Cracked Tooth

• •Sharp, brief pain when biting on something hard, or when releasing the bite.
• •Sensitivity to cold or sweets that disappears within seconds.
• •Pain that comes and goes for weeks or months without ever becoming constant.
• •Discomfort that you cannot localize to a single tooth at first.
• •Often no visible damage and no obvious finding on a regular two-dimensional X-ray.

Years of normal chewing forces, grinding (bruxism) at night, large old fillings that weaken the surrounding tooth structure, biting unexpectedly on a hard object (an olive pit, a popcorn kernel), and prior trauma all contribute. Lower second molars and upper first molars are the most commonly cracked teeth.

An endodontist combines several tests: a bite-stick test that reproduces the pain, examination under the surgical operating microscope with high magnification, transillumination, and three-dimensional CBCT imaging on the J. Morita Veraview X800 in Endo Mode (80 µm voxel, 40 × 40 mm limited field of view — the small-volume protocol the AAE/AAOMR Joint Position Statement on CBCT in Endodontics recommends) when the crack is suspected to extend below the gumline. No single test is definitive — the diagnosis is built from the pattern.

Treatment depends on how deep the crack runs. A crack confined to the enamel and outer dentin can often be saved with a crown alone. A crack that has reached the pulp typically requires root canal therapy plus a full-coverage crown. A crack that extends below the bone level (a vertical root fracture) usually cannot be saved and the tooth must be extracted.