A cracked tooth can cause intermittent sharp pain, especially when biting or releasing pressure, a condition often grouped under the term Cracked Tooth Syndrome. The pain and sensitivity occur because the crack allows movement and fluid shifts, irritating the living tissue inside the tooth. A dental crown is a common and effective treatment for a cracked tooth, acting like a protective helmet. The success of this restoration, however, depends entirely on the location, depth, and type of the fracture.
Understanding Different Types of Tooth Cracks
Diagnosing a cracked tooth is complex because fractures can vary widely in severity and direction. Dentists classify these cracks to determine the best course of action. The most superficial type is a craze line, which is a tiny crack confined only to the outer enamel layer. These are common, usually painless, and rarely require treatment, being mainly a cosmetic concern.
A fractured cusp occurs where a piece of the chewing surface breaks off, often near a large dental filling. This type of crack is frequently manageable, and the tooth can often be fully restored with a dental crown after the fractured segment is removed. The true cracked tooth begins on the chewing surface and extends vertically toward the root. This fracture may or may not reach the pulp, the center of the tooth containing the nerves and blood vessels, and its depth is a major factor in prognosis.
The most severe types are the split tooth and the vertical root fracture. A split tooth is the result of an untreated cracked tooth that has separated the tooth into two distinct parts. A vertical root fracture starts in the root and often moves upward toward the chewing surface, making it extremely difficult to treat. Symptoms such as pain when chewing or sensitivity correspond directly to how deep the crack extends into the tooth structure.
Determining If a Crown is the Right Solution
A dental crown works by completely covering the tooth, stabilizing the structure, and preventing the crack from flexing and propagating further under chewing forces. This protective shell essentially glues the fractured segments together, stopping the irritating movement that causes pain. For a crown to be a viable solution, the dentist must first confirm that the crack has not extended too far down the root.
A critical criterion is that the crack must not extend below the gum line to the point where it is irreparable or cannot be sealed. If the fracture extends deep below the bone level, it compromises the health of the tooth’s support structure, making a crown unlikely to succeed. There must be enough healthy tooth structure remaining to provide a stable foundation for the crown, ensuring it can withstand the forces of chewing. If the remaining tooth is too damaged, a crown will not have sufficient material to bond to.
Pulp health is another determining factor, as a crack extending into the nerve tissue can cause irreversible damage. If the crack has reached the pulp, root canal treatment must be performed first to remove the infected or damaged tissue. Once the root canal is complete, the tooth is structurally weaker, making the subsequent placement of a crown important to restore strength and prevent future fracture. Treating a cracked tooth with a crown early can significantly improve the tooth’s survival rate.
Treatment Options When Crowning is Not Possible
When a crack is too extensive, a crown alone may not be sufficient to save the tooth. For minor cracks that cause little to no pain and are confined only to the enamel, a simple dental filling or bonding may be used to seal the fracture and prevent it from deepening. This conservative approach is used only when the structural integrity of the tooth is not significantly compromised.
If the crack has progressed to a split tooth or is diagnosed as a vertical root fracture, the prognosis for saving the tooth becomes poor. Vertical root fractures are challenging because they allow bacteria to leak along the root surface, causing persistent infection and bone loss. In these severe cases, especially with complete fractures, the most common and often necessary treatment is tooth extraction.
Extraction prevents the spread of infection and preserves the surrounding jawbone, which is important for future tooth replacement options. In some select cases involving multi-rooted teeth, a procedure called hemisection or root amputation may be attempted, where only the fractured root is removed and the remaining healthy root is crowned. When the fracture is irreparable, removing the tooth and replacing it with a dental implant or bridge is the most predictable long-term solution.