Teeth are extremely strong and put up with incredible forces every day to help us with eating and speaking. These strong forces are constantly putting pressure on the teeth and sometimes the teeth crack and break!
Risks of a cracked tooth
A cracked tooth can seem like it happens suddenly and maybe from biting down into something hard or unexpected, can be caused by trauma or an accident, and sometimes can be just due to heavy biting forces and over time the tooth cracks.
Cracks can happen in teeth without any other previous fillings. A tooth that seems completely healthy and normal when placed under extreme forces such as grinding or some form of trauma will sometimes have a crack that runs through the middle of the tooth. This is actually quite common and often can cause the outside portions of the upper teeth and the inside portion of the lower teeth to completely break off. Other times the crack can progress and cause the tooth to completely split in half.
However, the risk of cracks increases dramatically if the tooth has previous fillings. The bigger the filling, the less strength the remaining tooth structure has in order to resist forces!
Previous root-canaled teeth are at an even higher risk. In most instances, root-canaled teeth have previous fillings which are very large and have already had lots of treatment on the tooth. The more tooth removed, then the higher the risk of a crack. Also, with root canals, there is a risk of root fractures in more than any other tooth! If a tooth requires a root canal, then we must plan to protect the tooth to allow best long term success for the tooth.
Types of cracked teeth
Enamel crack/superficial crack- Minimal risk
- These cracks are just in the outer layer of the tooth, often if you dry off the tooth completely you will be able to see little lines in the teeth, but often do not pick up stains and are usually a minimal risk of progressing or causing many issues.
Dentine crack or structural crack- Medium risk
- These cracks often are under an old filling and are seen after the filling is removed, they may also extend horizontally under tooth structure and lead to large bits of tooth fracturing. This is often seen in teeth with previous amalgam fillings.
Crack that collects debris – High risk
- A crack in a tooth that is wide enough to collect debris can lead to caries, is more at risk of extending/propagating and can lead to pain and symptoms. These cracks should be cleaned as best as possible, sometimes requiring root canal treatments and crowns.
Root fractures and deep cracks- Poor success
- Cracks in teeth that extend onto the root surface or cracks exclusively on the root often lead to extraction because it is extremely difficult to gain access to the crack and we cannot seal it with filling or root canal as bacteria can still enter into the crack and cause pain, swelling and infection.
Treatment of a cracked tooth
When a tooth cracks there is often pain and discomfort, and once there is pain this is often when the crack is first noticed and then a dentist should be seen as soon as possible. Sometimes cracks can be seen early with routine dental exams and hopefully addressed before they cause pain.
When a tooth is cracked, the tooth flexes when you bite on the tooth and the opening and closing of the crack may cause pain.
It is important to determine the severity of the pain and the status of the nerve inside the tooth.
If the damage to the nerve is reversible, then placing a well-sealed filling that protects the tooth is important. This is most often a full coverage crown. A crown covers the entire outer surface of the tooth and holds the tooth together to help prevent the flexure of the crack.
Often to determine if the damage is reversible or not, a temporary filling will be placed to mimic a crown. This is done with either filling material or sometimes a metal band. Also, a tooth can be adjusted to reduce the forces on the tooth and give the tooth a “rest” allowing the pain to settle down.
Irreversible nerve damage
If the damage to the nerve is irreversible, sometimes a root canal can be completed and then a crown placed. However, sometimes this means the crack has extended all the way into the nerve and down the root of the tooth. If this is the case, then often root canal may not be a good option and the only option is then to, unfortunately, have the tooth removed.
Given that if the crack extends too far or is causing pain, then the result is often tooth extraction; it is a good idea to assess cracks and restore teeth prior to them causing pain.
A Dental Crown can save a cracked tooth
A tooth with a moderate risk crack or high risk crack should be investigated and often placing a crown is the best option to help save the tooth!
If you feel pain, have increased stress, have noticed yourself clenching and grinding, have a lot of old previous fillings and had lots of dental work in the past, or just have not been to the dentist in a while; then I strongly suggest a dental visit so we can assess for cracked teeth and fix them up!
We look forward to seeing you!
This article was provided to you by Dentistry on Coolum on the Sunshine Coast.