Endodontic Information Menu Page

 Toothache and Tooth Pain Guide

 Diagnosing an Endodontic Problem

 Cracked and/or Fractured Tooth?

 What are my Options if I need Endodontic therapy (Root Canal)?

 Nonsurgical Endodontic Therapy (Root canal)

 When Nonsurgical Endodontics (root canals) are Unsuccessful

 Nonsurgical Retreatment of Endodontic Therapy

 Surgical Endodontic Therapy

 JD's Guidelines for Chosing an Endodontist

 Do I Need to be Refered to your Office?

Because people are living longer and dentists are helping keep teeth longer, teeth are being exposed to years of crack inducing habits.  Particularly, clenching, grinding, and chewing hard things such as ice can result in cracks and fractures in teeth.  Typically teeth with cracks/fractures do not show on radiographs (x-rays).  Hence, cracked and fractured teeth can especially be difficult to locate.  When the outer hard tissues of a tooth are fractured or cracked, chewing can cause movement of the pieces and the pulp becomes irritated.  Often this results in a momentary, sharp pain which eventually progresses to include thermal sensitivity.  In time the cracked or fractured tooth, similar to other teeth with pulp degeneration, can begin to hurt on it’s own.

Does your tooth feel like it "zaps" you when bite on it?   Well, that's not enough to know it's cracked or fractured. Unfortuantely, cracked and fractured teeth exhibit a variety of symptoms.  If your tooth is cracked/fractured, you might feel occasional pain when chewing, particularly between bites as you release the pressure on your teeth. You might also feel pain when you eat or drink something hot or cold. Cracks and fractures are fairly difficult to diagnose because the pain comes and goes, and cracks/fractures only rarely show up on x-rays. Because of this, you may see your dentist several times before the crack is diagnosed.

Not all cracked and fractured teeth hurt.  It really depends on the severity of the crack and the pulps response to the irritants allowed into the tooth.  Commonly it's not until they become symptomatic that we get involved.  A crack/fracture can make the tooth sensitive due to movement of the fractured tooth pieces and/or leaking irritants into the pulp and even allow bacteria to come right in causing eventual infection of the tooth.  Let's take a closer look at a normal healthy tooth.

Inside the tooth, under the white enamel is a hard layer called the dentin, and there is the inner soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue.  The pulp is a vestige of what originally formed your tooth when you were a kid!
 

When the outer hard tissues of the tooth are cracked, the chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

No single test or technique provides the correct diagnosis 100% of the time.  In fact, if a restoration is present, it can become quite difficult to diagnose without removing the restoration or drilling a hole into the tooth.  Most of the time we use a transilluminating light and see if the light transmits from one side of the tooth to the other.  Of course, fillings don't transmit the light the same so it's even harder to tell when cracks or fractures are present in teeth with restorations.  A trained eye can spot the difference. 

Normal tooth

A biting test can be performed.  We concentrate the biting forces commonly using an instrument as seen below.  This can isolate specific areas of the tooth that might be sensitive to bite, but does not tell us the underlying cause of the discomfort.

Sometimes some dye might be used to temporarily stain the tooth, and check to see if a tooth is fractured.  It is then washed off and evaluated.  This is most commonly done once access to root canals is obtained.

Stained Cracked Tooth

(Blue Stain Can be fully removed after diagnosis)

Hence, the answer is no, not all cracks seen on the outside of teeth are bad.

That depends.  If the crack/fracture is caught early enough, often times only a restoration that holds the tooth together will be needed.  Once the pulp begins to degenerate and/or becomes infected, it must be treated endodontically if the tooth is going to be maintained.   Like cracks in a windshield, cracks in teeth can often remain small or progress slowly over time.  I believe that the sooner a crack or fracture is detected and appropriate treatment delivered, the better the chance of maintaining your tooth.

Common Cracks and Fractures of the Crown region

(Top Part of the tooth above the gumline)

Cuspal Fracture

Cuspal Fracture: When a cusp or the pointed part of the chewing surface of your tooth becomes weakened, the cusp will fracture.  Part of the cusp may break off or may need to be removed by your dentist.  Depending upon the extent of the fracture, the pulp may also become damaged.  Endodontic therapy is needed when the pulp is damaged beyond repair and a crown will be placed to help protect the tooth and replace the fractured tooth structure.

Split Tooth:  A split tooth is a cracked tooth in which the crack has progressed so there are 2 distinct segments that can be separated from one another.  Unfortunately, with today’s technology, a split tooth can never be saved intact.  The extent and position of the crack will determine if any portion can be maintained but most of these teeth will be extracted.   In rare instances, endodontic treatment, possibly some gum surgery, and a crown may be used to retain a portion of the tooth.

Unlike a broken bone, the fracture in a cracked tooth will never completely heal. In fact, even after treatment, it is possible that a crack may continue to worsen and separate, resulting in the loss of the tooth.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your dentist and/or endodontist about your particular diagnosis and treatment recommendations. They will advise you on how to keep your natural teeth and achieve optimum dental health.

While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

• Don't chew on hard objects such as ice, unpopped popcorn kernels or pens.

• Don't clench or grind your teeth.

• If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.

• Wear a mouthguard or a mask when playing contact sports.

If you experience symptoms of a fractured or cracked tooth, see your dentist immediately. If detected early, a cracked/fractured tooth can often be more likely to be maintained.

Typically symptoms are associated with a tooth that has had endodontic therapy.  If you have persistent symptoms  which do not appear on a radiograph or x-ray, you tooth may have a tiny fracture in the root but keep in mind other causes can produce the same symptom.  Also these teeth commonly present with bone loss around an entire root in more advanced fractures and often go unnoticed until surrounding bone and gums become infected. 

Commonly a complication from endodontic therapy.  Sometimes believed to exacerbated by large post placement.

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