A cracked tooth is a dental fracture that does not result in the immediate, complete loss of a piece of the tooth. The initial symptoms are frequently intermittent, including a sharp, fleeting pain when biting down on a certain spot, which intensifies when the biting force is suddenly released. Sensitivity to temperature changes, especially cold, is common. Whether this damage requires extraction is not a simple yes or no answer, as the outcome depends on the specific location, depth, and direction of the fracture line within the tooth structure.
Understanding Different Types of Cracks
Dental professionals classify cracked teeth because the type of fracture dictates the appropriate treatment course. The least severe are Craze Lines, which are tiny, superficial hairline cracks that affect the outer enamel layer and typically cause no pain or functional issues. A more significant injury is a Fractured Cusp, where a piece of the chewing surface breaks off.
A true Cracked Tooth begins on the chewing surface and extends vertically toward the root. If this vertical crack progresses further, it can result in a Split Tooth, where the fracture travels completely through the tooth, separating it into two segments. The most problematic classification is the Vertical Root Fracture, which originates in the tooth’s root structure, often below the gum line, and moves upward toward the biting surface.
Procedures to Preserve the Tooth
The primary goal of modern dentistry is to stabilize the tooth and prevent the crack from spreading deeper. Minor surface damage, such as small chips or Craze Lines, can be addressed with Dental Bonding, where a tooth-colored composite resin is applied directly to the affected area.
When a larger portion of the tooth is compromised, such as with a Fractured Cusp or a Cracked Tooth that has not reached the pulp, a Dental Crown is the most common restorative solution. The crown acts as a protective cap placed over the tooth, holding the weakened structure together and absorbing the forces of chewing. This prevents the crack from propagating deeper into the root.
If the crack has extended deep enough to expose or infect the dental pulp, Root Canal Therapy becomes necessary before a crown is placed. This procedure involves removing the damaged pulp tissue to eliminate infection and pain. The tooth is then sealed and covered with a crown to restore its strength.
Indicators That Require Tooth Removal
Extraction is necessary when the structural damage to the tooth is so extensive that restorative procedures cannot guarantee long-term success. A primary indicator for removal is a Vertical Root Fracture, which compromises the tooth’s foundation. Since this crack starts in the root and often leads to a localized infection and bone loss around the root, the tooth cannot be properly sealed or supported.
A second indicator is when a Cracked Tooth has progressed to a Complete Split, separating the tooth into two or more distinct, mobile pieces. Once this complete separation occurs, the tooth fragments cannot be reliably bonded or capped back together, making the prognosis for saving the tooth extremely poor.
The inability to create a proper seal is a final determinant for extraction, especially when the fracture line extends significantly below the gum line and into the bone. A deep Subgingival Fracture prevents the placement of a restorative margin—the edge of a filling or crown—onto healthy tooth structure. Without a complete seal, bacteria will continuously leak into the underlying bone and root, leading to chronic infection, irreversible bone loss, and the eventual need for removal.