It hurts when I bite down…could my tooth be cracked…

Cracked-tooth syndrome describes symptoms that result from a fractured tooth. These symptoms usually involve pain or discomfort that’s provoked only when biting or eating, and can also be accompanied by increased sensitivity to hot, cold or sweets. Oftentimes, the fracture is a microfracture that can’t be viewed clinically or on an x-ray. In more severe fractures, a piece of the tooth may be mobile or missing.

Pain from biting on a fractured tooth results from movement of the pieces of tooth surrounding the fracture. If the fracture extends below the level of the gums, it can also irritate the gums and lead to bacterial accumulation and a resulting localized infection. Treatment of fractures aims to stabilize and prevent the advancement of the fracture. Early detection and treatment is crucial as fractures that extend vertically onto the root are usually not saveable.

Tooth fractures can develop above or below the gums. When the fracture is above the gums, the recommended course of treatment involves first placing a porcelain crown over the tooth to stabilize the fracture. While preparing the tooth for the crown, the fracture can sometimes be detected and removed. In the case of a microfracture that cannot be detected, the fracture may not be removed, but the placement of the crown holds the tooth together, preventing movement around the fracture and thereby resolving the pain, while simultaneously preventing the spread of the crack.

Sometimes, placing a crown does not alleviate the pain, or the tooth can be in MORE pain than it was in the first place. This may sound counterintuitive, but the preparation of the tooth for the crown involves its reduction so that the crown can fit on top. The tooth was in an “unhealthy” state to begin with, having endured the trauma of a fracture. The cumulative effect of multiple traumatic events in a tooth’s life can lead to eventual nerve damage. So if pain persists or even worsens after the placement of a crown, then the tooth will also need a root canal, which involves the removal of the damaged nerve.  

If a fracture goes untreated, it can spread and extend below the level of the gums and onto the surface of the root. These vertical root fractures often show minimal signs and symptoms and may, therefore, go unnoticed for some time. Symptoms can also mimic those of fractures above the gums, further complicating proper diagnosis and treatment. Vertical root fractures are often discovered when the surrounding bone and gum tissue become infected, causing a visible and painful swelling in the gums. Nothing can be done to repair a vertical root fracture, necessitating the removal of the tooth. 

After treatment for a cracked tooth, will my tooth completely heal?

Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases. The treatment you receive for your cracked tooth is important because it will reduce the likelihood that the crack will worsen.

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