All Cracked Up

Question:  I have always been concerned with cracks in my teeth. Over many years of seeing my dentist, I’ve asked him about the cracks in my front teeth. He’s always reassured me that they were superficial and in the enamel only. He said, “In the back teeth where there are much greater forces applied in eating or grinding and clenching one’s teeth, that’s a different story.” Whenever there’s been a crack in my back teeth I’ve had crowns done so the crack wouldn’t spread.

Two weeks ago, I bit an olive pit on my back lower molar. The pain was so intense I nearly fainted. I sat my chair back and put my head down between my legs, until the pain subsided and I regained my senses. Now, if I get cold on that tooth I get an intense sharp pain, so everything that goes in my mouth is room temperature and I don’t dare chew on that side.

My dentist said it was a cracked tooth. He said cracked teeth need to be crowned but he also said this might need a root canal as well. He said the tooth wasn’t split in half, but he couldn’t tell if the crack went into the nerve or just cracked into the dentin. I’m not sure what to do. How do you really know what’s going on and what to do? He did say I have a big filling that made it more susceptible to cracking.

Answer: Cracks in teeth fall in five different categories. The first is superficial and look like craze lines in porcelain. They usually aren’t of great consequence in front teeth. Most people only see and are aware of this category.

The second is a crack into the dentin. Many can experience this type of cracking, and it may or may not give a sharp sensation to temperature change or biting force. When this kind of cracking leads to tooth breakage it happens above the gum. Usually, these teeth get crowned. In your case, the dentist will have to take the filling out and examine the tooth for a crack. If the crack appears to be centered over the nerve chamber, a root canal may have to be done. The advantage is that he’ll see if the crack ends, or if it continues into the roots. If it ends above the root, the root canal will be completed, the tooth crowned, and you should have no pain.

The third is a crack that goes below gum and bone.

The fourth is a crack into the nerve and extends to the root.

The fifth is a crack through the roots. In 2025, in these last three categories, the teeth would be extracted and an implant placed.

Hopefully your dentist can care for all these contingencies once the final diagnosis is apparent.