Why Ignoring a Cracked Tooth Can Lead to More Costly Complications

Photo: Kamal Hosseinianzadeh

A cracked tooth doesn’t look like a crack in the wall. It moves. With each bite, the sides of the fracture bend apart and compress back together. This mechanical cycle makes the cracks very destructive over time. Teeth cannot repair themselves or close cracks in the enamel, so what starts as a minor structural defect will progress unless something physically stops it.

Craze lines are an exception here. These are superficial cracks that only affect the surface of the enamel and usually do not progress or allow bacteria to enter. The problem is that most people cannot tell the difference between a craze line and a fracture toward the pulp. The distinction requires clinical examination and, in some cases, transillumination and imaging to see what is really going on beneath the surface.

There are no nerves in the outer layers of the tooth, such as the enamel and dentin, so you won’t feel pain until the crack reaches the pulp. This is when you feel pain when the crack spreads into the soft tissue or pulp at the center of the tooth, which contains nerve endings and blood vessels. By this stage, continued biting can cause a more permanent level of sharp pain and sensitivity.

At this time, the nerves sense that something is wrong, and pulpitis may develop. In that case, as mentioned above, root canal treatment is required to remove the nerve and pulp before the crown can be placed, making the procedure even more complicated. Cracks don’t suddenly get worse. The pain continues to grow over several weeks or months while you try to determine the cause of the pain.

The complexity of treatment is directly proportional to how far the fissure has progressed. Cracks detected early can often be stabilized with bonding or a crown, before they compromise the structural integrity of the tooth. Crowns work by bonding the teeth together, preventing the sides from bending during chewing and stopping progression completely.

If the crack reaches the pulp of the tooth, root canal treatment will be required before a crown can be placed. This is two steps instead of one. If the crack extends from below the gum line to the root of the tooth, the tooth cannot be saved. At that point, tooth extraction becomes the only option, and implants, bridges, or partial tooth replacements add thousands of dollars in costs.

The comparison between the cost of initial imaging and dental implants is clear. The cost of X-ray or transillumination testing is a fraction of the cost of implant treatment, and while implants are effective, they require months of treatment and a significant amount of money that most people want to avoid.

Photo: Filip Rankovic Grobgaard

Structural issues may be manageable, but crises require immediate attention. For example, if bacteria reaches the pulp of a tooth and is not treated, a tooth abscess, a pocket of infection at the root, can form. This is a very painful condition, and the problem is not just in the mouth. If a dental infection is not treated, bacteria can enter the bloodstream and negatively impact your cardiovascular health.

The tooth is most likely to be lost, if not immediately, then weeks to years later, and infection, granulomas, or cysts develop in the tooth root, often complicating surgery. Sympathetic patients often say that it would have been kinder and more comfortable if they had removed it first.

Horizontal cracks and fissures can often be saved, especially if they are only on the top of the head. Your chances of survival are even better if crack repair is at the top of your “to do” list. If it has spread to the roots, the chances are even lower. If the tooth root is torn, the tooth may need to be extracted.

Final thoughts…

A cracked tooth is an ongoing mechanical failure. There is no physical change as there is no pain yet. Early stabilization is almost always cheaper, faster, and less invasive than treatment that is required after many months as the crack deepens.