomplete fracture of a posterior tooth. Common signs include:

  • Sharp pain when biting down that disappears quickly after
  • Pain that comes and goes and is rarely constant
  • Discomfort when eating or drinking something hot or cold
  • Pain that is difficult to pinpoint

Because the crack is often invisible and symptoms are inconsistent, cracked tooth syndrome can be challenging to diagnose. Dentists may use special bite tests or fiber-optic lighting to visualize the crack.

Diagnosing a Cracked Tooth

Many cracked teeth are not visible on routine dental x-rays, so they are usually diagnosed based on the patient’s reported symptoms and the dentist’s exam findings. Be sure to alert your dentist if you experience any of the following:

  • Twinges of pain when biting or chewing, especially if it’s sensitive to temperature
  • Tenderness or discomfort that’s hard to pinpoint
  • Pain that comes and goes
  • Feeling a rough or sharp edge on the tooth

Your dentist may have you bite down on a stick or cotton roll to try to recreate your symptoms and isolate which tooth is affected. Shining a bright light on the tooth can sometimes illuminate cracks as well.

At home, pay attention to how frequently your tooth feels sensitive (every meal vs. once a month), what triggers it (hot/cold vs. biting pressure), and if the pain lingers or disappears quickly. If you’re having trouble determining which tooth is bothering you, you can use your finger to apply pressure to each tooth until you localize the discomfort.

Treating a Cracked Tooth

Treatment recommendations for a cracked tooth depend on the type, location, and severity of the crack. Options include:

  • Bonding: Minor chips or cracks limited to the enamel can often be repaired with tooth-colored dental bonding.
  • Crown: A dental crown fits over the entire visible portion of the tooth to hold the pieces together and protect the crack from spreading. Crowns are the most common restoration for cracked teeth.
  • Root Canal: If the crack extends into the pulp, a root canal is usually necessary to remove the damaged pulp before placing a crown.
  • Extraction: Some cracks are too severe to treat, especially if they extend below the gumline and into the root. In these cases, the tooth will need to be extracted. Your dentist can discuss options for replacing the tooth, such as a dental implant or bridge.

The sooner you address a cracked tooth, the better the chances of saving it. Postponing treatment allows damage to accumulate and may limit your treatment options. In general, placing a filling or crown is simpler and less expensive than extracting and replacing the tooth later.

Preventing Cracked Teeth

While you can’t always avoid cracked teeth, there are several steps you can take to reduce your risk:

  • Don’t chew on hard objects like ice, popcorn kernels, pens, or your fingernails
  • Avoid using your teeth as tools to open or cut things
  • Wear a mouthguard if you play contact sports
  • See your dentist for regular checkups to catch cracks early
  • Ask your dentist about a nightguard if you grind or clench your teeth
  • Practice good oral hygiene and get cavities treated promptly so your teeth stay strong

If you’re prone to clenching and grinding, consider strategies to reduce stress, like exercise, meditation, counseling, or physical therapy. The less pressure you put on your teeth, the lower your chances of cracks.

Conclusion

Cracked teeth are a common dental problem that can lead to pain, infection, and even tooth loss if left untreated. Understanding the types, causes, and symptoms of cracked teeth can help you recognize when to seek professional care.

Remember, prevention and early intervention are key. By taking steps to avoid tooth cracks and seeing your dentist at the first sign of trouble, you can stop cracks from progressing and restore your tooth to full function. With the right diagnosis and treatment, your teeth can continue to serve you well for many years to come!

References

  1. Cracked Teeth. American Association of Endodontists.
  2. Kang SH, Kim BS, Kim Y. Cracked Teeth: Distribution, Characteristics, and Survival after Root Canal Treatment. J Endod. 2016 Apr;42(4):557-62. doi: 10.1016/j.joen.2016.01.014. PMID: 26873567.
  3. Cracked Tooth Syndrome. American Association of Endodontists.
  4. Lubisich EB, Hilton TJ, Ferracane J; Northwest Precedent. Cracked teeth: a review of the literature. J Esthet Restor Dent. 2010 Jun;22(3):158-67. doi: 10.1111/j.1708-8240.2010.00330.x. PMID: 20590967.
  5. Banerji S, Mehta SB, Millar BJ. Cracked tooth syndrome. Part 1: aetiology and diagnosis. Br Dent J. 2010 May 22;208(10):459-63. doi: 10.1038/sj.bdj.2010.449. PMID: 20489766.