Cracked Tooth

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With increasing life expectancy, dental awareness and knowledge, people are keeping their teeth much longer. This exposes teeth to more years of crack inducing habits such as chewing on hard food and parafunctional habits like grinding or bruxism. 

Teeth can crack in several different ways. Cracks may affect the crown, root or both parts of the tooth.

Cracked teeth can present variably. One may experience pain when chewing, sensitivity to hot and cold temperatures, or even spontaneous pain.

What can I do to prevent cracked teeth?
​While cracked teeth are not completely preventable, there are some steps to take to minimise your risk:

• Avoid chewing on hard food or objects (e.g. Ice, hard nuts, pens etc.)
  
• Consider a night guard if you habitually clench or grind your teeth.
  
• Wear a mouthguard for strenuous physical activity.
  
  
  

How will a cracked tooth be treated?
• Full coronal coverage (e.g. crown) is usually indicated. 

• A metal band (Fig 1 and 2) can be placed to act as a brace to splint the crack(s) and prevent their further progression prior to crown placement. 

• If there are signs and/or symptoms of disease in the pulp, root canal treatment will be done before coronal coverage. The treatment and outcome of a cracked tooth depends on the type, location and extent of the crack. Your endodontist is the best person to advise you on the appropriate treatment.

After treatment for a cracked tooth, will my tooth completely heal?
After root canal treatment, most cracked teeth will require a permanent crown to continue to function normally. However, it is important to realise that the root canal treatment takes away the pain but will not cure cracks as these are physical defects on the tooth surfaces. Unlike a broken bone, the fracture in a cracked tooth will not heal. Placement of a crown provides protection and retards progression of cracks. Nonetheless, some cracks may continue to progress and separate, resulting in eventual loss of tooth.

Treatment Outcomes

As previously mentioned, patients with cracked tooth will require a metal band placement to serve as a brace to splint the crack(s) and prevent further progression of the crack. When treated early, the pulp inflammation associated with cracked tooth is usually reversible. A local study[i] conducted in 2022 in NDCS, which assessed 122 cracked teeth with reversible pulp inflammation after orthodontic band placement in NDCS , found that 113 (92.6%) cracked teeth had pulp inflammation resolved within 2 months. The metal band would then be replaced by a permanent crown which helps to provide protection and retard the progression of crack.

If there are signs and / or symptoms of disease in the pulp, which gives rise to severe spontaneous pain, root canal treatment will be required. A local study[ii] done in NDCS in 2019, evaluated the incidence of pulpal complications in vital cracked teeth which had undergone band and crown placement. Out of 199 cracked teeth, 141 teeth (71%) remained healthy after 3 years without treatment, while 58 of them (29.1%) subsequently developed pulpal complications within 1-2 years, hence requiring root canal treatment or extraction.

Another local study[iii] done in NDCS in 2016 assessed the survival of cracked premolars and molars after root canal treatment at NDCS. It was found that 77 of 84 cracked teeth (92%) survived after 5 years, while 7 (8%) teeth were extracted. This showed that an endodontically treated cracked tooth is functional and may reasonably survive for 5 years and longer. The determining factor hinges on the extent of crack. Deep crack lines had a negative impact on teeth survival rate.

[i] Seet RF, Chan PY, Khoo ST, Yu VSH, Lui JN. Characteristics of Cracked Teeth with Reversible Pulpitis After Orthodontic Banding-A Prospective Cohort Study. J Endod. 2022 Dec;48(12):1476-1485.e1. doi: 10.1016/j.joen.2022.09.002. Epub 2022 Sep 21. PMID: 36150561. 

[ii] Wu S, Lew HP, Chen NN. Incidence of Pulpal Complications after Diagnosis of Vital Cracked Teeth. J Endod. 2019 May;45(5):521-525. doi: 10.1016/j.joen.2019.02.003. Epub 2019 Mar 22. PMID: 30905570. 

[iii] Sim IG, Lim TS, Krishnaswamy G, Chen NN. Decision Making for Retention of Endodontically Treated Posterior Cracked Teeth: A 5-year Follow-up Study. J Endod. 2016 Feb;42(2):225-9. doi: 10.1016/j.joen.2015.11.011. Epub 2015 Dec 23. PMID: 26723485.