Saving Humpty Dumpty

Article contributed by:

Parkway Dental Practice

 
Dental enamel, the outer surface of our teeth is the hardest substance in the human body, stronger even than our bones.  It is constantly assaulted by chewing force and grinding habits as well as the occasional knock from accidents.  Over time, all these cumulative forces can result in a cracked tooth, putting our wellbeing and smiles at risk.  If you think you have a cracked tooth, it is important for you to seek treatment promptly, before it gets worse.
 
How do I know if my tooth is cracked?

A cracked tooth often does not show any symptoms at the start.  During the early stage, the tooth may be sensitive to hot or cold food.  The fleeting and erratic nature of the discomfort during the early stage often makes it difficult for both patients and dentists to pinpoint the affected tooth.  As the crack propagate and widen over time, it gradually becomes painful to bite on.  Its presence also becomes more evident during clinical and x-ray examination.
 
Why does a cracked tooth hurt?

The pulp of a tooth contains nerve endings which are sensitive to temperature, pH and pressure.  The nerve endings become irritated by the cracked segments being wedged apart on biting.  The gum ligaments that surround a tooth root are also richly innervated.  Inflammation caused by impingement from fragments of a cracked tooth also result in pain and tenderness.  Inflammation of the pulp tissue caused by bacteria infection which spreads along the crack often result in severe pain and eventual death of the tooth.
 
How will my cracked tooth be treated?

The recommended treatment and long term success of treatment of a cracked tooth depends on the pattern and extent of the crack.  Common patterns include,
 

 
1) Fractured Cusp

A fractured cusp occurs when the crack is confined to the crown of a tooth.  This may happen as a result of minor accidents or when a tooth has been weakened by the presence of a large filling.  Fortunately, fractured cusps rarely damage the pulp and often cause little pain.  Your dentist can place a new filling or dental crown over the remaining part of the tooth to protect it.
 
2) Cracked Tooth

A cracked tooth implies that the crack has extended deeper, propagating vertically towards the neck of a tooth.  As the crack line is not complete, the tooth is not yet separated into pieces.  Early diagnosis and treatment is essential to prevent the crack line from spreading towards the root.  Your dentist will initiate root canal treatment if the pulp tissue has been infected and follow through with the placement of a dental crown to splint the tooth in an effort to prevent the crack from spreading.  Vertical crack lines that run deep below the gum line significantly reduce the effectiveness of treatment.  Your dentist may recommend tooth extraction and subsequent tooth replacement in such a situation.
 
3) Split Tooth

A split tooth is the most severe presentation of a cracked tooth.  It is easily identified as the crack lines are often complete and distinct on an x-ray.  The fragments of the split tooth are often able to move independently of one another.  In such cases, the position and extent of the crack becomes an important decision factor in determining most suitable treatment option.  If the split occurs just below the gum line and there is adequate root length present, your dentist may recommend root canal treatment, followed by orthodontic treatment to erupt the roots for the placement of a dental crown.  If the split occurs deep below the gum line, tooth extraction followed by tooth replacement is a more predictable treatment approach.
 
4) Vertical Fracture

Vertical root fractures are cracks that begin from the surface of the tooth root and extend towards the crown of a tooth.  They often cause little or no discomfort during the early stages and may therefore go unnoticed for months.  Vertical root fractures are often discovered when the surrounding bone and gum become infected, showing signs of persistent gum disease.  Treatment involves the extraction of the affected tooth followed by tooth replacement.  In select cases, endodontic microsurgery is sometimes indicated if the fractured portion is very small and accessible for the removal of the fractured portion.
 
After treatment for a cracked tooth, will my tooth completely heal?

A cracked tooth is a little bit like the story of Humpty Dumpty.  It will not be able to heal completely, unlike bone.  Over time, some treated teeth may have cracks that continue to spread and eventually split the tooth apart.  Quick action is therefore necessary to halt the propagation of the crack, relieve pain and eliminate infection when present.  Root canal treatment, followed by crowning of a cracked tooth helps provides maximum protection but does not guarantee success in all cases.  The treatment that you receive for your cracked tooth is important because a properly treated cracked tooth have the potential to help you avoid premature tooth loss and provide you with many years of use.
 
What can I do to prevent my teeth from cracking?

Most cracked teeth occur due to the cumulative damage from chewing forces over time or as a result of an accident.  While it may not be entirely preventable, it is recommended that we treat our pearly whites with kindness by not using them to chew on hard objects such as ice or popcorn kernels.  The use of a nightguard to protect your teeth if you have a known clenching or grinding habit is a great way to protect your teeth.  If you indulge in contact sports, such as hockey, boxing or martial arts, we recommended that you wear a sports mouthguard to protect against injury.
 

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Article contributed by:

Parkway Dental Practice

Dated: November 2015

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