As we live longer lives, our teeth are exposed to many more years of crack-inducing habits, such as clenching, grinding and chewing on hard objects.  Cracked teeth show a variety of symptoms including erratic pain when chewing, possibly with the release of biting pressure, or pain when the tooth is exposed to temperature extremes.  The pain may come and go and general dentists may have difficulty locating which tooth is causing the discomfort.  If a crack is suspected, the patient may be referred to an endodontist for diagnosis and appropriate treatment.

Cracked tooth pain often comes from damage to the inner soft tissue of the tooth called the pulp.  Irritation of the dental pulp can be repeated many times by chewing.  Eventually, the pulp will become damaged to the point that it can no longer heal itself.

Early diagnosis is extremely important since cracks in teeth often start small and progress slowly.  Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.  A crack that extends into the bifurcation of the tooth, called a split tooth, is not restorable and will need extraction.

Traumatic dental injuries can occur in children and adults as the result of an automobile accident, sports injury, altercation or bad fall. The severity or type of injury will determine if treatment is necessary. When the dental pulp is injured, root canal treatment may be needed. It is imperative to see the dentist as soon as possible following any traumatic injury. Chipped teeth account for the majority of all dental trauma. Other injuries include dislodged teeth, knocked-out teeth and root fractures. An Endodontic evaluation is usually recommended by the general dentist following an injury.

Children's permanent or adult teeth that are not fully developed at the time of the injury may need special attention. In the immature adult tooth, the tip of the root is open and the root canal walls are thin. An injured immature tooth may need one of the following two procedures to improve the chances of saving the tooth:

Apexogenesis - the injured soft tissue inside the tooth is covered with a medication to encourage further root growth. As the apex continues to close and the walls of the root thicken with maturation, no further Endodontic treatment may be necessary. However, apexogenesis is not always successful and the pulp tissue may die requiring the following procedure.

Apexification - the unhealthy pulp tissue is removed by the Endodontist who then places a medication into the root to help a hard tissue form near the apex or tip of the root. This provides a barrier for the eventual placement of the root canal filling.

Both of the above procedures usually require multiple visits to the Endodontist to monitor the immature tooth and how quickly it is maturing.

Traumatic dental injuries can also cause a process called resorption to occur, sometimes years after the original injury. Resorption occurs when the body, through its own defense mechanisms, begins to reject the hard tooth structure. Again, it is prudent to see your dentist as soon as possible following any traumatic dental injury.