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Cracked Tooth

Cracking a tooth may be easier than you think.

It can happen from chewing on hard objects or foods like ice, nuts or hard candy. Accidents can cause a cracked tooth, especially those involving a blow to the mouth. Tooth-grinding or clenching or having uneven chewing pressure can lead to a cracked tooth. Tooth structure wears down over time and large fillings or other restorations can result in a crack. Finally, you can crack a tooth by exposing tooth enamel to extreme hot and cold, such as when you eat hot food followed by drinking ice water.

The result of any of these events is often painful and can lead to further oral disease.

How to tell if you have a cracked tooth, why it's painful and how to treat it
First, how do you know if your tooth is cracked? Look for these signs:

You have sharp pain when biting down that quickly disappears.
You have pain that comes and goes but does not hurt all the time.
You feel pain when eating or drinking.
You may have no pain at all.

Cracks are sometimes invisible to the eye and don't always show up on dental X-rays. By noting a couple of things, you can help your dentist identify the problem:

Take note of the things that cause you pain, such as heat or cold, or eating foods that are sweet, sour or sticky.
Try to determine the area of the pain.

Why are cracked teeth painful? The pressure of biting causes the crack in a tooth to open, which can cause pain. And even if it's too small to see, the crack can open and irritate the pulp inside. The pulp is soft tissue that contains the tooth's nerves and blood vessels. If the crack irritates the pulp, the tooth may become sensitive to extreme heat and cold. The pulp can also be damaged or diseased as a result of the crack. If that happens, endodontic (root canal) treatment may be necessary to save the tooth.

Treating a cracked tooth depends on the size and location of the crack and the symptoms you are experiencing. Your dentist will discuss which treatment is best. It's possible that your dentist will recommend no treatment, since tiny cracks are common and usually do not cause problems. If you are experiencing localised pain, avoid chewing on that side of your mouth and call your dentist.

What Your Dentist Will Do
There are several types of tooth fractures and breaks, each of which requires different treatments. These include:

Minor cracks - Also called "craze lines," these are surface cracks that affect only the outer white surface of the tooth, called the enamel. Minor cracks rarely need treatment. However, your dentist may lightly polish the area to smooth out any rough spots.
Cracked tooth - This type of fracture involves the whole tooth, from the chewing surface all the way down to the nerve. The pieces remain in place, but the crack gradually spreads. Cracks can sometimes be repaired with filling material. The tooth often will need a crown to prevent the crack from getting worse. If the pulp (nerve and other live tissues) is damaged, you may need a root canal as well.
Chips - Minor chips don't always need treatment. Your dentist may suggest repairing the damage with filling material to prevent it from getting worse or to make the tooth look and feel better. If the chip is very small, the dentist may polish and smooth out the chipped area.
Broken cusp - These breaks affect the pointed chewing surfaces (the cusps) of the teeth. They usually do not affect the pulp and are unlikely to cause much pain. Your dentist may repair the damage to restore the tooth's shape. Frequently, however, an onlay or crown will be required.
Serious breaks - These breaks go deep enough to expose the nerve. They almost always cause the tooth to hurt and be sensitive. Usually, the broken part of the tooth will bleed. You will need root canal treatment to remove the exposed nerve and probably a crown to restore the tooth to normal function so you can eat and chew properly.
Split tooth - This means that the tooth has split vertically into two separate parts. Some teeth, such as your back teeth (molars), have more than one root. It may be possible to keep one of the roots, which will then be covered with a crown. First, you will need root canal treatment. Second, the dentist will remove any roots that cannot be kept. Third, you will need a crown to cover the root and replace the tooth. In some cases, when a root cannot be saved, the tooth will have to be removed.
Vertical breaks or split root - These cracks start in the root of the tooth and extend upward toward the chewing surface. These breaks are often painful because the area around the root may be inflamed or infected. In most cases, the tooth will have to be removed.
Decay-induced break - In this case, the tooth has broken or crumbled because a cavity weakened it from the inside out. Your dentist will evaluate the cavity and recommend the best way to restore the tooth. In some cases, if the decay is extensive and goes down to the bone, the tooth may have to be removed.

Perhaps most importantly, regular dental check-ups enable your dentist to diagnose and treat problems in the early stages. A cracked tooth can become a bigger problem if left untreated. If you think you may have a cracked tooth, visit your dentist.

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