One of the most difficult problems to diagnose and treat for a dentist is called, “Cracked Tooth Syndrome.” This is a condition that can arise at any time on a tooth with a filling or a tooth that has never been filled. It is most common on teeth with old silver fillings that tend to expand and contract with hot and cold. There may be a weakened cusp of the tooth that is undermined by an old filling. Unfortunately, it also occurs in teeth that look perfectly fine. You may have bitten down hard on some food, or hit the cusp of an opposing tooth the wrong way. Some people will experience a cracked tooth in an accident where they sustain a blow to the jaw.

This syndrome is often difficult to diagnose because the cracks are often microscopic and do not show on an x-ray film. We are sometimes able to see them with our intra-oral camera that will enlarge the tooth by 30 times. Sometimes the only thing we can do is listen to your symptoms, such as pain upon biting, pressure, and sensitivity. We can try to duplicate the symptoms with tests. Once a diagnosis has been made, the choice of treatment is not simple. The choices are as follows:

1) Placement of a Crown to hold the tooth together and protect the crack from enlarging. Sometimes this is all that is required. If there is still sensitivity, we progress to the next stage, which is:

2) Root Canal Treatment to remove the irreversibly damaged nerve of the tooth. We don’t like to do this if we don’t have to, but we sometimes don’t have a choice. We may elect to refer you to a specialist for this procedure. If the crack is severe and this still does not eliminate the discomfort the final option is:

3) Extraction to Remove the Offending Tooth. We may opt to refer you to a specialist for this if needed. After extraction, the tooth can often be replaced with a fixed bridge, or an implant and crown (false tooth).

Now you see why this is a difficult condition to diagnose and treat. There is no guarantee for success. These procedures are not predictable (except extraction) when dealing with a cracked tooth. Feel free to ask questions and let us know of your concerns.