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Tooth enamel is the hardest substance in the human body. It is very protective, particularly against impacts, but even enamel can crack. Cracks often happen to a tooth when a force applied to a tooth is strong, the tooth was previously treated with a root canal, or the tooth has untreated tooth decay or existing restorations like fillings or crowns. A cracked tooth is different from a chipped tooth, and your dentist will diagnose and treat them differently.

A crack is a fracture in the tooth. They can range from obvious, visible fractures to microscopic lines that can only be seen through imaging. Unlike chips, cracks often do not result in a loss of tooth structure. Cracks may only affect the enamel (known as "craze lines"), or they may extend into the dentin layer beneath the enamel. They are typically caused by excessive forces such as biting or grinding. Cracks can occur in the tooth's clinical crown or in the tooth root, where they are more difficult to diagnose and treat.

Cracks can allow bacteria to enter and grow within the tooth's inner layers. The bacteria can lead to tooth decay and infections. Your dentist should examine all cracks to determine if treatment is necessary to prevent further damage or decay. In extreme cases, tooth removal may be necessary.

• Chewing hard foods, seeds, or ice.
• Trauma: Any impact to the face, jaws, or teeth can cause teeth to crack.
• Using your teeth improperly.
• Misaligned teeth: If your upper and lower teeth don't align properly, bite forces may concentrate on just a few teeth. This increases the bite stress on those teeth and may cause them to crack.

• Grinding or clenching your teeth can increase forces on your teeth and cause cracks.

• Sports or activities (especially without proper mouth and face protection).
• Accidents of any kind that cause impact to the teeth, face, or jaws.
• Trips and falls.
• Weakened enamel (which may be from lack of proper exposure to fluoride).
• Untreated tooth decay.
• Tooth restorations like fillings, inlays, and root canal therapy.
• Dental health problems, such as abfractions, tooth wear, or previously chipped teeth.

Tooth cracks may be visible or microscopic. You may not realize your tooth is cracked until your dentist diagnoses it at your next dental exam.

You should schedule an appointment with your dentist when:

• You become aware that you have cracked a tooth, even if it doesn't hurt.
• You experience pain or increased sensitivity to hot or cold. Keep in mind that tooth pain and sensitivity may come and go.
• Your teeth hurt when biting, especially if pain occurs when releasing the bite. These teeth are often found to have cracks.
• A tooth was cracked due to an accident or impact. Your teeth and jaws may have sustained other injuries that only a dentist can diagnose.

Your dentist can often identify cracks visually. If your dentist suspects a microscopic crack, they will use X-ray images and photographs. They are also used to determine the extent of a crack and if it has impacted the nerve.

Your examination will include your dentist:

• Asking about your pain level, which may indicate how deep the crack has progressed.
• Looking for any restorations to the tooth which may have led to the crack.
• Determining if the tooth is loose or has any loose or missing pieces, which may indicate more serious problems.
• Ruling out any other problems that may have occurred at the same time as the crack.
• Tapping on the teeth with a solid object, such as a dental instrument, to see if they can reproduce the sensitivity you report.
• Performing a 'bite test.' This involves having you bite down on a wooden stick or plastic instrument called a 'tooth sleuth.'

With this information, your dentist can diagnose the presence, location, and severity of the crack and determine if the crack has made your tooth more susceptible to tooth decay or infection. This will allow them to recommend a course of treatment.

• Use mouthguards, masks, or face cages to prevent a tooth from being knocked from sports or activities.
• Avoid hard foods and ice: Chewing ice or biting down on hard candy, bread crusts, pretzels, seeds, or popcorn kernels are often related to cracked teeth.
• Brush and floss to avoid tooth decay and periodontal disease that can weaken teeth.
• Avoid using your teeth improperly.
• Occlusal guards: If you have the habit of grinding or clenching your teeth, an occlusal guard can prevent your teeth from being cracked by the grinding or clenching forces.
• Orthodontics: Misaligned teeth can increase your risk of cracking a tooth.

Your dental insurance might not cover all situations associated with tooth injuries. This is especially true in cases of trauma. While you might end up seeing a dentist for evaluation and treatment, your course of action may need to be coordinated through a medical provider. Talk to your insurance provider, physician, and dentist to be sure you understand the provisions of your medical and dental coverage before beginning a course of treatment.

There are often temporary methods for stabilizing cracked teeth that are inexpensive and allow you time to consider more permanent options.

It is not generally recommended that you delay treatment for cracked teeth.

Initial (at-home) care

If you crack a tooth, make an appointment to see your dentist as soon as possible. Meanwhile, following these steps may provide temporary relief:

• Rinse your mouth with warm, salty water.
• If there is bleeding in your mouth, use moist gauze to apply pressure to the area until the bleeding stops.
• If you can safely do so, take an over-the-counter pain reliever if necessary for pain.
• If you can't see your dentist the same day you cracked your tooth, many drugstores sell dental materials that you can use to cover the crack until your appointment.
• Try to eat soft foods,
• Avoid hot or cold food and drinks.
• Avoid biting or chewing with the affected tooth.

Professional treatment

Depending on the location and the extent of a crack, there are a number of ways to treat your tooth. Some cracks can be easily repaired, while some may be too serious to be fixed at all. This is especially true if the crack extends into the tooth roots or to the bone level. Your dentist's goal will be to preserve as much natural tooth structure as possible and help ensure no decay or further damage will occur.

The best protection against a crack in your tooth growing larger is generally a restoration like a crown or onlay. These treatments may also require root canal therapy. Your dentist may be able to place a bonded filling that can last long enough to help you prepare for these treatments.