â– Does the tooth hurt (especially to bite and cold)? If so, the crack is likely to be at least as deep as the dentin layer of the tooth, and is probably relatively new. If not, it is likely more superficial, or has been present long enough for the tooth to produce “reparative dentin” over the crack. Reparative dentin is a calcified material produced by living cells called odontoblasts in the pulp space of a healthy tooth. It is produced at an accelerated rate when a tooth sustains an injury, and can often be seen on X-ray images. See if your dentist can point it out to you. If the tooth is asymptomatic, you may have time to consider your options for fixing it, and conservative options are more likely to work. Keep in mind: Even if a cracked tooth can be repaired conservatively in the short term, the best protection against propagation of the fracture and subsequent infection and tooth loss is generally provided with onlays and crowns.
â– Is the tooth loose? If so, it may be fractured at or just beneath the gum level. These are normally serious problems.
â– Is the tooth in pieces? If so, are the pieces loose? Often vertical or oblique fractures will result in one side being loose and the other stable. These are also serious problems.
â– Is there stain or pigment in the crack? If so, the crack has likely been present for awhile. If it is, and the tooth has never been symptomatic, the crack may not be very deep. This doesn’t mean the cracked tooth shouldn’t be fixed, but the urgency for fixing it may not be as great, and conservative treatment may be an option. Again, a full coverage restoration like a crown or onlay is generally the best way to prevent progression of a crack in a tooth.
â– Has the tooth had endodontic (root canal) treatment? If so, it is more likely to fracture than a tooth that has not had a root canal. This does not mean that every tooth that has been endodontically treated needs to be crowned. The risk of an uncrowned tooth breaking after root canal therapy increase the further back the tooth is in the mouth (where greater chewing forces are exerted), and the more the tooth has been decayed or filled.