Cracked Teeth
Cracked Tooth Syndrome
As the name implies, cracked tooth syndrome relates to a variety of symptoms and signs caused by a crack in a tooth.
Cracked tooth syndrome usually occurs in a molar or premolar but may affect any tooth.
The Syndrome May Include
- Teeth with large fillings where the crack runs under a weakened cusp (the raised edge of the tooth).
- Teeth with minimal or no fillings where the tooth has been subjected to heavy biting forces due to grinding.
- Teeth that have suffered trauma.
Cracks may start in the top of the tooth and run downwards. These cracks may propagate and involve the pulp, nerve and root.
Symptoms & Signs of a Cracked Tooth
- Sharp and erratic pain upon chewing (especially when biting on grainy food) or after release of biting pressure.
- Pain and discomfort when the crack is exposed to cold or hot food or liquids.
- Sensitivity to sweet foods.
- Difficulty in pinpointing which tooth hurts or whether the pain is coming from the top or the bottom tooth.
- The crack may not be visible to the eye or detectable on a dental x-ray film.
- Often a patient will present with a history of other cracked teeth.
Causes of Cracked Tooth Syndrome
- Cracked Tooth Syndrome has become more common because people keep their teeth longer than in previous generations. As a result people often have large fillings that may weaken the teeth and make them prone to fracture.
- Stress could cause clenching or grinding of the teeth, particularly at night. This is called bruxism, which can cause teeth to crack.
- Over the years, daily wear and tear from clenching, grinding and chewing can slowly cause cracks.
- Chewing on hard food or substances, such as ice, sweets and pencils.
- Trauma such as a blow to the teeth, especially if the upper and lower jaws have been rammed together.
Diagnosis
Diagnosis can be difficult because symptoms are not consistent; cracks are often discovered only when a variety of symptoms are present.
The Examination
- Signs of tooth wear
- Your “bite”, that is, the occlusion between the top and bottom teeth
- Cracks on the surface of teeth
- Large fillings with weakened cusps
Bite Test
Bite tests are helpful in locating the pain. Dr Cliff may ask you to bite on a hard object that is focussed on one cusp. This will allow him to localise your bite pressure to one tooth or part of the tooth. When you bite down on the part that is cracked or release the biting pressure, you are likely to feel pain.
Radiographic Examination (X-Ray)
Dr Cliff may want to take an x-ray to rule out other causes of tooth discomfort, such as decay. Cracks in teeth rarely show up on x-ray films. Cracks in the root may show up as a loss of bone around the cracked root or have the appearance of an abscess.
Removal of a filling
If the suspect tooth has a filling, Dr Cliff may remove the filling. This will determine if a crack is present and if so, extend the direction of the crack.
Staining
To test for the presence of a crack in the tooth, Dr Cliff may apply a coloured dye to the
- Surface of the suspect tooth
- Tooth cavity after the filling has been removed
- Root of the tooth
Temperature Change
Dr Cliff may also use ice or hot or cold water to test which tooth is sensitive.
Treatment for a Cracked Tooth
Cracks may be stopped or slowed down, increasing the changes that the tooth can be saved.
Simple Crack
The treatment for most cracked teeth involves removing the weakened cusp and placing a large filling or crown on the tooth. The crown protects the tooth and often prevents the crack from progressing. Sometimes before a crown or filling is placed, a stainless steel band is put in place with a sedative dressing to see if the tooth ache can be stopped. If discomfort stops, a filling or crown will then be placed. If the discomfort does not stop the dentist may suggest the need for root canal treatment.
Complex Crack
If the crack has progressed to the pulp or has caused inflammation of the pulp, root canal treatment may be needed before the crown or filling is put in place.
In severe cases, the tooth may split in half. In this case the tooth usually has to be extracted. A bridge or dental implant may be needed.
Prevention
- If you clench your teeth or grind the together (bruxism), you can have a night guard made to protect your teeth.
- Avoid chewing on hard objects such as ice, hard sweets, pens and pencils.
- Wear a protective mouth guard when playing contact sports.
- Practice good dental hygiene to minimise the need for fillings.
Cost
Dr Cliff will provide an estimate of the costs of treatment; costs vary according to the extent of treatment. Extra costs may apply if complications occur and additional treatment is required. It is advisable to discuss cost before and during treatment rather than after.
