Cracked tooth syndrome occurs when there is a very fine crack in the tooth surface. It could be difficult to locate a fine crack in an x-ray. Also, sometimes, these cracks are beyond the gum, which makes the diagnosis challenging. Cracked molar is the most common example of such a scenario.

Common causes of a cracked molar are large restorations, chewing on something hard like ice or meat bones, trauma to the face or mouth, bad oral hygiene routine or bruxism. (1)

Cracked molar treatment options vary from crowns, root canal to extraction (if the crack extends beyond the gums and into the root of the molar).

Also, cracked tooth and chipped tooth are different. We will see more on this as we go further in this article.

Symptoms of a cracked molar

Molars (lower back teeth) absorb most of the forces of chewing and hence cracks on molars are common. The common symptoms are –

  • The tooth may hurt while chewing or biting. The pain is not constant but intermittent. You feel pain when you eat certain foods or when you bite in a particular way. Sensitivity or pain may last for a brief period or a long time and can be mild or intense. The tooth may be sensitive to hot and cold foods or sweet food items.
  • When the crack becomes more prominent, a piece of the tooth may chip off. In case there is an infection in the gum around the fractured tooth, you may notice a bump near the tooth. Pus may drain from this bump and is called a fistula.

When the crack is small, people don’t realize the cause of pain since the crack is not visible. So, people usually have the symptoms for months.

The pain is unpredictable, making it a difficult problem to diagnose in the initial stages. The patient finds it difficult to pinpoint the pain.

Diagnosis of a cracked molar

Diagnosis of cracked molar involves patient history, x-rays and examination of the tooth causing pain.

  • Your dentist will start by asking you about the kind of pain and the nature of pain followed by an examination of the tooth in question and oral cavity in general.
  • Your dentist will use a sharp instrument called the dental explorer to feel for the crack in the concerned tooth. X-rays are not always helpful in detecting cracks, but any unhealthy changes in the pulp tissue may help in diagnosing a crack.
  • Tooth slooth is a special tool which looks like a toothbrush without bristles and is used to identify cracked molar. The dentist will place it on the tooth in question and ask you to bite down. If you feel pain while biting down on the tooth slooth, it is an indicator of a cracked tooth. (2)
  • Staining the tooth with a dental dye may help the dentist visualize a crack better. If the tooth has a large filling, he may remove the same to examine the tooth.
  • The dentist will also examine the gum for signs of inflammation because cracked tooth irritates the gum and there may be pus accumulation too.

What to do if you have cracked molar?

If you experience any of the symptoms mentioned above, then you may have a cracked molar and need to see a dentist to assess the situation and get treatment.

  1. While you wait for your appointment, you may feel pain in the affected molar while chewing or when you expose your mouth to temperature changes (hot or cold food). You should try to pinpoint where exactly you are feeling the pain so that you can guide your dentist better. Don’t overdo with the biting on the affected side since too much pressure can open the crack and irritate the pulp.
  2. Minor cracks in the molar affect only the enamel, and in such cases, your dentist may not recommend any treatment. Minor cracks, also called craze lines are relatively common in adults. The dentist can improve its appearance by polishing the tooth

Treatment of a cracked molar

Treatment of cracked tooth depends on various factors like the extent of the crack, experience of the dentist and patient symptoms.

There is no definitive treatment for a cracked tooth. Proper diagnosis, preventive strategies, and treatment according to severity is the protocol followed in majority cases.

Treatment depends on location, width, and depth of the crack. (5)

  1. At times the crack affects one or more cusps of a molar. Cusps are the highest points of a tooth. In such cases, the dentist may place a crown over the tooth.
  2. Some cracks affect the nerves and blood vessels, so they require root canal treatment followed by crown placement. Around 20% of cracked molars need root canal therapy. (3) After root canal treatment your tooth will not be sensitive to temperature, but you still might feel pressure. The intensity of pressure will reduce with the passage of time. You may feel pressure or pain at times but the frequency will decrease, but it may still occur.
  3. Some cracks affect the root of the tooth. In such cases, the tooth may need to be removed. If the crack extends up to the root of the tooth, extraction is the sole treatment option in such cases. If you have to go for extraction of the affected tooth, you may opt for an implant or a bridge. (4)

Difference between a chipped tooth and a cracked tooth

There is a difference between a chipped tooth and a cracked tooth. When the enamel of a tooth chips off, it is a painless condition.

Only when the underlying nerve is exposed, a person feels pain whereas cracked tooth causes pain while chewing or when you eat hot or cold food.

In both situations, you should see a dentist and get treatment (or follow certain precautions) to prevent any further damage.

Over to you

It is difficult to diagnose a cracked molar on your own unless it has progressed to a state where you can see your tooth split into two parts in the jaw.

Any tooth pain that you feel but are unable to locate the source, do visit the dentist at the earliest so that you do not have to go for tooth extraction.

The simple answer is YES. Cracked molar treatment options vary from crowns, root canals to tooth extraction.