There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In cases where the crack is not too deep, root canal therapy can be performed, and the natural tooth can remain in the mouth. In other situations, the tooth is too badly damaged and requires extraction.
Here is a brief overview of some of the most common types of cracks:
Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.
Oblique supragingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will remain unaffected.
Oblique subgingival cracks – These cracks extend beyond the gum line and often beyond where the jawbone begins. When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown) and endodontic treatment to place a crown or other restorative device.
Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can usually save the tooth.
Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible, depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.
Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.