Cracked Tooth Syndrome - Can my tooth be saved?

Root Canal, Post and Crown vs Dental Implant

Cracked teeth, or cracked tooth syndrome, can present a range of symptoms indicative of dental issues. These include sporadic discomfort while chewing, often worse after bite pressure, sensitivity to hot or cold temperatures, and a dull ache. The pain associated with cracked teeth can be intermittent and not directly over a given tooth, posing a challenge for dentists in identifying the precise tooth causing the discomfort.

Various types of cracked teeth exist, and the appropriate treatment and outcome depend on factors such as the type, location, and extent of the crack. Treatment ranges from cosmetic bonding and fillings, to root canal, post and crown to compelte tooth replacement with a dental implant.

Craze Lines - Are They Cracks? - No….not really

Craze lines are minuscule cracks that affect only the tooth's outer enamel. While these cracks are commonly found in adult teeth, they are superficial or cosmetic and do not cause pain.

Concerns regarding craze lines are primarily aesthetic or personal preference and do not require treatment unless appearance is a concern.

Can they be fixed? Sometimes craze lines can be resolved with composite fillings or bonding and polishing.

Fractured Cusp

When a piece of the tooth's chewing surface fractures, typically occurring around an old amalgam or composite filling, inlay or onlay, it is referred to as a fractured cusp.

This type of crack seldom damages the pulp and generally does not cause significant discomfort. Although the damage can feel extensive in the mouth, fractured cusps can almost always be saved. Dr. Tsai can restore the damaged tooth by applying a new filling or full coverage crown, thus preserving the tooth structure and resolving any sensitivity.

Cracked Tooth

A cracked tooth denotes a crack that extends vertically from the chewing surface of the tooth towards the root. Although the tooth remains in one piece, the crack may gradually progress. Early detection is crucial for preserving the tooth. If the crack has reached the pulp, the tooth can usually be treated with a root canal, post and crown procedures to prevent the crack from spreading.

However, if the crack extends below the gum line, it becomes irreparable, rendering the tooth unsalvageable and necessitating extraction, grafting, and a dental implant placed (a dental bridge is sometimes an option as well). Thus, early detection and treatment are very important. An untreated cracked tooth can deteriorate rapidly, ultimately leading to tooth loss and possibly surrounding bone loss. Timely diagnosis and intervention play a pivotal role in saving a cracked tooth.

Split Tooth

A split tooth often results from the long-term progression of a cracked tooth. It can be identified by a crack with distinct segments that can be separated. Unfortunately, a split tooth cannot be saved entirely.

The position and extent of the crack determine whether any portion of the tooth can be preserved. In certain cases, endodontic treatment and a post and crown may be performed to save a segment of the tooth.

In most cases, the split tooth will be extracted, grafted, and a dental implant placed.

Vertical Root Fracture

$vertical root fracture usually cannot be saved$

Vertical root fractures initiate in the root tip (or end) of the tooth and extend toward the chewing surface. They typically exhibit minimal signs and symptoms, often remaining undetected for a considerable period.

The presence of a vertical root fracture is often discovered when the surrounding bone and gum become infected, or the patient experiences a deep, dull ache.

Treatment may involve tooth extraction, grafting, and a dental implant, although, in certain instances, endodontic apex root surgery may be considered to save the tooth by removing the fractured portion.

Why Does a Cracked Tooth Cause Pain?

To understand the source of the pain caused by a cracked tooth, one must understand the tooth's anatomical structure. The outermost layers of the tooth consist of the white enamel layer and the hard dentin within. Within these layers lies the inner soft tissue known as the pulp, which contains an intricate network of nerves and blood vessels.
Tooth anatomy to understand cracked tooth syndrome

Tooth anatomy to understand cracked tooth syndrome

When a tooth's outer hard tissues become cracked, the act of chewing exerts pressure on the fragmented segments, leading to irritation of the pulp. As time progresses, the pulp sustains damage beyond its capacity to self-repair. Consequently, the cracked tooth not only elicits pain while chewing but it also becomes sensitive to extreme temperatures.

As the crack worsens, the pain associated with the cracked tooth may intensify and even occur spontaneously without any external stimulation. Moreover, extensive cracks can facilitate the infiltration of harmful bacteria into the pulp tissue, potentially resulting in infection. This infection can subsequently spread to the surrounding bone and gum tissues, exacerbating the discomfort and presenting additional oral health concerns.

Do I have Cracked Tooth Syndrome?

Dr Tsai evaluating a patinet for cracked tooth syndrome

Cracked tooth syndrome and present in a variety of different ways. The most common is bite pressure pain. When you bite on food the sensitivty of a tooth or multiple teeth "shoots" up to the point of making you pay attention.

The second most common form or symptom of cracked tooth syndrome is a constand throbbing or pulsing pain around the base of one of your teeth. Often, if the fracture it caught early enough, the tooth can be saved. If not, we can look at extracting the tooth, grafting the socket and placing a dental implant or a dental bridge.

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Dr. Sherry Tsai provides treatment for cracked tooth syndrome, root canals, grafting, dental implants and oral surgery in Millbrae, San Bruno, Burlingame, San Mateo and the Bay Area