A cracked tooth often causes a sharp, brief pain when you bite down or release your bite, along with sensitivity to cold, but the crack itself is often too fine to see. Cracks do not heal on their own, and they can grow over time, so early assessment gives you the widest range of treatment options, which may include a filling, a crown or, if the nerve is affected, root canal treatment.
Types of tooth cracks
Not all cracks are the same. Dentists generally describe several types, and the type affects the outlook for the tooth.
Craze lines
These are tiny surface lines in the enamel, very common in adult teeth, especially front teeth. They usually cause no symptoms and do not need treatment, although they may pick up stain.
Fractured cusp
A piece of a chewing surface, often next to a large filling, breaks off or cracks. This usually does not affect the nerve, and the tooth can often be restored with a filling or crown.
Cracked tooth
A crack extends from the biting surface down into the tooth. It may cause intermittent pain when biting and sensitivity to cold. If the crack reaches the pulp (nerve), root canal treatment may be needed.
Split tooth
A crack that has progressed until the tooth separates into two parts. Depending on where the split is, part of the tooth may be saved, but extraction is often needed.
Vertical root fracture
A crack that starts in the root and runs towards the biting surface. These may cause few symptoms until the surrounding bone and gum become infected. They are more common in teeth that have had root canal treatment and often mean the tooth needs to be removed.
Signs and symptoms of a cracked tooth
- Sharp pain when biting, especially on something firm or grainy, or when releasing the bite
- Pain that comes and goes, rather than a constant ache
- Sensitivity to cold, and sometimes to sweet foods
- Difficulty pinpointing which tooth hurts
- Swelling of the gum around the tooth, if the crack has led to infection
- A sharp edge you can feel with your tongue, if a piece has broken
Because symptoms can be intermittent, many people put off seeing a dentist. Unfortunately, a crack that is ignored may extend deeper, which can reduce the chance of saving the tooth.
What causes teeth to crack?
- Grinding and clenching, often during sleep, puts heavy, repeated forces on teeth.
- Large fillings leave less natural tooth to support the remaining walls.
- Biting hard objects such as ice, hard lollies, popcorn kernels, olive pits, nuts in shells, pens or fingernails.
- Trauma from a fall, sport or an accident.
- Root canal treated teeth without a protective crown, which can be more brittle.
- Age, as cracks are more common from middle age onwards after years of chewing forces.
- Sudden temperature changes, such as hot food followed by ice water, may contribute in some cases.
How a cracked tooth is diagnosed
Cracks can be surprisingly hard to find. Many are invisible to the eye and do not show up on standard X-rays. Your dentist may use several methods together:
- Asking detailed questions about when and how the pain occurs
- Examining the tooth under magnification and good lighting
- Having you bite on a special instrument, one cusp at a time, to reproduce the pain
- Shining a bright light through the tooth or using a dye to highlight a crack
- Testing how the tooth responds to cold
- Checking the gum around the tooth for a deep, narrow pocket, which can suggest a crack extending down the root
- Taking X-rays to check for decay, the nerve and the surrounding bone
Sometimes the full extent of a crack only becomes clear once an old filling is removed.
Treatment options for a cracked tooth
Treatment depends on where the crack is, how deep it goes and whether the nerve is affected. The goal is to protect the tooth from flexing so the crack does not grow.
Bonding or a filling
Small cracks and minor chips can sometimes be repaired with tooth-coloured bonding. This is quick and conservative but offers limited protection against further cracking in back teeth.
A crown
For many cracked back teeth, a crown is recommended. A crown covers and holds the tooth together, reducing flexing under biting forces. Our dental crowns page explains the options, including single-visit CEREC crowns made in the practice. Crowns start from $1,820 per crown, with the fee confirmed after assessment.
A crown can help, but it does not always prevent problems. Some cracked teeth go on to need root canal treatment after a crown is placed, and some cracks continue to progress. Preparing a tooth for a crown also removes some tooth structure, and crowns can chip or need replacement in the future.
Root canal treatment
If the crack has reached the nerve, causing lingering pain or infection, root canal therapy may be needed before the tooth is crowned. Its success depends on how far the crack extends; if it runs deep into the root, saving the tooth may not be possible.
Extraction
Split teeth and vertical root fractures often cannot be saved. If the tooth needs to be removed, your dentist will discuss replacement options such as an implant, a bridge or a denture, each with its own benefits, risks and costs.
What to do in the meantime
Until you can see a dentist:
- Avoid chewing on the affected side
- Avoid very hot, very cold and hard foods
- Use over-the-counter pain relief as directed on the packet, if suitable for you
- If a sharp edge is irritating your tongue or cheek, a piece of sugar-free gum or orthodontic wax can cover it temporarily
Reducing the risk of future cracks
If you grind or clench your teeth, a custom-made night guard can reduce the forces on your teeth. Avoid chewing ice and other hard objects, wear a mouthguard for contact sports, and ask your dentist whether heavily filled teeth would benefit from extra protection.
When to see a dentist
Book an appointment if you have pain when biting, sensitivity to cold that keeps returning, or you notice a piece of tooth has broken off. The sooner a crack is assessed, the more options you are likely to have.
See a dentist promptly if you have constant pain, swelling or a pimple on the gum. Our Macquarie Park practice offers same-day emergency appointments where available; calling before 10am gives you the strongest chance of being seen that day.
Frequently asked questions
Can a cracked tooth heal on its own?
No. Unlike a broken bone, a crack in a tooth does not heal. Treatment aims to stop the crack spreading and protect the tooth.
Why does my cracked tooth only hurt sometimes?
Pain often occurs when biting pressure opens the crack slightly and then releases it. Between those moments, the tooth may feel normal, which is why symptoms can be intermittent.
Will a crown fix a cracked tooth?
A crown often helps by holding the tooth together and reducing flexing. However, some cracked teeth still need root canal treatment later, and deep cracks may not be saveable.
Can a cracked tooth be seen on an X-ray?
Often not. Fine cracks are usually invisible on standard X-rays, so dentists rely on symptoms, bite tests, magnification and other tests to find them.
Is a cracked tooth an emergency?
A cracked tooth with severe pain, swelling or a large broken piece should be seen promptly. Intermittent biting pain is less urgent but should still be checked soon.
If you think you may have a cracked tooth, an early assessment keeps more options open. Call North Ryde Dentistry on (02) 8090 1102 or book an appointment.
This article is general information only and is not a substitute for advice from your own dentist. Any treatment carries risks; your dentist will discuss whether it is suitable for you.
Related at North Ryde Dentistry: our North Ryde dental clinic