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Cracked tooth syndrome can be one of the most difficult diagnoses in dentistry. A crack in a tooth can be visible with the naked eye, but often times it is not. It can show up on a radiograph, but often not.

I liken it to a cracked china plate; when you hold the crack together you cannot see it. When the tooth is under strain, the crack is pulled apart. That’s when you can feel it. But when you open, the pieces generally go back together. That’s why the cracks usually don’t show up on an x-ray.

Cracks in teeth migrate just like cracks in your windshield. Catching a crack early can prevent it from causing the loss of a tooth. Nobody knows which direction the crack will progress. It may crack toward the side and a piece break off. It may crack toward the pulp and cause the tooth to abscess. It may crack toward the root and cause the tooth to be lost. It may crack in more than one direction at the same time.

Signs and symptoms of a cracked tooth include but are not limited to:

1. Pain when chewing but often it can be intermittent.

2. Teeth that suddenly become sensitive to sweet, hot, cold or biting.

3. Pain that comes and goes.

4. Discomfort that is hard to pinpoint.

What causes a tooth to crack?

1. Large, old fillings that are failing are the primary cause of cracked teeth.

2. Biting too hard on something.

3. Grinding or bruxing teeth at night or during the day.

4. Accident or injury.

5. Sometimes the cause is unknown.

Treatment of a cracked tooth:

1. Small or minor asymptomatic cracks can be bonded or filled to try to stabilize the crack.

2. Larger cracks often require a crown to help stabilize the crack. Hoping to keep it from progressing.

3. Symptomatic cracks often involve the pulp of the tooth which can require a root canal and a crown.

4. Some teeth regardless of treatment can be lost due to continued sensitivity. This usually involves teeth that are cracked into the root and cannot be stabilized.

Dentists try to diagnose and treat cracked teeth in the most conservative way and often in a stepwise manner. If a more conservative treatment does not resolve the issue the next step can be tried. Unfortunately, some teeth no matter what you do cannot be saved.

One thing is for sure, the quicker a crack is detected and addressed the less chance it will progress toward tooth loss.