A cracked tooth is a fracture extending from the chewing surface downward. This damage presents a challenge because the full extent of the fracture is often hidden beneath the gumline. Even minor fractures create a pathway for bacteria to invade the tooth’s inner pulp, potentially leading to infection and tooth loss. Therefore, any suspected tooth fracture should be evaluated promptly by a dental professional, as severity can rapidly change. Ignoring initial signs can lead to severe pain, swelling, and more complex treatment.
Classifying Cracks: Determining the Urgency
The urgency of a cracked tooth depends entirely on the type and depth of the fracture, necessitating professional assessment.
Craze lines are the least urgent; these are tiny, superficial hairline cracks in the enamel that cause no pain and rarely require treatment. A fractured cusp is a moderate concern, where a piece of the chewing surface breaks off, often near a filling. This usually causes sharp pain when biting but rarely involves the inner pulp.
A cracked tooth is a serious vertical fracture running from the chewing surface toward the root, sometimes extending below the gumline. Symptoms include intermittent pain when chewing, especially when releasing the bite, and sensitivity to cold, indicating possible pulp involvement. If the crack progresses and completely separates the tooth into two distinct segments, it becomes a split tooth, a severe condition that usually requires extraction.
The most severe fracture is a vertical root fracture, which begins in the root and extends toward the chewing surface. These cracks may not cause symptoms until the surrounding gum and bone become irritated or infected, causing localized swelling and bone loss. Because they start deep within the structure, they often have a poor prognosis and frequently necessitate tooth removal.
Immediate Steps: Managing Pain and Preventing Further Damage
While waiting for a dental appointment, several steps can manage discomfort and protect the tooth from further harm. Rinsing the mouth gently with warm water helps keep the area clean and washes away debris. If bleeding occurs, apply light pressure with a piece of clean gauze to control it.
Pain can be managed with over-the-counter pain relievers, such as ibuprofen or acetaminophen. If external swelling is present, apply a cold compress or ice pack to the cheek near the affected area to reduce inflammation. Avoid chewing any food on the side of the mouth with the cracked tooth to prevent the fracture from worsening or splitting.
Professional Assessment and Diagnostic Methods
Diagnosing a cracked tooth is challenging because the fracture line is often microscopic and may not be visible on standard X-rays. The professional assessment begins with a thorough visual examination, often using magnification tools like dental loupes or a microscope.
Dentists frequently use transillumination, where a bright fiber optic light is shined through the tooth; the crack line absorbs the light, making the fracture appear dark. To confirm the location and depth, the dentist may ask the patient to bite down on a specialized instrument, like a Tooth Slooth, which isolates pain to a specific cusp. A sharp, painful sensation upon the release of biting pressure strongly indicates a crack.
Additionally, a special staining dye may be applied to the tooth surface, which penetrates and highlights the fracture line. X-rays are routinely taken, but they are primarily used to check for signs of infection, such as bone loss around the root, since the crack itself may not show up.
Treatment Options Based on Crack Severity
Treatment depends entirely on how far the fracture has penetrated the tooth structure.
For minor cracks, such as craze lines or small chips, dental bonding using a composite resin may be sufficient to repair the defect. If a fractured cusp breaks off without affecting the pulp, the remaining structure is protected with a dental crown, a custom cap that covers the entire tooth to prevent further splitting.
When a crack extends into the pulp chamber, exposing the nerve tissue to bacteria, Root Canal Therapy (RCT) is necessary to save the tooth. This procedure removes the infected pulp, cleans the internal canals, and seals the tooth, which is then covered with a crown for structural support.
If a crack has progressed to a split tooth or a vertical root fracture that extends deep below the gum line, the tooth is often deemed non-restorable. In these cases, extraction is the only viable option, followed by replacement with a dental implant or bridge.