Fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of fractured teeth increases. There are many reasons why teeth may fracture, for example, biting on hard objects, trauma, as well as grinding and clenching of the teeth. All of these behaviors place the teeth under extra strain and render them more susceptible to becoming fractured.

When tooth enamel becomes fractured, pain can become momentarily debilitating. In the absence of pressure on the fracture, there may be no discomfort.  However, use of the fractured tooth, may cause the fracture to widen similarly to a fracture in a windshield. The pulp chamber which contains the vital inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the fracture fuse back together, and pain subsides. If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth - known as irreversible pulpitis, thus creating a need for root canal therapy 

Symptoms of a cracked tooth may include:

• Unexplained pain when eating.
  
• Sensitivity to hot and cold foods.
  
• Pain with no obvious cause.
  
• Difficulty pinpointing the location of the pain.
•  

What kind of fractures can affect the teeth?

There are many ways in which a tooth can become fractured. The specific type of fracture will determine what type of treatment is viable. In cases where the fracture is not too deep, root canal therapy can be performed, and the natural tooth can remain stable.  In other situations, the tooth is too badly damaged and requires extraction which we also may provide with our in office Periodontist. 

Here is a brief overview of some of the most common types of cracks:

Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.

Oblique supragingival fractures – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will remain unaffected.

Oblique subgingival fractures – These fractures extend beyond the gum line and often beyond where the jawbone begins.  When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival fractures are painful and may require a combination of periodontal surgery (to expose the crown) and endodontic treatment to place a crown or other restorative device.

Vertical furcation fractures – These fractures occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can usually save the tooth.

Oblique root fractures – These fractures tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible, depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.

Vertical apical root fracture – These fractures occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such fractures are eventually extracted.

How are cracks in the teeth treated?

There are many different types of fractured teeth. While some fractures are clearly visible to the naked eye, Some can only be exposed using X-rays, and our office utilizes the extremely beneficial technology of a CBCT or cone beam CT scan allowing us to view the tooth from every angle to better asses the fracture.  In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves, and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha.  A crown or filling will be added to stabilize the tooth, and it will continue to function as normal. Our office, however, does not provide crowns - your general dentist will provide the necessary crown under their discretion. 

When a fracture is too severe for the tooth to be saved, we recommend an extraction which can be provided in our office or otherwise. There are a number of restorative options in this case, such as bridges, dental implants and partial dentures. All of these structures can restore biting, chewing, and speaking functions.

If you have any questions or concerns about cracked teeth, please contact our office.