Cracked Tooth Syndrome
Pain from a small, hard-to-see crack in a tooth
Quick Facts
- Type: Dental condition
- Hallmark: Sharp pain on biting and releasing
- Common in: Back (molar) teeth
- Treatment: Crown, bonding, or root canal depending on the crack
Overview
Cracked tooth syndrome refers to the pain and sensitivity caused by a crack in a tooth that is often too small or too deep to show clearly on routine X-rays. The crack may run through the enamel and into the dentin, and sometimes toward the pulp, allowing tiny movements of the tooth fragments that trigger sharp pain.
It most often affects the back teeth, which absorb the strongest chewing forces. The classic sign is a sudden, sharp pain when biting down on or releasing a bite from certain foods. Because the crack can be hard to find, the condition is sometimes difficult to diagnose, but a dentist can usually identify and treat it before it worsens into a split tooth or infection.
Symptoms
Symptoms can be intermittent and easy to overlook at first:
- Sharp pain when biting down, and often a more noticeable jolt when releasing the bite
- Sensitivity to hot, cold, or sweet foods
- Pain that comes and goes rather than being constant
- Difficulty pinpointing which tooth hurts
- Discomfort with certain chewing motions but not others
If a crack reaches the pulp, the pain may become more persistent, signaling inflammation of the pulp or, eventually, infection.
Causes
Cracks develop when forces or weaknesses overcome the tooth's strength:
- Biting hard objects: Ice, hard candy, popcorn kernels, or unexpected hard pieces in food.
- Teeth grinding and clenching: Habitual grinding stresses teeth over time.
- Large fillings: Teeth with extensive fillings have less natural structure and are more prone to cracking.
- Uneven chewing forces: A misaligned bite that concentrates pressure on certain teeth.
- Sudden temperature changes: Alternating very hot and very cold foods can stress enamel.
- Trauma: A blow to the mouth.
Risk Factors
- Teeth grinding or clenching
- Large or old fillings, especially in molars
- A habit of chewing ice or hard objects
- An uneven or misaligned bite
- Older teeth that have weakened over time
- Previous dental work on the affected tooth
Diagnosis
Diagnosing a cracked tooth can take some detective work:
- Bite test: Biting on a special tool one cusp at a time helps reproduce the pain and locate the crack.
- Examination and dye: The dentist inspects the tooth, sometimes using a special dye or strong light to reveal the crack line.
- Removing old fillings: A crack is occasionally found only after a filling is removed.
- X-rays: Often do not show fine cracks but help rule out other causes and check the root and surrounding bone.
Treatment
Treatment depends on the size, depth, and direction of the crack:
- Crown: A cap that covers and protects the tooth is a common treatment, holding the cracked tooth together.
- Bonding or onlay: Smaller cracks may be repaired with bonding material or a partial restoration.
- Root canal: If the crack reaches the pulp, removing the inflamed pulp and placing a crown can save the tooth.
- Extraction: A tooth split deep below the gum line may need to be removed.
- Bite adjustment and a night guard: Reducing grinding forces helps protect the tooth and others.
Early treatment offers the best chance of saving the tooth before the crack deepens.
Prevention
- Avoid chewing ice, hard candy, and other hard objects
- Wear a night guard if you grind or clench your teeth
- Use a mouthguard during contact sports
- Address an uneven bite with your dentist
- Keep up regular dental check-ups to catch problems early
When to See a Doctor
See a dentist if you have:
- A sharp pain when biting down or releasing a bite
- Tooth sensitivity to hot, cold, or sweet that comes and goes
- Difficulty identifying which tooth is causing discomfort
Seek prompt care if pain becomes constant or if you develop swelling, a bad taste, or fever, which may mean the crack has led to infection. Treating a crack early gives the best chance of saving the tooth.
Frequently Asked Questions
Why is a cracked tooth so hard to diagnose?
Many cracks are too fine to appear on X-rays and may not be visible to the eye. The pain is often intermittent and hard to localize, so dentists rely on bite tests, special dyes, and sometimes removing old fillings to find the crack.
What does cracked tooth pain feel like?
The classic symptom is a sharp pain when you bite down on certain foods, often most noticeable when you release the bite. There may also be sensitivity to hot, cold, or sweet, and the discomfort tends to come and go rather than being constant.
Can a cracked tooth heal on its own?
No. Unlike bone, tooth enamel cannot repair a crack, so the problem will not heal by itself and may worsen with continued chewing. A dentist can protect the tooth, often with a crown, before the crack deepens or causes infection.
How is a cracked tooth treated?
Treatment depends on the crack. Many teeth are protected with a crown, while smaller cracks may be bonded. If the crack reaches the pulp a root canal may be needed, and a tooth split deep below the gum line may have to be removed.
Will a cracked tooth get worse if I wait?
It often will, because chewing keeps stressing the crack and can let it spread or allow bacteria into the tooth, leading to pulp inflammation or an abscess. Seeking treatment early gives the best chance of saving the tooth.
References
- American Association of Endodontists. Cracked Teeth.
- American Dental Association (ADA). MouthHealthy.
- Merck Manual. Tooth Disorders.
- MedlinePlus, U.S. National Library of Medicine.