A cracked tooth is a common dental emergency that often causes sharp pain or sensitivity. While a crack is a serious injury, extraction is not the only outcome, and in many cases, the tooth can be saved. The decision to save or remove a tooth depends entirely on the nature, depth, and location of the fracture, requiring a precise diagnosis by a dental professional. Understanding the different ways a tooth can crack determines the most appropriate treatment.
How Dentists Classify Cracked Teeth
A cracked tooth is a spectrum of injuries, each with a different prognosis. The most superficial injuries are called craze lines, which are tiny, hairline fractures confined only to the outer enamel layer. These lines are common in adult teeth, are usually cosmetic, and rarely require active intervention.
A fractured cusp involves a break in the pointed chewing surface of the tooth, typically occurring around a filling. The fractured piece often breaks away, but the crack usually does not extend into the pulp tissue. A cracked tooth (cracked tooth syndrome) is a vertical fracture originating on the biting surface and extending toward the root. This crack is incomplete, meaning the tooth has not yet separated, but it may cause significant pain when chewing or exposed to cold temperatures.
A split tooth is the progression of an untreated cracked tooth, where the fracture has fully separated the tooth into two distinct segments. The crack runs through the entire tooth, often extending below the gum line. The most severe classification is a vertical root fracture (VRF), which begins in the tooth’s root and travels upward toward the chewing surface. These fractures are often hidden, frequently occurring in teeth that have had a previous root canal, and can be difficult to detect without specialized imaging.
Methods for Saving a Cracked Tooth
When a tooth is cracked, the primary goal is to preserve the natural tooth structure. For minor injuries like craze lines or small chips, dental bonding is often sufficient. This involves applying a tooth-colored composite resin directly to the tooth surface to fill the crack and restore its contour.
For more significant cracks, such as a fractured cusp or a cracked tooth that has not yet reached the pulp, a full-coverage crown is the standard treatment. The crown acts like a helmet, holding the compromised tooth structure together and preventing the crack from spreading further down the root. Placing a crown significantly improves the tooth’s prognosis and survival rate.
If the crack has progressed deep enough to reach and damage the sensitive internal pulp tissue, a root canal procedure becomes necessary. An endodontist removes the infected or inflamed pulp, cleans and seals the inner chambers, and eliminates the source of the infection. Following this, a crown is mandatory to protect the weakened tooth from fracturing further under normal biting forces. The combined treatment of a root canal and a crown can successfully save many teeth.
When Extraction is the Only Solution
While dental professionals make every effort to save a natural tooth, some fractures are non-restorable, leaving extraction as the only viable option. The most common cause for mandatory extraction is a vertical root fracture (VRF). Because this crack begins in the root and often leads to chronic infection and bone loss, it is nearly impossible to clean and seal the fracture line effectively.
A fracture that has progressed into a true split tooth, extending deep below the gum line, also often requires removal. Once the tooth is separated into two distinct, movable segments, there is insufficient structure remaining to hold a crown or any other restoration. The tooth is considered non-restorable because the entire fracture cannot be sealed against bacteria.
Extraction is also necessary if the crack has led to severe, untreatable infection that threatens the surrounding jaw bone and adjacent teeth. If the remaining tooth structure above the bone level is minimal, even after a root canal, there may not be enough foundation to support a protective crown. In these severe cases, removing the infected and unstable tooth is necessary to preserve the overall health of the mouth.
Why Immediate Dental Consultation is Crucial
The most important factor in saving a cracked tooth is the speed of intervention. Cracks are progressive injuries, and a delay allows a small, salvageable fracture to propagate further down the tooth. A crack confined to the enamel and dentin today could extend into the pulp tomorrow, turning a simple crown procedure into a complex root canal, or worse.
A prompt dental examination is the only way to get an accurate diagnosis of the fracture type and depth. Dentists use specialized tools, such as transillumination (shining a light through the tooth) and staining dyes, to visualize the crack line, which is often invisible. X-rays are also taken to check for signs of infection or bone loss around the root.
If a crack is left untreated, bacteria can seep into the pulp and cause a severe infection or abscess, accelerating bone loss and increasing the likelihood of extraction. Seeking immediate care maximizes the chance that a conservative, tooth-saving treatment can be used. If extraction proves unavoidable, early diagnosis allows for better planning of post-extraction options, such as a dental implant or bridge.