Cracked teeth are defined as partial fractures that appear on the crowns of teeth and may extend under the gums. Some tooth cracks may cause little to no pain. Although, most cause acute pain before or after mastication (biting down), which is characterized as “cracked tooth syndrome.” Lastly, tooth cracks commonly form on the surfaces of teeth facing the front of the mouth and the surfaces of teeth facing the back of the mouth.
Tooth cracks occasionally appear on the front teeth due to injuries or weakened dental restorations. Cracks also commonly develop on teeth with heavy occlusal forces, which refers to the chewing surfaces of back teeth. This includes mandibular first molars, mandibular second molars, maxillary premolars, maxillary first molars, and maxillary second molars. However, cracks rarely develop on mandibular premolars.
There are five types of tooth fractures, including:
Craze lines develop on the mesial and distal borders of the occlusal (biting) surfaces of permanent teeth. They can also be on facial and lingual surfaces. Further, the lines appear as very small cracks in the enamel. Craze lines are common, cause no pain, and do not require treatment.
Fractured cusps are relatively easy to diagnose, treat, and have a good prognosis. The fractures either develop in teeth with extensive caries or teeth with large dental fillings. However, the fractures do not extend to the pulp of teeth (the soft center where connective tissues, nerves, and blood vessels are), which means they typically do not cause pain. They often cause sensitivity, though, by exposing dentin.
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Teeth with cracks that extend subgingivally (below the gumline) need to be extracted. Although, if the crack hasn’t reached the gum line, sometimes it can be saved with other restorative dental treatments, such as crowns or bonding. These fractures typically cause acute pain before or after biting down and sensitivity to cold.
If left untreated, a severely cracked tooth typically results in a split tooth, which is characterized as a complete fracture. Split teeth extend to the surfaces in all areas. Causes of split teeth include persistent and destructive forces to dental restorations or traumatic injuries. It’s impossible to save a tooth that has a complete split.
Vertical root fractures travel upward from below the gumline. These occur most commonly on teeth that have had root canal treatments. Dentists always extract the affected teeth.
Frequent and repetitive forces damage tooth structure, which results in a minor fracture and continued growth of that fracture over time. People over 50 years of age are mainly affected by cracked teeth. Although, adults can experience them at any age depending on their lifestyle habits. Causes of cracked tooth syndrome include:
Common symptoms of cracked tooth syndrome include:
If a patient has craze lines, which are small and superficial cracks in teeth, no treatment is necessary. If they have fractured cusps, cracks below the gumline, split teeth, or vertical root fractures, treatment is necessary. Common restorative dental treatment options include:
Dental crowns are artificial tooth-colored and tooth-shaped caps that fit over damaged and weak teeth. They consist of metals, ceramics, or composite resin. If a patient’s tooth crack is severe but the tooth does not have to be removed completely, crowns are the ideal option. Crowns hold together the cracked parts of teeth and restore their natural shape, function, and look.
During a dental bonding procedure, a high-intensity curing light and special adhesive are used in combination with tooth-colored composite resins. The materials bond to the teeth and fill any noticeable cracks. Bonding is one of the most popular restorative treatment options among adults because it is painless and completed within one office visit.
Often times, cracks in teeth reach the pulp of teeth. In this case, root canal therapy is necessary. Root canals, also known as endodontic treatment, are effectively used to restore infected or inflamed roots, while also relieving dental pain. If the tooth is unsavable due to infection or a deep crack, it will have to be extracted instead.
A dentist usually extracts teeth due to extreme decay, trauma, injuries, or damage (such as severe cracks). If the crack reaches below the gum line, removing the entire tooth and root pieces is necessary. Then the dentist examines the tooth socket and removes any remaining fragments. Many patients opt for dental implants after the tooth is removed.
“Cracked Teeth.” American Association of Endodontists, www.aae.org/patients/dental-symptoms/cracked-teeth/.
Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.
Torabinejad, Mahmoud, and Richard E. Walton. Endodontia: princípios e prática. ELSEVIER, 2010.