Cracked Tooth Syndrome

Cracked Tooth Syndrome is defined as an incomplete fracture of dental tooth structures. It can sometimes be associated with a sharp pain during chewing. During chewing function, a crack, craze or fracture line may allow broken tooth sections to flex or move. This causes sensitivity and pain in the dentin, which is the sensitive portion of the tooth. If symptoms are present the usual one is a sensitivity to biting. However, it is not uncommon for there to be a sensitivity to cold. This can progress to a full-blown toothache, pulp death or necrosis and abscess. When the nerve of a tooth dies or abscesses it will require a root canal procedure or tooth extraction to resolve the problem. It should be remembered that cracks and fracturing can be present in tooth structure without the production of pain or other symptoms.

Cracks in tooth structure can be created in several ways. The most common is as a result of previous dental fillings. Silver Mercury fillings (amalgam fillings) have been around for decades. Chances are that most people who have had tooth decay drilled out, have had this silver mercury compound placed in the tooth. That is great for filling the hole, but usually is not so good as far as the structural integrity of the tooth is concerned. Too often the silver mercury filling (especially the earlier generations) will expand or "grow" over time, which in turn places pressure on the tooth structure. Eventually, (usually anywhere from 15 - 25 years) something has to give as this stress is relieved, usually at the expense of tooth structure. Of course, the continued forces from chewing and clenching on the tooth, and the on-going expansion - contraction cycles of temperature fluctuations with food and drink, produce additional stresses on the tooth structure. The most common finding with a broken tooth is the existence of an adjacent filling which was placed without consideration for protecting the structural integrity of the existing tooth structure.

Note that the crack in the tooth begins and propagates from an inside line angle of the filling or cavity preparation. It usually extends at an angle toward the outside of the tooth. When this crack exits below the gum line or bone level, far more extensive restorative measures are often required such as gum surgery and/or root canal treatment.

Not infrequently, teeth with aged silver fillings exhibit all these problems shown simultaneously. Fortunately, there are restorative treatments that can be suggested that can prevent this outcome far ahead of its happening. A "permanent filling" does not mean that it will last forever or permanently.

Appropriate treatment must take into consideration the requirements for tying the tooth structure together in such a way that it can withstand the functional demands placed upon it by chewing & biting forces, as well as the restoration materials themselves. In the end, the objective of therapy is to create a stable solution that can withstand any and all forces that might be placed upon it, and which will allow it to function in comfort for a long duration.

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