When you have a cracked tooth, you might have any one (or several) of a range of signs and symptoms. We dentists use the umbrella term cracked tooth syndrome (CTS) to refer to all of the possibilities.
In most cases, cracked teeth can be treated and saved. That said, the earlier a crack is detected and treated, the higher the likelihood that the treating dentist will be able to stop the crack progressing from a simple one to a complex case.
CTS usually involves the back teeth, purely because they carry the greatest load and pressure when we bite down.
Otherwise, the teeth most prone to CTS are:
- molars/premolars with large dental fillings and restorations (In these cases the crack usually shears across and under the cusps of predominantly heavily filled teeth.)
- teeth that are subjected to strong forces from grinding or chewing hard foods
- trauma-affected teeth.
Cracks typically start on top of the crown in the enamel of the tooth. If they progress, they can involve the pulp and eventually the root of the tooth.
Most common signs of a cracked tooth
To make a diagnosis, we listen out for your description of these common symptoms of cracked teeth:
- Sharp pain when chewing small, hard things.
- Short sharp pain from hot and cold food or drink.
- Sensitivity to sweet foods, like chocolate.
- “It’s hard to pinpoint which tooth hurts and I am unsure if it is top or bottom.”
- The gum around the tooth is sore and feels bruised.
- “I have cracked another tooth.” (Often patients who have a predisposition to crack a tooth will crack multiple teeth in their lifetime, unless they have preventative care.)
Why is CTS becoming more common?
- In developed countries, the typical population is living longer now than ever before. And the older we get (and hence the longer we retain our teeth), the more each tooth is exposed to all of the factors that can cause CTS, including wear and tear.
- Our lifestyle today carries more stress than in days gone by. Heightened levels of stress lead to increased instances of clenching or grinding of the teeth called bruxism. Bruxism is particularly prevalent at night and can cause and contribute to tooth wear and cracking.
How your dentist will assess you
Diagnosing a cracked tooth is challenging and takes time because the symptoms are inconsistent and can mimic many other conditions that we dentists encounter regularly.
When looking in your mouth, we try to get an overall picture of the general tooth wear, how the upper and lower jaws meet, surface fractures and existing large fillings.
Often we have to resort to placing a hard object between the teeth and asking you to bite down hard and release to elicit a response.
We also check the surrounding gums of the suspected tooth, as this can point to the affected one.
X-rays may be taken – not necessarily to look for a crack but to rule out any other potential causes of the pain.
As a last resort we might have to remove the old restoration and place a staining dye on the inner tooth surface; this can help us determine the presence, direction and depth of the crack.
We also have specialised lights that shine into teeth, illuminating potential cracks.
What can we do to treat a cracked tooth?
Catching a simple crack early improves the chance of saving the tooth.
Simple crack treatment involves removing the weakened cusp and replacing it with either a large dental filling or a crown. If complex cracks have progressed into the pulp or caused pulpal inflammation, treating the pulp could involve root canal treatment or eventual loss of the tooth.
The old adage “prevention is better than the cure” is still true. You can minimise damage by:
- wearing a protective guard when playing sport
- avoiding chewing on hard objects
- wearing a nocturnal guard if you have signs of bruxism
- practising good dental hygiene.
Dr Jacques Theron