TL;DR
A cracked tooth usually announces itself with a sharp pain when you bite, often as you release, along with sensitivity to cold or sweets. Cracks are often too fine to show on an X-ray, so diagnosis relies on bite tests, magnification and a close look with an intraoral camera. Treatment depends on how far the crack runs: bonding or an onlay for a small one, a crown for most, a root canal if the nerve is affected, and removal for a split root. Finding a crack early gives the tooth its best chance.
How do you know if a tooth is cracked?
The telltale sign is a sharp, brief pain when you chew, especially the moment you let go of the bite. As you bite down, the two sides of the crack flex apart slightly; as you release, they snap back and pinch the nerve inside. Between bites, the tooth may feel completely normal.
Other clues include sudden sensitivity to cold, heat or sweets, and pain that’s hard to locate. People often can’t say whether it’s an upper or lower tooth. Because the symptoms come and go, a cracked tooth can go unnoticed for weeks, and that delay gives the crack time to grow.
What kinds of cracks can a tooth have?
Not every crack is the same, and the type decides the treatment. From least to most serious:
The first is cosmetic at most. The others need attention, and the sooner the better.
- Craze lines: fine surface lines in the enamel, common in adult teeth and usually harmless
- Fractured cusp: a piece of the chewing surface breaks or cracks off, often around a large filling
- Cracked tooth: a crack running from the chewing surface down toward the root
- Split tooth: a crack that has gone all the way through, dividing the tooth into separate pieces
- Vertical root fracture: a crack that starts in the root and may cause few symptoms until infection sets in
How is a cracked tooth diagnosed?
A cracked tooth is diagnosed mostly by testing and looking, because X-rays often miss a crack that runs in the same direction as the beam. We ask you to bite on a small tool one cusp at a time to find the spot that triggers the pain. We check the tooth’s response to cold, examine it under magnification, and sometimes use a dye that makes a crack line stand out.
An intraoral camera puts a magnified image on the screen so you can see the crack yourself. Low-radiation digital X-rays still matter, since they show the bone around the root and any infection there. The gums around the tooth are measured too, because a deep pocket in one narrow spot can point to a crack running into the root.
How is a cracked tooth treated?
Treatment depends on where the crack runs and whether it has reached the nerve. A crack confined to the outer enamel can sometimes be bonded or simply watched. When a cusp is involved, an onlay that covers it may be enough.
Most cracked teeth need a crown, which wraps the tooth and holds the two sides together so they can’t flex. If the pulp inside has become inflamed or infected, root canal therapy comes first, then the crown. A tooth that has split through, or a root with a vertical fracture, usually can’t be saved, and removal with a plan for replacement becomes the kindest option.
Why do teeth crack, and how can you prevent it?
Teeth crack under force they weren’t built to take, often repeated over years. Grinding and clenching, chewing ice, hard candy or popcorn kernels, large old fillings that leave thin walls, and a bite that loads some teeth too heavily all contribute. Teeth that have had root canal treatment without a crown are especially vulnerable.
Dr. Carleigh Prane studied the bite in depth through the Dawson Academy’s core curriculum, so a cracked tooth leads her to look at what caused it as well as the tooth itself. A night guard for grinders, crowns or onlays on teeth with weak walls, and an adjustment where a tooth takes too much force can all help protect the teeth you still have.
What should you do if you think you’ve cracked a tooth?
Call us and chew on the other side until we see you. Rinse with warm water, and use a cold compress on the cheek if there’s swelling. Avoid very hot, cold or hard foods. Over-the-counter pain relievers can help in the meantime.
Don’t wait for the pain to settle, because a crack can deepen with every bite. If a piece has broken off, bring it with you. Our office sees dental emergencies as soon as possible, and the page on dental emergencies covers what to do in the meantime.