Service 05
Cracked Tooth Diagnosis.
The most commonly missed diagnosis in dentistry. A crack rarely shows on an x-ray, the pain comes and goes, and patients are often told there is nothing wrong — while the fracture quietly deepens.
The Classic Sign
Pain when you let go of a bite
Not when you bite down — when you release. That single symptom is the strongest clue there is.
As you bite, the segments of a cracked tooth separate very slightly. When you release, they snap back together and the fluid movement inside the dentinal tubules fires the nerve. It is a sharp, startling, momentary pain that is easy to describe and hard to reproduce on demand — which is why so many people are sent away without an answer.
Other things patients report
- Sensitivity to cold, or oddly to sweet foods
- Pain that appears with certain foods and not others
- An inability to say which tooth it is — often not even which jaw
- Symptoms that vanish for weeks and then return
- A history of grinding, or a large old filling in the tooth
How we find it
Under the microscope, with the tooth dried and lit from the side, a crack often becomes visible as a fine line running across the marginal ridge. Transillumination — shining fibre-optic light through the tooth — makes it clearer still, because the fracture stops the light dead at the crack line. Methylene blue dye seeps into the fracture and stains it. A bite stick tested cusp by cusp tells us which segment is moving. And a cone beam scan shows whether the crack has already reached the bone.
Five Types
Not every crack means the same thing
The prognosis depends entirely on where the fracture runs and how deep it has gone.
Craze lines
Fine cracks confined to the enamel. Extremely common in adults, entirely harmless, and no treatment is needed beyond reassurance.
Fractured cusp
A piece of the chewing surface breaks away, usually around a large filling. The pulp is often unaffected — a crown normally resolves it.
Cracked tooth
A crack running from the chewing surface toward the root. If it is caught before it reaches the bone, root canal treatment followed promptly by a crown gives a good prognosis.
Split tooth
A cracked tooth left untreated. The segments are now completely separated. Sometimes one segment can be saved; often it cannot.
Vertical root fracture
A crack beginning at the root and travelling up. Usually discovered because the surrounding bone has been lost. These generally cannot be saved, and we will tell you that rather than treat a tooth with no future.
Get an answer, not another guess
Bring the symptom you cannot explain. That is exactly the kind of case we do best.