Cracked Tooth Diagnosis & Treatment
If you experience sharp pain when biting or sensitivity to temperature, you may have a cracked tooth. At Green Mountain Endodontics in Burlington, VT, Dr. Eric Feuer uses advanced microscopes and 3D imaging to diagnose and treat all types of cracked teeth.
Why Do Cracked Teeth Hurt?
To understand why a cracked tooth hurts, it helps to understand the anatomy of a tooth. Under the hard outer white enamel is a layer called dentin. Deep inside the dentin is the pulp, which contains the tooth's nerves, blood vessels, and connective tissue. When a tooth is cracked, the outer hard layers move independently when you bite down. This movement irritates the pulp inside:
- Biting down puts pressure on the crack, causing it to open.
- Releasing the bite causes the crack to snap closed, which often triggers a sharp, sudden pain.
- Over time, the constant rubbing and opening of the crack exposes the pulp to bacteria, leading to inflammation, infection, and constant, throbbing toothaches.
Types of Cracked Teeth
How a cracked tooth is treated depends on the location, direction, and depth of the crack. Dr. Eric Feuer classifies cracks into five primary types:
1. Craze Lines
Craze lines are tiny, superficial cracks that affect only the outer enamel of the tooth. They are highly common in adult teeth and are entirely cosmetic. Craze lines do not cause pain and require no treatment other than cosmetic correction if desired.
2. Fractured Cusp
A cusp is the pointed part of a chewing surface on a back tooth. If a cusp becomes weakened (often around an old, large metal filling), it can crack. The cusp may eventually break off on its own or be removed by a dentist. A fractured cusp rarely damages the inner pulp. Usually, your general dentist can restore the tooth with a dental crown or overlay. If the crack extends deep into the pulp chamber, a root canal will be required before the crown is placed.
3. Cracked Tooth
This refers to a crack that extends from the chewing surface of the tooth vertically down toward the root. In some cases, the crack may run below the gumline. A cracked tooth is not split into two pieces, but the damage to the inner pulp is typically extensive. Early detection is key. If the crack has not reached the root canal system or extended below the gumline, Dr. Eric Feuer can perform a root canal to remove the damaged pulp and seal the canal. Your general dentist will then place a protective crown to bind the tooth back together and prevent the crack from spreading. If the crack extends far below the gumline, the tooth may not be saveable and extraction will be necessary.
4. Split Tooth
A split tooth is the result of an untreated cracked tooth that has progressed. The crack has spread, splitting the tooth completely into two distinct segments. A split tooth cannot be saved as a single unit. However, depending on the position of the split and the anatomy of the roots, it is sometimes possible to save a portion of the tooth using root canal therapy and a crown, while removing the damaged segment. In many cases, a complete extraction and replacement with a dental implant is required.
5. Vertical Root Fracture
Vertical root fractures are cracks that begin at the tip of the root and extend upward toward the chewing surface. They often show few symptoms and are frequently discovered during routine X-rays or when an infection develops in the surrounding bone. Because the fracture originates in the root structure under the bone, these teeth are almost always unsaveable. Treatment typically involves extraction. However, in multi-rooted teeth, we can sometimes perform an endodontic surgery (hemisection) to remove the fractured root while saving the healthy portion of the tooth.
Symptoms of a Cracked Tooth
Cracked teeth can be difficult to diagnose because the pain is often intermittent and hard to pinpoint. Common signs that you may have a crack include:
- Sharp pain when biting down or chewing, particularly when releasing the bite.
- Sensitivity to hot, cold, sweet, or acidic foods and liquids.
- Intermittent discomfort that comes and goes without a clear trigger.
- Gum swelling or tenderness around the affected tooth.
How We Diagnose Cracked Teeth in Burlington, VT
Diagnosing a cracked tooth requires specialized training and advanced diagnostic equipment. At Green Mountain Endodontics, we use a multi-step process to locate even the most elusive micro-cracks:
- 3D Cone Beam Imaging (CBCT): Traditional 2D dental X-rays cannot show vertical cracks. Our state-of-the-art 3D CBCT scanner allows us to view the tooth, roots, and surrounding bone from every angle, looking for subtle patterns of bone loss that indicate a root fracture.
- Surgical Microscope Evaluation: Dr. Eric Feuer uses high-powered operating microscopes during examinations. This allows us to inspect the tooth's surface under high magnification and intense illumination, revealing cracks that are invisible to the naked eye.
- Bite and Percussion Testing: We use specialized testing tools to pressure individual cusps of the tooth to locate exactly where the crack is flexing.
- Transillumination: We project a high-intensity fiber-optic light through the tooth. A crack will block the light, creating a visible line of shadow that helps map the extent of the damage.
Can a cracked tooth heal?
No. Unlike bones, teeth do not have a blood supply to the hard outer structure (enamel and dentin), so they cannot knit back together. Treatment is designed to relieve pain and prevent the crack from spreading further.
How can I prevent a cracked tooth?
While you cannot prevent all cracks, you can minimize your risk by:
- Avoiding chewing on hard objects like ice, unpopped popcorn kernels, hard candies, or pens.
- Wearing a custom nightguard if you clench or grind your teeth (bruxism) while sleeping.
- Wearing a protective mouthguard during contact sports.
- Replacing old, large metal amalgam fillings that can weaken tooth structure over time.