Ask the Dentist: A cracked tooth can be a slippery ticket unless you get it looked at

Lucy Stock, dentist at Gentle Dental Care in Belfast, says a cracked tooth isn't always a problem and can usually be treated

A cracked tooth may become sensitive when eating something cold or hot
Lucy Stock

ARE you cracking up? Well your teeth could be if they are suffering from Cracked Tooth Syndrome (CTS).

If your tooth cracks it can give an exquisitely sharp pain when biting or rebound pain upon release of biting so chewing gum is definitely off the menu. The tooth will not only hurt when chewing but may also become sensitive when eating ice cream or hot soup. Given time, a cracked tooth may begin to hurt all by itself.

CTS can be a slippery ticket as the teeth often look normal in the mouth. It's difficult for someone to point to the exact tooth which hurts and often there's nothing to see on X-rays. With more people today living longer and keeping their teeth, more people are at risk of experiencing the displeasure of a cracked tooth.

But don't dismay if you can see cracks (or more aptly named craze lines) on your teeth as it doesn't mean that they are all going to give you pain. Most people have multiple visible craze lines on their teeth that never give any problems. It's only if the crack propagates and advances towards the inner nerve tube of the tooth or a cusp fractures, breaking off like a chunk of melting iceberg, that the tooth needs attention.

Teeth that have large fillings are more prone to cracks; however, perfect virgin teeth can also crack if someone is grinding a lot and exerting overloading forces on a tooth. Similarly, after a root canal treatment teeth become brittle and they are more susceptible to CTS, especially the molar teeth where studies show that 50 per cent of them break after a root filling if they are not crowned.

There are tiny tubes, dentinal tubules, running inside the tooth that contain fluid and minute nerves. When a tooth cracks, pressure is exerted on the fluid and this swishing of fluid contacts the nerves – eliciting the pain that we feel. Extensive cracks can lead to bacteria invading the tooth which track to the tooth nerve chamber, causing the nerve to die and an abscess to form.

In the early stages of a cracked tooth it can be treated with a restoration that will help to hold the tooth together, such as a crown. If a cusp fractures off then often a simple filling is enough to save the tooth. In extreme circumstances where the tooth has totally split in two it's often beyond saving and unfortunately needs removed. The possibilities to replace the tooth can then be discussed.

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