How is a cracked tooth treated?

A cracked tooth can be difficult to diagnose and treat. If the crack in only in the top part of the tooth and not into the pulp or root, it can be treated with a crown. If the crack has extended into the pulp, it can be treated with a root canal. If the crack extends down the root, the tooth may need to be extracted. If you suspect a cracked tooth, you should see your dentist.
One of my first bad experiences in dentistry was from being too conservative and not treating a patients 'cracked tooth'. When you first start practice it is very hard for a young dentist to take a vacation. The overhead is too high and you just feel that if your patients have an emergency, you need to be there for them. While I was on my vacation a patient by the name of Gloria had an emergency. She had to go to another dentist because she was having pain when chewing and increased sensitivity to hot and cold. When I came back I received a call from Gloria and she told me she would not be coming to me anymore. It seems that the dentist that she went to told her that she almost lost a tooth because I didn't diagnose a cracked tooth. To make things worse he said that she could still very well lose the tooth. He told her in order to save the tooth he would treat it with a crown and possibly a root canal. It was like a dagger going through my heart.

A cracked tooth was very hard to diagnose at that time because it was largely not recognized as being a problem. Usually you waited for a tooth to totally break and if it broke the right way you may be able to save it. It happens in teeth with large fillings and it appears as a small hairline crack on the marginal ridge or the tooth structure that is connected to the filling. I would see these cracks all day long but  felt I was over treating a minor 'little crack', or taking advantage of the patient. Definitely that thinking was not in the best interest of the patient.

These little cracks were vertical fractures that on the surface seemed harmless. They are like an iceberg seeming small on the surface but being big on the bottom. The symptoms are pain on occlusion(biting) and sensitivity to hot and cold temperatures. They seem very benign but it they essentially can be a symptom of 'Split Tooth Syndrome'. This is a very serious condition, which if not treated correctly, will result in the loss of  your tooth.

Essentially what happens is that the filling divides the integrity of the as a solid unit. It makes it weaker instead of stronger and when you bite it is kind of like splitting a log. The filling acts as the wedge and your occlusion acts as the mallet. After a while the crack gets into the dentin and then it becomes symptomatic. As a partnership in your oral health between you and your dentist, if something hurts you need to find out why.
Cracked teeth are some of the most difficult and varied situations to manage in dentistry. Cracked teeth present with a variety of symptoms and ones that are not easy to reproduce. It is not always clear to the patient where the pain is coming from. Diagnostic tests will help to determine the nature of the crack, the location and the potential extend of nerve damage if it exists. If no nerve damage is identified but symptoms exist such as sensitivity to sweets or cold, conservative measures can resolve the symptoms, depending on the location and extent of the crack. If a crack chips off a small corner or bit of tooth, smoothing the area may resolve the issues. If a larger portion breaks off, a restoration or filling may be required. Depending on the condition of the underlying tooth, a crown may be necessary to stabilize the tooth. If symptoms do not resolve, the crack may be internal and affect the nerve or pulp and the tooth may require a root canal in order to remove the irritated or damaged nerve tissue.

If the attachment apparatus, the bone, periodontal membrane and gums are affected the longevity of the tooth is severely compromised and should be extracted. When the dentist checks the periodontal health of the area and you hear readings like 3-2-3, or 2-2-2, these indicate attachment levels of the structures supporting the tooth. Depths of under 4 are areas you should be able to maintain at home between dental visits. If a single reading that is different from the others such as 3-8-4 exists, this can be an indication of a crackdown the root that will not heal. In this case the potential crack has affected the tissues overlying that area of the root and caused a rip or tear in the gums attaching to that area of the root. Radiographs or x-rays and further tests should be employed to confirm such a crack and rule out other periodontal conditions.

Once the acute or painful case is managed, steps must be employed to reduce cracks developing in other teeth. This goes back to diagnosis and determination of the cause of the crack. In the case of cracked teeth, it must be considered if the patient is grinding or clenching and is not only a crown for a single tooth is required, but other therapies such as mouth guard may offer protection for the remaining teeth. 

Treatment for a cracked tooth depends on the size and location of the crack and the symptoms you are experiencing. Your dentist will talk with you about which treatment is best for your tooth. It is possible that your dentist will recommend no treatment at all, since tiny cracks are common and usually do not cause problems. If you have pain, avoid chewing on that side of your mouth and call your dentist. Examples of treatments include:

  • repairing the tooth with a filling material
  • placing a crown (cap) to protect the tooth from further damage
  • endodontic (root canal) treatment if pulp is involved
  • extracting (taking out) the tooth if the tooth is severely cracked and cannot be saved

Regular dental checkups are important. They let your dentist diagnose and treat problems in the early stage. A cracked tooth can become a bigger problem if left untreated. If you think you may have a cracked tooth, visit your dentist.

Jonathan B. Levine, DMD
When an area within the crown of the tooth has cracked, impulses cause fluids to flow through the crack down to the nerve of the tooth, which signals it to respond in pain.
  • WORRY LEVEL: The seriousness of this condition varies, depending on the size of the crack within the tooth
  • TREATMENT: It depends on the level of seriousness. In some cases, you can support the tooth all the way around with a crown so that the crack doesn't extend any further. The crown binds a tooth like the metal reinforcement bands bind a barrel, and it could be made of ceramic, porcelain or a metal structure. If the fracture is near the gum line, sometimes lowering the gum line through surgery can save it. The worst-case scenario is when the fracture has gone through the tooth down to the root area. When that happens, the tooth needs to be extracted.
Smile!: The Ultimate Guide to Achieving Smile Beauty

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Smile!: The Ultimate Guide to Achieving Smile Beauty

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Badly cracked teeth should be extracted if they cannot be reinforced with a filling, crown, bonding, or root canal. A dentist may give you a pain medication after these procedures to lessen pain in the healing phase.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.