Tooth Fracture

Tooth Fracture

(Fractured Tooth; Cracked Tooth)

Definition

A tooth fracture is a break or crack in the hard shell of the tooth. The outer shell of the tooth is called the enamel. It protects the softer inner pulp of the tooth. The inner pulp contains nerves and blood vessels.

An untreated tooth fracture can lead to pain, infection, or tooth loss. It depends on the type of fracture.

Types of tooth fractures include:

  • Craze lines—shallow cracks that cause no pain and do not need treatment
  • Fractured cusp—breaks in the chewing surface of the tooth
  • Cracked tooth—the tooth cracks from the chewing surface down toward the root of the tooth
  • Split tooth—cracks down through the root, separating a section of tooth
  • Vertical root fracture—cracks begin in the root and move up toward chewing surface

Tooth Fracture

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Causes

A crack in the tooth can be caused by:

  • Chewing on hard foods
  • Biting down on a hard object
  • Being hit in the face

Risk Factors

Tooth fractures are more common in older adults.

Other things that raise the risk are:

  • Tooth decay or damage
  • Teeth restored with silver alloy
  • Chewing hard foods or objects
  • Contact sports
  • Teeth exposed to temperature extremes in a short time
  • Teeth grinding and jaw clenching
  • Not wearing seatbelts
  • Not wearing mouthguards or masks with contact sports

Symptoms

Tooth fractures do not always cause symptoms.

If symptoms happen, they may be:

  • Pain with chewing
  • Chewing on only one side of the mouth
  • Sharp pain when biting down
  • Pain with cold or hot air, water, or food
  • Tooth pain that comes and goes

Vertical root fractures may not be noticed until a bone or gum infection happens.

Diagnosis

The dentist will ask about symptoms and past health. A mouth and tooth exam will be done.

A fracture cannot always be seen by the eyes alone. To find the fracture and look at the damage, the dentist may do tests such as:

  • Dye staining—solution is put on the tooth to help see the crack
  • Transillumination—passing a light through the tooth
  • Periodontal probing—using special tools to look at the size of the crack
  • Bite test—biting down on a stick to find the fractured tooth
  • X-ray—to look for certain defects

Early diagnosis may help save the tooth.

Treatment

Teeth cannot heal. The goal is to protect the tooth and the inner pulp.

Treatment depends on how badly the tooth is damaged. Options may be a:

  • Crown—A cap is placed over the tooth.
  • Dental Veneer—A thin covering is placed over a small, chipped surface.
  • Root canal—May be needed for severe damage to the pulp. A root canal clears out the damaged pulp and places a new filler in the tooth.
  • Tooth extraction—The tooth may be removed if the crack goes below the gum line.
  • Removal of the fractured portion—May be possible in vertical root fracture.

Prevention

To help reduce the risk of fractured teeth:

  • Do not chew on hard objects such as ice, hard candy, popcorn kernels, or pens.
  • Be aware of temperature extremes between foods and drinks.
  • Wear a mouth guard for sports or contact activities.
  • Do not use teeth to cut things or open plastic bags.
  • Do not clench or grind teeth.
  • Talk to the dentist about teeth grinding at night.

RESOURCES:

American Association of Endodontists
https://www.aae.org
Mouth Healthy—American Dental Association
https://www.mouthhealthy.org

CANADIAN RESOURCES:

Canadian Dental Association
http://www.cda-adc.ca

References:

Cracked teeth. American Association of Endodontists website. Available at: https://www.aae.org/patients/dental-symptoms/cracked-teeth/. Accessed August 10, 2021.
Dental emergencies. Mouth Healthy—American Dental Association website. Available at: https://www.mouthhealthy.org/en/dental-care-concerns/dental-emergencies. Accessed August 10, 2021.
Facial trauma in adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/facial-trauma-in-adults. Accessed August 10, 2021.
Fractured and avulsed teeth. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/dental-disorders/dental-emergencies/fractured-and-avulsed-teeth. Accessed August 10, 2021.
Hilton TJ, Funkhouser E, et al. National Dental Practice-Based Research Network Collaborative Group. Baseline characteristics as 3-year predictors of tooth fracture and crack progression: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc. 2021;152(2):146-156.
Last reviewed July 2021 by EBSCO Medical Review Board Dan Ostrovsky, MD
Last Updated: 8/10/2021

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