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Cracked Tooth Syndrome

Do you have a cracked tooth?

Sometimes when you bite or chew, you feel a sharp pain. It quickly disappears and perhaps you ignore it. You avoid certain foods or only chew on one side of your mouth. Does this sound familiar? If so, you may have a cracked tooth.

What Is Cracked tooth syndrome?

Cracked tooth syndrome is a term that describes recurring discomfort, sensitivity or pain that is caused by an incomplete fracture or crack in a tooth.

Cracked tooth syndrome is most common in lower back teeth (molars). That’s because these teeth absorb most of the forces of chewing.

What Causes A Tooth To Crack?

A tooth may crack due to variety of factors:

  • Chewing on hard objects or foods such as ice, nuts or hard candy
  • An accident, such as blow to the mouth
  • Grinding and clenching of your teeth
  • Uneven chewing pressure
  • Stress on a tooth
  • Loss of significant portion of tooth structure through wear, large fillings or other restorations
  • Exposure of tooth surface/enamel to temperature extremes, such as eating hot food and then drinking ice water
  • Brittleness/ weakness of ‘teeth that have undergone root canal treatment.

People with one cracked tooth are more likely to have others, either at the same time or in the future.

How Can You Tell If A Tooth Is Cracked?

It could be difficult. You may not even be able to tell which tooth hurts or whether the pain is from an upper or lower tooth. A crack may appear as hairline fracture, running vertically along the tooth. It often is invisible to the eye and may not show even on an X-ray.

Sometimes the tooth may hurt when you bite or chew. The sensitivity or pain can be mild or intense. It may be painful only when you eat certain foods or when you bite in a specific way. You will not feel a constant ache, as you would if you had a cavity or abscess. The tooth may be more sensitive to cold temperatures.

Usually a cracked tooth hurt because the pressure of biting causes the crack to open. When you stop biting, the pressure is released and a sharp pain results as the crack quickly closes.

If the crack gets bigger, a piece of the tooth can break. You many also develop an infection. This can happen in the gum around the fractured tooth. You may notice a pimple-like bump on the gum near the tooth. This is known as a fistula.

Many people with cracked tooth syndrome have symptoms for months. It is hard to diagnose cracked tooth syndrome because the pain is not predictable.

Diagnosis

Your dentist will examine your mouth and teeth, focusing on the tooth or area that’s painful. He or she may use a sharp instrument called an explorer to feel for cracks in the tooth. Your dentist also will look at the gums around the tooth. You may have X-rays taken but X-rays often do not reveal the crack.

Your dentist may use a special tool to test the tooth. There are different kinds of tools. One looks like a toothbrush without bristles. It fits over one part of the tooth at a time as you bite down. If you feel pain, the part of the tooth being tested most likely has a crack in it. Your dentist may shine a very bright light on the tooth. He or she may stain it with a special dye. If the tooth already has a filling or crown, your dentist may remove it in order to see the tooth better.

Expected Duration

How long symptoms last depends on how quickly a cracked tooth can be diagnosed. Even after a crack is found, treatment may not completely relieve the symptoms.

Prevention

If you grind or clench your teeth, talk to your dentist about treatment. Grinding can increase your risk of having cracked tooth syndrome.

Your dentist can make a night guard (a plastic bite appliance) to prevent you from further grinding your teeth. This will relieve the pain from grinding. For some people it can reduce tooth sensitivity as the process of tooth wear is arrested. The night guard can be worn during sleep. It can also be worn at other times if clenching or grinding happens during waking hours as well.

You are also encouraged to stop destructive habits like ice chewing or pen biting, because they can contribute to the formation of new cracks and also the propagation of existing cracks.

Treatment

Treatments for cracked tooth syndrome do not always relieve the symptoms. Depending on the location, direction and extent of the crack, treatment may vary from bonding to root canal treatment. A severely cracked tooth may need extraction. Your dentist will determine the best treatment for you.

Tiny cracks are common and usually do not cause problems. Regular dental checkups are important. They allow your dentist to diagnose and treat problems in the early stage. Some initial cracks progress slowly. If they are identified and treated appropriately, their progression can be stopped or at least slowed down to increase the lifetime of the tooth.

Sometimes a crack affects just the outer layer of one or more cusps of a tooth. These usually are the highest points of the tooth. In this case, the tooth may be fixed with a crown or onlay to stabilize it and protect the tooth from further damage.

If the crack affects the underlying pulp; the soft tissue at the centre of the tooth, where the nerves and blood vessels are, you’ll need more complicated treatment such as root canal therapy before a crown can be place on it. Twenty percent (20%) of teeth with cracked tooth syndrome will need root canal treatment. After a root canal treatment, the tooth will no longer be sensitive to temperature, but it will still respond to pressure. If you feel pain before the root canal treatment, you may still feel some pain afterward. It probably will not be as intense or as frequent, but it may still occur.

In some cases, the tooth may need to be removed. Some cracks extend all the way through the tooth and inside the jaw bone. There’s no way to fix this type of crack and as such the tooth is considered not restorable. If your tooth is removed, you can have it replaced with an implant, a bridge or a denture.

When to Call a Professional?

If you feel pain when you bite or chew, contact your dental clinic.

Prognosis

Treatment of cracked tooth syndrome is not always successful. Your dentist should talk to you about the possible outcomes and the unpredictable long term prognosis. In some people, a crown will fix the problem. Others may need root canal treatment to solve the problem. Some people continue to have occasional symptoms after treatment. In this case, they may need to have the tooth removed.

The key to better prognosis is to find the crack early in its developmental stage and treat it appropriately. Regular follow-up is necessary in the long term management of cracked teeth.

Last reviewed : 20 April 2012
Writer : Dr. Roshima bt. Mohd Sharif
Reviewer : Dr. Isma Liza bt. Ali