People are living longer and more stressful lives, and they are therefore subjecting their teeth to many more years of crack inducing habits such as clenching, grinding, and chewing on hard objects.

Cracked teeth show a variety of symptoms and sometimes almost defy diagnosis. Pain to chewing coupled with cold sensitivity, and pain upon "bite and release" are common. The most common cracks occur in a front to back direction which does not show up on a x-ray.

Sometimes it takes removing an older restoration to unveil the crack. Occasionally they can be seen under our microscope at 10 power magnification or higher. Cracks often start small and can progress similar to spitting a log of wood. If the crack gets close to the root canal space or system then pulpitis or pulp infection can occur. When the crack reaches through enamel and involves dentin symptoms usually begin. Dentin is somewhat compressible so that when you chew the dentin moves on either side of the crack and stimulates the pulp as a painful episode. The crack can also allow bacteria filled salvia to migrate close or into the canal space. The latter results in an infection. If the crack extends below the gum line then a periodontal pocket may form next to the crack. The most frequently fractured tooth in our dentition is the lower second molar.

The next two most frequently fractured teeth are the lower first molar and the upper first premolar. Cracks that involve only one corner of a back tooth may be repaired with a crown and not a root canal procedure. Teeth that are causing symptoms and are cracked into dentin frequently require root canal treatment and a crown is needed as soon as possible. If the crack extends into the root surface or into the area where the roots divide then extraction may be needed.

One uncommon crack occurs when the split occurs from the root tip end and doesn't involve the crown of the tooth. These cases are almost impossible to diagnose without surgery or extraction. Placement of a crown on a cracked tooth doesn't guarantee long term success as the crack sometimes progresses so these cases are unpredictable. Generally the smaller the crack the better the prognosis, and in fact, sometimes the crack is removed during the crown prep. Dental microscopes aid us in detecting the extend of the crack and providing patients with better predictions on prognosis.