Cracked teeth can cause a wide range of symptoms, and the discomfort may come and go. Some patients have significant pain, while others notice only occasional sensitivity.

Common symptoms include:

• Sharp pain when biting or chewing

• Pain when releasing biting pressure

• Sensitivity to cold or hot temperatures

• Intermittent pain that is difficult to localize

• Tenderness when chewing on a particular part of the tooth

• Spontaneous pain if the crack has affected the dental pulp

Because these symptoms can resemble other dental conditions, a careful evaluation is important before treatment is recommended.

Cracks can be challenging to diagnose because they are often very small, may extend in different directions, and are not always visible on traditional dental X-rays. Symptoms may also be intermittent or difficult for the patient to associate with one specific tooth.

Evaluation may include bite testing, temperature testing, periodontal probing, magnification, transillumination, and dental imaging. In most cases, 3D CBCT imaging can provide additional information about the tooth and surrounding bone or help identify other possible causes of the patient's symptoms.

The diagnosis is based on the overall clinical picture rather than any single test.

Not all cracks have the same prognosis or require the same treatment. The location and extent of the crack are especially important when determining whether a tooth can be preserved.

Craze lines are shallow cracks limited primarily to the enamel and generally do not require treatment.

Fractured cusps involve a portion of the chewing surface of the tooth and can often be restored depending on the extent of the fracture.

A cracked tooth has a crack extending from the chewing surface deeper into the tooth. Treatment depends on how far the crack extends and whether the dental pulp is involved.

A split tooth occurs when a crack has progressed to the point that portions of the tooth have separated. These teeth often have a poor prognosis.

A vertical root fracture begins in the root and may be difficult to detect initially. This occurs, in the vast majority of time, in teeth that have a previous root canal treatment. These teeth often have a poor prognosis.

Not every cracked tooth requires root canal treatment.

If the crack is limited and the dental pulp remains healthy, the tooth may be managed with an appropriate restoration. However, if the crack causes irreversible inflammation or infection of the pulp, root canal therapy may be recommended to treat the internal tissues of the tooth.

Root canal treatment addresses the condition of the pulp, but it does not make the crack disappear. The extent and location of the crack must also be considered when determining whether the tooth can be predictably restored and maintained.

Many cracked teeth can be preserved, particularly when the crack is identified before it extends too deeply into the tooth or root.

The prognosis depends on several factors, including the location and depth of the crack, the condition of the dental pulp, the amount of remaining tooth structure, periodontal findings, and whether the tooth can be predictably restored.

Cracks that extend deeply along the root or result in separation of the tooth generally have a less favorable prognosis.

Our goal is to determine not only whether a tooth can technically be treated, but whether preserving it offers a reasonable long-term prognosis.