Cracked Tooth

中文版  

With increasing life expectancy, dental awareness and knowledge, people are keeping their teeth much longer. This exposes teeth to more years of crack-inducing habits such as chewing on hard food and parafunctional habits like grinding or bruxism. These habits make teeth more prone to cracks.

Teeth can crack in several different ways. Cracks may affect the crown, root or both parts of the tooth.

Cracked teeth demonstrate many types of symptoms ranging from discomfort to pain when chewing, pain on release of biting pressure and sensitivity to hot and cold temperatures. Often, these symptoms occur inconsistently, making diagnosis difficult.

What can I do to prevent cracked teeth?

​While cracked teeth are not completely preventable, there are some steps to take to minimise your risk:

• Avoid chewing on hard food or objects such as ice, hard nuts, pens etc.
• Do not clench or grind your teeth.
• If you clench or grind your teeth at night, speak to your dentist about wearing a night guard.
• Wear a mouth guard when playing contact sports.

How will a cracked tooth be treated?

The treatment and outcome for a cracked tooth depends on the type, location and extent of the crack. Not all teeth are amenable to treatment. Split teeth are almost always doomed for failure. Your endodontist is the best person to advise you on the appropriate treatment.

Usually, there will be a need to stabilise or splint the tooth with a band to prevent further progression of the cracks. Endodontic or root canal treatment is often necessary if there is pulpal involvement aising from the crack. Endodontic treatment will relieve pain and resolve pulpal inflammation and infection but it will not cure cracks, as these are physical defects on the tooth surfaces. When the cracked tooth becomes asymptomatic and has stabilised, a crown will be placed. Placement of a crown provides maximum protection, retards the progression of the cracks but does not guarantee success in all cases.

After treatment for a cracked tooth, will my tooth completely heal?

Treatment for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth will continue to function and provide years of comfortable chewing.

However, it is important to realise that unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in the loss of tooth.

Chewing on a cracked tooth can cause micro-movement of the affected fragments and changes in the dentine and pulp resulting in pulpal irritation. It is the release of biting pressure on the affected tooth that causes the sharp pain experienced by some patients. Over time, the pulp becomes irreversibly damaged and the tooth will hurt consistently even when not in function. Cracks are also pathways for bacteria ingress leading to infection of the pulp and its surrounding tissues.

Treatment Outcomes

 As previously mentioned, patients with cracked tooth will require a metal band placement to serve as a brace to splint the crack(s) and prevent further progression of the crack. When treated early, the pulp inflammation associated with cracked tooth is usually reversible. A local study[i] conducted in 2022 in NDCS, which assessed 122 cracked teeth with reversible pulp inflammation after orthodontic band placement in NDCS , found that 113 (92.6%) cracked teeth had pulp inflammation resolved within 2 months. The metal band would then be replaced by a permanent crown which helps to provide protection and retard the progression of crack.

If there are signs and / or symptoms of disease in the pulp, which gives rise to severe spontaneous pain, root canal treatment will be required. A local study[ii] done in NDCS in 2019, evaluated the incidence of pulpal complications in vital cracked teeth which had undergone band and crown placement. Out of 199 cracked teeth, 141 teeth (71%) remained healthy after 3 years without treatment, while 58 of them (29.1%) subsequently developed pulpal complications within 1-2 years, hence requiring root canal treatment or extraction.

Another local study[iii] done in NDCS in 2016 assessed the survival of cracked premolars and molars after root canal treatment at NDCS. It was found that 77 of 84 cracked teeth (92%) survived after 5 years, while 7 (8%) teeth were extracted. This showed that an endodontically treated cracked tooth is functional and may reasonably survive for 5 years and longer. The determining factor hinges on the extent of crack. Deep crack lines had a negative impact on teeth survival rate.

[i] Seet RF, Chan PY, Khoo ST, Yu VSH, Lui JN. Characteristics of Cracked Teeth with Reversible Pulpitis After Orthodontic Banding-A Prospective Cohort Study. J Endod. 2022 Dec;48(12):1476-1485.e1. doi: 10.1016/j.joen.2022.09.002. Epub 2022 Sep 21. PMID: 36150561. 

[ii] Wu S, Lew HP, Chen NN. Incidence of Pulpal Complications after Diagnosis of Vital Cracked Teeth. J Endod. 2019 May;45(5):521-525. doi: 10.1016/j.joen.2019.02.003. Epub 2019 Mar 22. PMID: 30905570. 

[iii] Sim IG, Lim TS, Krishnaswamy G, Chen NN. Decision Making for Retention of Endodontically Treated Posterior Cracked Teeth: A 5-year Follow-up Study. J Endod. 2016 Feb;42(2):225-9. doi: 10.1016/j.joen.2015.11.011. Epub 2015 Dec 23. PMID: 26723485.