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Cracked Tooth Syndrome

What Is It?

crackTeeth are essentially a hard crystal structure. But like any crystal even though they are hard they are also brittle and can crack or fracture.

Unlike teeth with obvious fractures, teeth with cracked tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

Cracked tooth syndrome more often occurs in molars and premolars but can affect any tooth.

Cracks most often start in the top or crown of the tooth and run downwards. These cracks may propagate and involve the pulp or nerve and the root. People with one cracked tooth are more likely to have others, either at the same time or in the future.

Causes of Cracked Tooth Syndrome

The most common cause of tooth fractures is teeth with large fillings. People are keeping their teeth longer but often they have large fillings that have weakened the teeth and made them prone to fracture.

People who grind or clench their teeth may be more susceptible to cracked tooth syndrome because of the constant forces put on their teeth.
Sometimes a person’s normal bite causes certain molar cusps (the highest points of the tooth) to exert so much pressure on the opposing tooth that it cracks.

Teeth that have undergone root canal treatment are weaker than other teeth and are more likely to crack.

Trauma such as a blow to the teeth may cause a hairline fracture to start.


You may experience pain in the tooth when you bite or chew. However, it probably will not happen all the time. The tooth may be painful only when you eat certain foods or when you bite in a specific way. You will not feel a constant ache, as you would if you had a cavity or abscess unless the crack has progressed to the pulp. The tooth may be more sensitive to cold temperatures. If the crack worsens, the tooth may become loose.

Many people with cracked tooth syndrome have symptoms for months, but it’s often difficult to diagnose because the symptoms are not consistent.

It is not uncommon for a cracked tooth to be symptom free. I’d like a dollar for every time a patient has come in saying that their tooth broke while they were eating something soft. Obviously the fracture was there for a long time, slowly progressing through the tooth unnoticed by the patient. This is why at Vision Dental, we stress the importance of regular dental checks to pick up these fractures as early as possible so they can be treated successfully before it becomes a disastrous emergency.


Diagnosis of cracked tooth syndrome is often difficult. At Vision Dental, your dentist will do a thorough examination of your mouth and teeth, focusing on the tooth in question. He or she may use an explorer to feel for cracks in the tooth and will inspect the gums around the tooth for irregularities. The dentist will also look for signs of tooth wear, a bite imbalance and check teeth with large fillings and weakened cusps.

Teeth may be tested for reaction with temperature change which would indicate a possible fracture.
Your dentist may also take X-rays. Although X-rays often do not show the crack they will rule out other causes of tooth discomfort such as decay.

Your dentist may use a special instrument to test the tooth for fractures. One instrument (a fracfinder) looks like a toothbrush without bristles that fits over one part of the tooth at a time as you bite down. If you feel pain, the cusp being tested most likely has a crack affecting it.

Your dentist may shine a fibre-optic light on the tooth or stain it with a special dye to search for a crack. If the tooth already has a filling or crown, your dentist may remove it so he or she can better inspect the tooth.


Grinding can increase your risk of cracked tooth syndrome so if you grind or clench your teeth, talk to your Vision Dental dentist about treatment such as a night guard or splint to protect the teeth.

Have your Vision Dental dentist make a custom fitted protective mouth guard when playing contact sport.

Practice good dental hygiene to minimise the need for fillings.

Avoid chewing hard objects like ice, hard sweets, pens or pencils.

Treatment for a Cracked Tooth

crack-diagramTreatments for cracked tooth syndrome do not always completely relieve the symptoms. Early treatment is important because the further the crack has propagated the greater the chances for complications or the tooth being lost.

Treatment depends on the location, direction and extent of the crack. Cracks vary from superficial ones in the outer layers of the tooth to deep splits in the root affecting the pulp (the centre of the tooth, which contains the tooth’s nerves).

Simple Cracks: If the crack affects one or more cusps of a tooth, the tooth may be restored with a crown. The crown protects the tooth and prevents cracks from progressing

Complex Cracks: If a crack has progressed to the pulp, root canal treatment will be needed prior to placing a crown. About 20% of teeth with cracked tooth syndrome require root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure.

In some severe cases, the tooth may need to be extracted. Some cracks extend into the root of the tooth under the bone and there’s no way to fix the tooth.


Treatment of cracked tooth syndrome is not always successful. At Vision Dental, we will carefully assess the tooth and inform you about the prognosis. In some people, a restoration with a crown will relieve all symptoms. In others, root canal treatment solves the problem. Some people continue to have occasional symptoms after treatment, and may need to have the tooth extracted.

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