Broken Tooth Pain - Cracked Tooth Syndrome

Cracked tooth pain is characterized by sharp pain when chewing or/and extreme sensitivity when eating cold or hot foods. The condition is known as cracked tooth syndrome and it is caused by a crack or fracture in the tooth. The severity of the cracked tooth pain depends on how deep the fracture is, and how close to the dental pulp it extends.

The enamel which is the outer layer of the tooth is the hardest tissue in the human body but it is not unbreakable. If for any reason the enamel is cracked, the damage can easily extend to the softer dentin layer underneath and to the dental pulp chamber containing the tooth nerves in the center of the tooth.

Most common cracks affect the crown of the tooth starting from the biting surface and with time slowly extending toward the roots. Fractures limited to the enamel will rarely cause any pain or discomfort.

If the crack extends only as deep as the dentin, the tooth becomes sensitive to hot, cold or touch due to the exposed dentin. Chewing causes a movement of the fluids in the dentin’s microtubules resulting in a sharp pain similar to that of tooth sensitivity. The pain is felt particularly between bites when the pressure is released from the tooth.

If the crack has reached the pulp chamber, chewing can cause movement of the cracked piece of the tooth irritating the pulp and the tooth nerves resulting in a momentary, sharp pain. If the condition is not treated, besides of having to suffer the cracked tooth pain, the pulp may become permanently damaged. In this case the toothache will intensify and appear even without any external stimuli. Bacteria may also invade through the crack and into the pulp tissue causing a painful infection.

The crack causing the toothache may be not visible to the eye if it is a very small one or if it is in the root area under the gums. Sometimes even x-rays may fail to reveal a small hair-like ‘hidden’ crack. Minor tooth fractures are unlikely to cause symptoms, so the problem may exist for a long time before the patient starts to feel the cracked tooth pain.

A tooth crack may happen under several conditions, such as:

• Natural wear
• Clenching or grinding teeth (bruxism)
• Bad habits such as biting pencils
• Accidents / mouth injuries
• Large fillings can weaken the teeth resulting in tooth fracture
• Complications during/after endodontic therapy

Cracked tooth pain as any other toothache must not be ignored. Visiting the dentist may help to diagnose a fractured/cracked tooth before the crack causes irreparable damage to the tooth. Tooth cracks do not heal like a crack in a bone. A crack will only get worse expanding more and increasing the risk to need complicated treatment or suffer tooth loss. In fact, even after treatment, a previously cracked tooth remains susceptible to new fractures in the future.

The treatment for cracked tooth pain depends on the type, location, and severity of the crack.

• If the crack is not too deep and it is diagnosed early enough, when it has only affected the enamel or partially the dentine, a simple dental filling may offer adequate treatment. The dentist will evaluate the extend of the damage and decide if a dental crown is required. For fractured teeth or deep extensive cracks, a dental crown can help maintain the integrity of the tooth and prevent further damage.
• Cases of cracked tooth syndrome where the crack has reached and damaged the pulp of the tooth (pulpal necrosis) will need endodontic treatment before they can be restored. Root canal treatment is needed also in the case a crack has caused the infection of the tooth by bacteria. A post and crown is commonly used to restore a fractured tooth following a root canal therapy.
• Root cracks that start from the tip of the root and progress towards the center of the tooth can be treated in multirooted teeth with a procedure known as apicoectomy (root resection) that includes the removal of the affected root.
• A single rooted tooth with a root crack isn't treatable and it has to be extracted.
• In several cases of severe cracked tooth pain, the damage may be so extensive that the tooth can not be maintained and tooth extraction is necessary. A split tooth (broken vertically in two pieces) or a singled root tooth with a root crack are examples of cases that the tooth will usually have to be removed to relieve the pain from the crack or fracture.

Although a tooth crack can happen accidentally at any time, the following recommendations may help to reduce the risk of cracked tooth pain:

Stop bad habits such as biting pencils

Don't clench or grind your teeth. Wear a night mouth guard until you stop the habit

Wear a mouth guard when playing contact sports

Be careful when eating hard foods

Replace large fillings with a dental crown