Life can be stressful and with this stress can come habits that are damaging to your teeth. Since the beginning of the COVID-19 pandemic we all have experienced changes that can take a toll on our physical, mental, and emotional health. Not surprisingly, dentists have been reporting an increase in cases of cracked teeth since the pandemic.
What is a cracked tooth?
A cracked tooth is a thin fracture line that travels to the inner layers of the tooth. Often times this can cause discomfort because even small movements along this fracture line can irritate the pulp of the tooth, which is the very inside of the tooth where the nerves and blood vessels are. Another reason that a cracked tooth can cause a problem is because it is an entry point for bacteria to get into the tooth.
Cracked tooth seen after removal of filling
A cracked tooth is different from ‘craze lines’ which are small fracture lines that stay within the outer layer of the tooth and do not produce symptoms. Craze lines are very common to see in teeth over time due to general wear and most times they do not need to be treated.
Craze Lines
A cracked tooth is also different from a chipped tooth or fractured cusp, which is when a piece of tooth breaks off. The severity of the break of the tooth will determine what restorative treatment is needed, such as a filling or a crown.
Fractured Cusp
Chipped Tooth
What causes a cracked tooth?
A cracked tooth can be caused by many different factors. Clenching and grinding puts stress on teeth that can cause a crack over time. Eating something hard can also cause a tooth to crack. For instance, chewing on ice, hard candy, meat bones, or even catching a hard popcorn kernel can cause damage to the tooth. An uneven bite can also put harder pressure on some teeth more than others and this repeated stress may increase risk of a crack. A tooth that has extensive treatment such a a root canal or large filling can result in the tooth being brittle and weakened; this can make them more susceptible to a crack or fracture. Often a crack is caused by many of these factors working together over time.
How do you know if you have a cracked tooth?
Signs of a cracked tooth could be pain on biting or release from biting. This could be a consistent chewing discomfort or something that happens on occasion. Sometimes sensitivity to temperature changes are also a sign of a cracked tooth. A throbbing or spontaneous pain could be a sign of a severely cracked tooth that has caused infection to the nerve of the tooth. On other occasions, a crack may not be showing any symptoms and may just be detected at a routine dental exam.
Due to their range in symptoms, identifying a cracked tooth can be difficult. If a cracked tooth is suspected then the dental team will do some testing of the tooth to help identify the problem. This can involve checking for symptoms, checking your bite, and checking the periodontal health around the tooth. Since a crack is so thin it often does not show up on a traditional x-ray. Many times a crack can be visualized on the outer surface of the tooth, but the extent to which it travels is harder to predict. Sometimes a dentist will try to remove the crack to see how far it travels. If the crack is suspected to travel more extensively toward the pulp or down the root of the tooth then additional investigation is required. In these cases a referral to an endodontist, who is a dentist that specializes in root canal treatment, may be recommended. They work under high powered microscopes and often have additional imaging devices such as a CBCT which can take 3-dimensional images and help to better visualize the extent of the crack.
How do you treat a cracked tooth?
Treatment for a cracked tooth is dependent on its severity. If the crack is explored and determined to be fairly shallow then removing the fracture line and stabilizing the tooth with a filling and bite adjustment may be all that is needed. If the crack is a bit more extensive then often times the best treatment option is to place a crown on the tooth. A crown is a strong restorative option and provides full circumferential support to hold the tooth together and helps prevent continued movement along this fracture line. If a crack is suspected to travel to the nerve of the tooth, then you may be referred to an endodontist for a root canal. In the most severe cases, if the crack travels down the root of the tooth under the bone level, then unfortunately there is no definitive way to access and treat it. Bacteria will be able to continuously enter through the fracture line and is a risk of re-infection. In these cases, the best treatment option is to have the tooth extracted and consider an implant in the site if possible.
A crack that travels onto the root surface vs staying confined to the crown of the tooth
With cracked teeth, prevention is an important factor. If you clench and grind your teeth then a nightguard is a great way to protect your teeth from overnight forces. If you notice these habits throughout the day then try to be aware of the issue and remind yourself to release the tension you are putting on your teeth. Stress reduction is also key. Always be cautious to avoid any hard foods- ice, popcorn kernels, and hard nuts can often be culprits of a fractured tooth. Your dentist can also check how your teeth occlude, or bite together, to make sure that your teeth aren’t catching any unwanted traumatic force during their natural function. Be sure to keep up with your routine dental visits and let your dentist know of any concerns you may have in regards to a cracked tooth.
For more information check out the American Association of Endodontic's article on Cracked Teeth.