A cracked tooth is a challenge both to diagnose and to treat. Patients will often present with a sharp pain on biting but they are unable to localize it to a specific tooth. Sometimes the problem tooth
is obvious. It may have a large filling in it, or cracks may be visible on the surface of the tooth. We sometimes have the patient bite down on an instrument that isolates the bite force on just one part of the tooth in order to localize not just the tooth but the cusp that is affected. Once the problem tooth is identified the next step is to determine how to treat the tooth.
The difficulty is that we cannot visualize the extent of the crack on radiographs (x-rays) or clinically and yet treatment success depends entirely how far the cracks have progressed. These cracks can travel down the root, below the gum or even into the nerve of the tooth.
Cracks that are above the gum line can usually be treated successfully. The fractured segment is removed and the tooth is crowned to prevent further fractures of tooth or filling. If the crack involves the nerve of the tooth, a root canal in addition to a crown will be required.
Any crack that extends below the gum line and travels down the root is more difficult to treat and thus the treatment has a poor prognosis. Even if the tooth can be saved (usually with root canal treatment, a small gum surgery to expose the crack and then a crown) the prognosis is poor and it advisable to discuss other treatment options that may have better prognosis. The photo above shows just such a crack. I had to extract the tooth because the crack extends well onto the root surface and into the nerve of the tooth causing the patient significant discomfort.
If you have a cracked tooth it is important to discuss all you treatment options with your dentist and realize that despite our best efforts to save the tooth, it may be lost eventually in the future.