Authored by: Minahil Syed
Tooth fractures are more common than we think.
A fractured tooth often initially appears as a ‘crack’ in your tooth, and while generally harmless, other times, a simple crack can cause your tooth to break further or even split! While tooth fractures are the most prevalent amongst young children and the elderly, anyone can fracture their teeth. Let’s talk about tooth structure, how fractures occur, symptoms thereof, and what to do if you experience a fracture!
There are two ‘external’ parts to your tooth structure, the crown which refers to the ‘actual tooth’ (the visible area above the gums) and the root (which lies directly below the gums). The enamel is the white outer layer on the surface of the dental crown, it forms a barrier around the dentin, which then surrounds the dental pulp.
The dental pulp is the most sensitive layer and contains nerves and blood vessels. The tissues structures of dentin and pulp are mutually contingent on one another and interrelated. The dentin-pulp complex is primarily fueled by the pulp. Pulp is responsible for dentin formation and nutrition thereof, pulp supports the middle layer with moisture! Hence, it inversely also protects itself (since pulp is surrounded by dentin). As illustrated, the pulp is protected by the stronger outer layers, however, if your tooth experiences a fracture or decay, the pulp can become exposed.
How a Fracture Appears
The most common causes of tooth fractures are:
1. Biting into tough foods or objects: Chewing ice, eating popcorn or chomping on hard candy.
2. Age: Since tooth enamel wears as you age, your teeth become more vulnerable to decay and damage to your inner dentin-pulp complex, as such, the possibility of tooth fractures increases as you age.
3. Large dental fillings:
Large fillings can actually compromise the integrity of the tooth itself and cause it to become less stabilized. Since fillings simply rest in or on the tooth, they don’t necessarily provide any ‘strengthening’ to the unit itself! This is why some people choose a dental crown as opposed to a filling — because it acts as a splint that holds the tooth together as a whole.
Once the structural integrity of the tooth has been compromised (i.e. it has fractured, split, or decayed), it is just not as strong. Unfortunately, big fillings cannot easily mitigate this issue. Consequently then, biting force from other teeth can cause cracks and inflammation at the base of the tooth as well — eventually leading to splitting or fracture.
4. Root Canals:
A root canal is performed to repair damaged or decayed teeth or save a tooth whose pulp has become exposed and henceforth inflamed. A root canal involves the removal of the infected pulp, cleaning of the canal from which removal occurred, and resealing the tooth. While advancements in technology and treatment have ensured that the process is continuously swift and precise, as mentioned beforehand, once a tooth has been ‘compromised,’ it is naturally less rigid as a unit. As such, fractures can even appear following a root canal. If you hear a popping sound during root canal filling, a stabbing pain, or experience bleeding in the area, these symptoms may point to a vertical root fracture!
5. Teeth grinding:
Grinding your teeth or clenching your jaw — which often occurs for patients who unknowingly perform this habit while sleeping or simply as a result of stress — can put pressure on your teeth. Prolonged grinding (called ‘bruxism’) can lead to cracked teeth and can even break your fillings and crowns!
6. Trauma/Contact Sports:
Falls or general injuries from playing spots, riding a bike, or even getting hit in the face can cause tooth cracks and fractures.
Symptoms of a Cracked Tooth
Tooth fractures are surprisingly common and while they can occur to individuals of all ages, they’re more so common in individuals 25+.
- Pain when biting or chewing.
- Rather than chronic pain, the pain is fleeting, it may ‘come-and-go’.
- Sensitivity to cold and hot food, some individuals may even react e to sour or sticky foods!
- Inflammation around the gum line or area of the fracture may point to a cracked tooth — since the crack exposes inner connective tissues to bacteria and increases possibility of infection!
- Chewing only on one side of the mouth.
What do I do If I’m Experiencing those Symptoms?
In order to provide a thorough examination, your dentist may ask whether you tend to grind your teeth or chew on hard foods, from there, they may check to see if your tooth is visibly broken and inspect your teeth for crack lines. They may assess your gums for inflammation and ask you to bite down on a stick to assess if you feel any pain. Oftentimes, a fracture cannot be detected by your dentists’ eyes alone, as such, they might use the following methods to find the fracture:
1.Transillumination: A bright light is shot through the tooth. When the light ‘finds’ the fracture line, the beam will reflect. As a result, there will be a dark and light area of the tooth; divided by the aforementioned fracture line.
2. Periodontal Probing: A probe is used to measure depth around the tooth in order to establish the health of surrounding tissues. Probing can help distinguish a fracture if the tools used get caught in the crack/split, and between the type of fracture.
3. X-ray: A simple x-ray of a patient’s teeth can reveal fractures, imaging can also showcase bone loss, indicative that a split or fracture has occurred.
4. Staining dye: In this exam, a solution, often methylene blue/gentian violet dye is put on the tooth in order to help see the fracture lines by highlighting them via contrast.
While your teeth cannot necessarily go back to their original shape after a tooth fracture, the goal becomes to protect the inner connective tissue, most notably, the pulp. To help reduce the risk of teeth fractures, avoid chewing hard food or objects, grinding your teeth, engaging in contact sports without a mouth-guard or helmet, and avoid switching between extremely cold and hot foods! Good luck!
Authored by Minahil Syed
1.“Fractured Tooth (Cracked Tooth).” Cleveland Clinic. Accessed August 17, 2022. https://my.clevelandclinic.org/health/diseases/21628-fractured-tooth-cracked- tooth#:~:text=Fractures%20occur%20most%20often%20on,even%20with%20less%20severe%20trauma.
2. N/A, “Fractured Tooth (Cracked Tooth).”
3. Ghannam, Mousa G., Babak Abai, Hania Alameddine, and Bruno Bordoni. “Anatomy, Head and Neck, Pulp (Tooth).” Essay. In StatPearls [Internet]. Treasure Island, FL : StatPearls Publishing LLC, 2019. https://www.ncbi.nlm.nih.gov/books/NBK537112/.
4. Ghannam, Mousa G., Babak Abai, Hania Alameddine, and Bruno Bordoni. “Anatomy, Head and Neck, Pulp (Tooth).”
5. Ghannam, Mousa G., Babak Abai, Hania Alameddine, and Bruno Bordoni. “Anatomy, Head and Neck, Pulp (Tooth).”
6. Ghannam, Mousa G., Babak Abai, Hania Alameddine, and Bruno Bordoni. “Anatomy, Head and Neck, Pulp (Tooth).”
7.Yetman, Daniel. “What You Need to Know About Your Tooth Pulp.” Edited by Jennifer Archibald. healthline, February 9, 2021. https://www.healthline.com/health/tooth-pulp.
8. Sulyanto, Rosalyn. “Effects of Aging on the Mouth and Teeth.” Merck Manual, August 2021. https://www.merckmanuals.com/home/mouth-and-dental-disorders/biology-of-the-mouth-and-teeth/effects-of-aging-on-the-mouth-and-teeth.
9. Cotner, Paul. “Crowns vs. Fillings.” Animated-Teeth.com. Accessed August 17, 2022. https://www.animated-teeth.com/dental_crowns/t2_dental_crowns_large_fillings.htm.
10. Cotner, Paul. “Crowns vs. Fillings.”
11. “How Biting Forces Effect Teeth With Large Fillings.” Pi Dental Center. Accessed August 17, 2022. https://dentalimplants-usa.com/bone-and-teeth/how-biting-forces-effect-teeth-with-large-fillings/#:~:text=Once%20a%20filling%20becomes%20too,to%20crack%20at%20the%20base.
12. “Root Canal Treatment.” Canadian Dental Association. Accessed August 17, 2022. http://www.cda-adc.ca/en/oral_health/talk/procedures/root_canal/default.asp.
13. Khasnis, Sandhya Anand, Krishnamurthy Haridas Kidiyoor, Anand Basavaraj Patil, and Smita Basavaraj Kenganal. “Vertical Root Fractures and Their Management.” Journal of Conservative Dentistry 17, no. 2 (2014): 103–10. https://doi.org/10.4103/0972-0707.128034.
14. Jaw Clenching and Teeth Grinding (Bruxism).” Canadian Dental Association. Accessed August 17, 2022. https://www.cda-adc.ca/en/oral_health/talk/complications/bruxism/.
15. “Four Types of Tooth Fractures.” Family Dental Group, May 31, 2014. https://thefamilydentalgroup.com/blog/four-types-tooth-fractures/#:~:text=Fractures%20are%20extremely%20common%20in,are%20typically%20easy%20to%20treat.
16. 5 Signs That You Cracked a Tooth.” Akron Smile, November 16, 2015. https://akronsmile.com/blog/5-signs-cracked-a-tooth/.
17. N/A, “Fractured Tooth (Cracked Tooth).”
18. Strassler, Howard E., and Mark L. Pitel. “Using Fiber-Optic Transillumination as a Diagnostic Aid in Dental Practice.” Compendium 35, no. 2 (February 2014). https://www.aegisdentalnetwork.com/cced/2014/02/using-fiber-optic-transillumination-as-a-diagnostic-aid-in-dental-practice.
19. Mathew, Sebeena, Boopathi Thangavel, Chalakuzhiyil Abraham Mathew, SivaKumar Kailasam, Karthick Kumaravadivel, and Arjun Das. “Diagnosis of Cracked Tooth Syndrome.” Journal of Pharmacy and Bioallied Sciences 4, no. 2 (August 2012). https://doi.org/10.4103/0975-7406.100219.
20. N/A, “Fractured Tooth (Cracked Tooth).”
21. Mathew, Sebeena, Boopathi Thangavel, Chalakuzhiyil Abraham Mathew, SivaKumar Kailasam, Karthick Kumaravadivel, and Arjun Das, “Diagnosis of Cracked Tooth Syndrome.”