Cracks in human teeth are so common that virtually every adult and many children have them. Patients often notice visible cracks in their teeth, resulting in frequent questions at dental visits. Luckily, not all tooth cracks cause discomfort or require immediate treatment. Read on to gain a better understanding of why they develop and what treatments are available to remedy the situation.
A Dental Anatomy Primer
By the time our teeth erupt through the gums, much of the tooth has already finished forming. Typically, within 1-2 years of eruption, the root formation will be complete. Your teeth are made up of three main layers. The white outer layer is a hard, glass-like material called enamel. Under the enamel is a strong, resilient, bone-like tissue called dentinthat also makes up most of the root. The pulp resides in the middle of the tooth and consists of blood vessels, nerves, and soft tissue similar to other parts of our body. The visible segment of the tooth above the gums is referred to as the crown, which is connected to the usually submerged root.
We use our back teeth, molars and premolars, to chew food, whereas our front teeth cut and tear food. Back teeth have two or more peaks that are referred to as cusps.
Once a tooth erupts, and unlike bones, our body is not able to repair damage to the outer layers of the tooth. Therefore, the longer a tooth has been present and in function, the more likely it is to develop cracks.
Types of Cracks
The most common and least problematic crack is called an enamel craze. These fractures involve only the glassy outer enamel of the tooth. They are usually caused by an impact with a glass, utensil, tooth, or another hard surface. Enamel crazing can be present for many years without propagating deeper into the tooth, although some patients are concerned with their appearance.
Another common tooth crack is an incomplete fracture around the cusp of a back tooth. Such cracks often extend from a filling along natural formation lines between cusps or in-between teeth. Incomplete cusp fractures spread in a similar manner to a rock-chipped windshield. Eventually, many of these cracks encircle the cusp and may result in a complete fracture of part of the tooth crown.
Finally, a more traumatic impact can result in an immediate fracture of a tooth with complete separation of a segment or loss of a whole tooth. In this case, immediate consultation with a dentist is recommended.
How Common are Tooth Cracks?
As mentioned earlier, cracks in adult teeth are almost universal. One study by Bader and colleagues reported that complete fractures occur at the rate of 1 tooth per 20 adults per year. Another recent US study reported that 44% of caps (crowns) placed by general dentists were completed to prevent complete tooth fracture. In my dental office, we treat partially or completely fractured teeth every day.
Cracked teeth occur far more frequently in patients that clench or grind their teeth. Your dentist can recognize the signs of these habits and help you reduce the chance of harm to your teeth, muscles, and joints. Since clenching and grinding are more harmful at night, your dentist may prescribe a nighttime appliance to protect your teeth and jaws.
The classic symptoms of a cracked tooth are increased sensitivity to hot or cold, or a sharp pain in the tooth when biting into hard or chewy foods. Sometimes the sharp pain is felt immediately after biting down, upon releasing. Occasionally, a crack in the tooth can lead to a toothache or infection around the tip of the root, referred to as an abscess. This can happen even when there were no previous symptoms in the area.
Diagnosis & Treatment
As with most other medical conditions, the best treatment is to prevent the problem before it becomes serious. Your dentist will gather a history of any symptoms you’ve experienced. Then, he or she will complete a clinical examination that will likely include X-rays and use of magnification to identify the presence of and extent of any cracks. They may perform additional tests to check the health of the pulp and the presence of pain when biting.
Treatment may involve monitoring, placement of an adhesive filling, a cap over the tooth, or in some cases a root canal to ensure long-term health and comfort. With incomplete fractures, quick treatment improves the chance that the tooth can be saved with the most conservative approach. Early treatment saves money and usually ensures less aggressive restorative options.