Unfortunately, the incidence of cracks in teeth seems to be increasing. People are living longer and keeping their teeth longer. People of all ages are also living more stressful lives, which can result in crack-inducing habits, such as Clenching and Bruxism. Sometimes tooth sensitivity can be part of a syndrome named “Cracked Tooth Syndrome“. This often presents as a constellation of symptoms that may include intermittent sensitivity to biting, cold sensitivity and /or hot sensitivity. Intermittently, when the patient bites down just right on something hard, they get a “wincing” pain. What actually has happened is a tooth with a microscopic crack present has “flexed “along the crack fissure. This momentary opening and closing of the crack stimulates the tooth’s nerve endings and causes pain.
If not corrected in time, the crack can slowly propagate and cause further irritation of the tooth’s nerve and the patient will complain of sensitivity when drinking cold liquids. Sometimes, even though the crack is quite severe and the patient will not have this symptom (cold sensitivity) at all.
If the crack propagates into the tooth’s pulp chamber (where the nerve and blood supply are housed) then it is possible for bacteria to get into the pulp and lead to an abscess (infection of the pulp and surrounding tissue).
Cracks can result in teeth needing; root canals, or even result in the eventual loss of the tooth. If the crack does continue to propagate in a vertical direction it can even split a tooth and cracks which extend below the level of the supporting bone are very serious and tend to cause infections in the bone.
So how should cracked teeth be handled? At our office at Atrium Dental, when a patient presents with these symptoms, we first do a visual examination and look for any cracks wearing magnifying glasses. Sometimes we will use transillumination with fiber optic light. Based on law of physics the penetrating light will continue to penetrate the substance until it reaches a space, after which the light beam is reflected. This result in a light and dark area separated by a fracture line. We may have the patient try and provoke the pain by biting on a bite stick until they are able to position it in a way that causes pain when the bite on it.
The treatment of choice for a cracked tooth is a placement of crown. The full coverage of the tooth redistributes the chewing forces on the tooth and tends not to allow the crack to propagate as easily. Most of the time, when the cracked tooth is covered with a crown, it provides the patient with a “happy” tooth that function in a more normal way. If the pain does not go away sometimes it is necessary to root canal the tooth or extract it.
Intermittent pain on chewing is a sign that should be reported to your dentist and most likely is a problem that should be addressed before it becomes worse!