John O'Grady BDS MSc
Claire Rogers BDS MSc

 

 

Tel: 01442 865646
Fax: 01442 865446

 

Click here to download our Health Questionnaire

 

20a, Lower Kings Road
Berkhamsted 
Herts HP4 2AB

 

Tel:
Fax:

01442 865646
01442 865446

Email:
info@berkhamsteddental.com

 

Cracked Teeth

Because teeth are made of brittle enamel & dentine they can develop cracks.

Cracks are more likely to occur in teeth that have already been filled. They can also be caused by bumps or blows to the teeth and by habits such as tooth clenching & grinding or chewing ice cubes.

Cracks in the outer enamel of teeth are the commonest. They do not cause pain but can be unsightly if they are stained (by tea, coffee or smoking). The best advice with such cracks is to leave well alone as cutting away the cracked area will weaken the tooth still further.

A Crack line visible in the incisor tooth.

A Crack line visible in a previously filled molar tooth.

Cracks that run deeper into the inner layer of dentine within a tooth are more likely to be painful. Sometimes cracked teeth can be sensitive to hot, cold or sweet things but the classic sign is pain caused by biting hard on the affected tooth (e.g.: when eating tough or chewy foods). This pain is caused by the crack opening minutely as the tooth flexes under load.

Cracks that run deeper into the inner layer of dentine within a tooth are more likely to be painful. Sometimes cracked teeth can be sensitive to hot, cold or sweet things but the classic sign is pain caused by biting hard on the affected tooth (e.g.: when eating tough or chewy foods). This pain is caused by the crack opening minutely as the tooth flexes under load.

Sometimes locating a cracked tooth can be difficult, particularly if pain from the tooth is only intermittent. Cracks don't normally show up on x rays though bite tests and very strong lighting can often help the dentist identify which tooth is giving rise to the discomfort.

Having located the offending tooth, isolating where the crack is in that tooth can still pose problems as teeth often have more than one visible crack.

The options for managing cracked teeth are:

Watch: if symptoms are mild then merely monitoring the affected tooth is a possibility. Sometimes a fragment of tooth will eventually break off. Not withstanding the fact that the chipped piece needs repairing, symptoms such as pain on biting often settle down at this stage. The potential downside of this option is that it is often difficult to predict how large a piece of tooth might break off. A very large break may make it difficult or impossible to repair the tooth. 


This heavily filled molar tooth has lost a corner.

A Crack visible under an old filling.

Investigate: if the problem tooth has been filled previously, then removing the existing filling can help locate where the crack lies. The cracked piece of tooth can then be removed and the tooth rebuilt with a larger filling. Having removed the existing filling it is still sometimes difficult to locate the problem crack. In these circumstances a layer of adhesive cement can be spread across the base of the cavity to cover any possible cracks before the filling is replaced - whilst this may not completely resolve the problem it often helps to make things more comfortable.

Crown: for very heavily filled teeth, or when replacing the filling hasn't completely solved the problem, crowning the tooth can help. Because a crown completely surround a tooth it helps to hold any cracks shut so that they cannot open and close under biting and chewing pressure. As crowns are complex restoration we generally only crown teeth when we are sure they are perfectly healthy, however sometimes a crown is the only way of getting a problem cracked tooth to settle down. Occasionally a plastic temporary crown or a metal band around the tooth are useful as simpler options to asses how well the tooth will settle before placing a definitive crown.

An upper molar tooth restored with a gold crown.

Root canal filling: cracks in teeth can run very deeply into the tooth until they reach the nerve. As the nerve dies off the tooth can become very sensitive to temperature changes and can cause spontaneous pain. A tooth with a dead or dying nerve requires root canal filling. A root filled tooth is more brittle and prone to fracture and in these circumstances will definitely need to be crowned soon after being root filled.

This tooth has fractured too severely to be saved.

Extraction: sometimes cracks that are deep enough to cause problems with the nerve run so deeply into the tooth that the tooth is too weak to be restored. Whilst
it may be possible to patch such teeth up for a while they inevitably need to be extracted sooner or later. 


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