Tooth fractures or cracks are sometimes quite obvious. When a cusp becomes weakened or undermined by decay, it may break off. Sometimes these breaks will expose the pulp and the tooth may become quite sensitive or painful. Once your dentist has confirmed that the tooth can be salvaged, a root canal will be performed if deemed necessary. Fractures that involve just the enamel are often restored with a bonded filling material. Small cracks or enamel craze lines are very common in adults, but rarely cause symptoms and are usually not treated.

Some fractures, or “infractions” are inconspicuous, and may cause significant but inconsistent pain. This often results in cold sensitivity, and biting and releasing a certain way will cause a very sharp shooting “nerve” pain in the tooth. This “cracked tooth syndrome” or microscopic flexing is often misdiagnosed because teeth can appear healthy both clinically and on an x-ray. Simple tests will determine if endodontic treatment is necessary or just a new filling or crown.

In some cases, a crack may extend from the chewing surface below the gum line along the root surface. These vertical root fractures will need to be thoroughly evaluated. If left untreated, these types of fractures can progress into the roots of the tooth, causing mobility and infection of the surrounding tissues. Sometimes endodontic treatment or surgery can save the tooth; otherwise the tooth will need to be extracted. Fractures are normally invisible on an x-ray or radiograph, so it is imperative to have a proper diagnosis.