What to Do When Your Tooth Cracks Down the Middle: Treatment Options and Solutions

When a tooth cracks or splits down the middle, it can be a concerning and potentially painful dental emergency. The appropriate treatment depends on the severity and extent of the crack, ranging from conservative approaches to tooth extraction. Understanding your options can help you make informed decisions about your dental care.

Initial Assessment and Diagnosis

If you experience a cracked tooth, it's essential to visit a dental professional as soon as possible. The dentist will typically perform a periapical X-ray to determine whether the crack is limited to the crown (the visible part of the tooth) or extends into the root. This assessment is crucial for determining the most appropriate treatment plan.

Treatment Options Based on Crack Severity

Minor Cracks Limited to the Crown

When the crack only affects the crown and hasn't reached deeper structures, the dentist may remove the loose, fractured portion of the tooth. If the remaining tooth structure has sharp edges, these will be smoothed and rounded to prevent injury to surrounding soft tissues like the tongue, cheeks, or gums.

Shallow Cracks Affecting the Dentin

If the crack extends into the shallow layer of dentin (the layer beneath the enamel), you may experience mild tooth sensitivity. In such cases, desensitizing treatment can be applied. For more severe sensitivity, a temporary plastic crown filled with zinc oxide eugenol paste may be placed over the tooth. This allows time for the tooth to form reparative dentin, which can reduce sensitivity. Once symptoms subside, permanent filling material can be applied.

Deep Cracks Approaching the Pulp

When a crack comes close to the pulp chamber (the innermost part of the tooth containing nerves and blood vessels), the dentist will place a calcium hydroxide base before filling the tooth with restorative material. This protective layer helps preserve the vitality of the tooth.

Pulp Exposure

If the crack has exposed the pulp, root canal treatment becomes necessary for mature permanent teeth. This procedure involves removing the damaged pulp tissue, cleaning and disinfecting the root canals, and sealing them to prevent infection. For young permanent teeth with immature root development, a pulpotomy (partial pulp removal) may be performed initially, followed by complete root canal treatment once the root apex has fully formed.

Severe Vertical Root Fractures

When a tooth splits vertically into two halves extending to the root, the situation becomes more complex. If both halves are significantly mobile, painful, or the crack is complete, extraction is typically the safest option. After extraction, you should wait approximately three months for the bone to heal before considering replacement options such as dental implants, bridges, or dentures.

However, in some cases where one half is loose while the other remains stable with healthy surrounding bone and gum tissue, it may be possible to remove only the mobile portion and restore the remaining stable part, particularly in multi-rooted teeth.

Understanding Craze Lines vs. True Cracks

It's important to distinguish between two types of tooth splitting:

A craze line or hairline crack may be visible on the chewing surface but doesn't extend to the root or cause the tooth to separate. These can often be treated with root canal therapy under local anesthesia, followed by a full crown to protect and strengthen the tooth.

A complete vertical split that extends through the root divides the tooth into two separate pieces. Unfortunately, such teeth typically have no salvage value and require extraction.

Prevention and Dietary Considerations

Tooth fractures often result from poor dietary habits, such as eating excessively hard foods or chewing too quickly. To prevent tooth fractures:

• Chew slowly and carefully
• Avoid extremely hard foods like ice, hard candy, or unpopped popcorn kernels
• Don't use your teeth as tools to open packages
• Wear a mouthguard if you grind your teeth at night

Post-Treatment Care

After any treatment for a cracked tooth, maintaining excellent oral hygiene is essential. Regular dental check-ups allow your dentist to monitor the treated tooth and ensure proper healing. Avoid placing excessive force on the affected tooth during chewing, especially in the initial healing period.

Conclusion

The key to managing a cracked tooth is prompt professional evaluation and treatment. While some cracks can be successfully treated with conservative approaches like root canal therapy and crown placement, others may require extraction. The specific treatment depends on the crack's location, depth, and impact on the tooth's structural integrity. By seeking immediate dental care and following your dentist's recommendations, you can maximize the chances of preserving your natural tooth or, when necessary, transition smoothly to appropriate replacement options.