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What should you do about a cracked tooth?

You were confidently enjoying your periodic tooth cleaning when your dentist spots something that ruins the mood. You’re told you have a crack in a tooth. Boo! How does one decide what to do about cracks in teeth? I’ll do my best to share with you my process for deciding what I’d do if it were my problem.


Let me start by acknowledging that our patients are depending on us for information. They have little experience with cracks in teeth or the potential consequences of treating or not treating a crack. They are at the mercy of their dentist when it comes to education about cracks. As a patient, it’s important you’re in front of a dentist you trust to do the right thing for you. And figuring out what to do varies from patient to patient. As a dentist, I have 25 years worth of hearing why a patient would prefer not to deal with this at all. And that’s an option; sometimes a good one!


So you say I have options?


Sure, you have options. The first option is to do nothing. Pretend that crack doesn’t exist. A patient that doesn’t hold value in their teeth might want to pull such a tooth; there may be options for replacement that make better sense to them. Someone else might take limited measures to minimize bite collisions in hopes of making fracture less likely, or replace fillings in an attempt to fortify vulnerable structure with a glued-in filling. Someone that wants to minimize risk of losing a tooth might have their dentist crown the tooth, which is the most careful, controlling way to handle a crack.


How do we decide what I need?


Before your dentist decides what to recommend, he has to evaluate the risk to you and your tooth. When we are evaluating a crack in a tooth, one thing that we’d love to know is the extent of the crack, both in length, and in depth. Length seems simple enough, unless the crack line disappears under an existing filling, or under the gum tissue. Rarely, we will remove an old filling just to evaluate the extent of a crack. X-ray technology shows us very little about a crack, unless some of the tooth has been displaced, or is missing. So the depth can be more difficult to assess. Sometimes light can be a useful tool, transmitted perpendicular to a crack. If the light transilluminates the tooth like a crack is not there, this is generally an indication of shallow depth. Other times, when light is applied to a tooth, the crack provides enough of an interface that there becomes a lit portion and a darker portion. This is generally a crack with some depth to it. An impression of depth equates to an increase in worry. The tooth is more likely to fracture, sooner.


Another measure of severity is position of the crack, both in the mouth, and on the tooth. To illustrate this, I have yet to see a front tooth split vertically up the middle of a front tooth, in 25 years. So when I see a crack in this position, it can be unsightly, but I have less worry that the tooth is at risk than a crack between two cusps of a back tooth. We see examples of back teeth breaking between cusps like this several times a week. So when we see a back tooth cracked in this location, we know there’s a chance of heading off a catastrophe. If we can prevent this, we have done the patient a great service. So we evaluate length of crack, depth, position of mouth, and position on the tooth. Now what?


What about a wait and see approach?


The truth is, none of us know when a cracked tooth would break, nor do we know for sure how severe it would be if it broke. Your dentist develops a sense of this, but we simply do not have a crystal ball. When we are lucky enough to see a crack in what used to be an uncracked tooth, we have a spectrum of risk. As you can imagine, a crack is least likely to break in the near future, but the longer we watch it, the risk increases every day moving toward the day it breaks. Waiting on a crack that is barely visible seems safer than watching one that looks like it should have broken yesterday. There is judgement involved here; first on the dentist, but also on each patient, and it’s unavoidable.


So what if we let a tooth break?


Once a chunk of a tooth breaks off the result can vary from being barely noticeable, to one that is unbearable. Structurally, they can range from one that is easily patched up and put back into service, to another that is non-restorable and must be extracted. Some are uncomfortable enough they press us into extracting them immediately. Fractures can be very superficial, or deep enough to involve the pulp, (nerve), or the least repairable, the vertical fractures that propagate beyond tissue connection. These are the most certain to result in tooth loss.


Would I know if my tooth were cracked?


It’s hard to predict which cracks provide pain and which are absent that discomfort. Most of us may very well be running around with cracks in our teeth right now. Some have developed enough movement that they “stab” at you when you apply bite force. As is the message with most dental advice articles, see your dentist and use that opportunity to spare yourself learning about cracks the hard way!

Lance P. Martin, DMD 

Comprehensive, General & Family Dentist 

Spring Valley Dental Group

904 E Highway 50, O'Fallon, IL 62269

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