What should I do if my tooth is cracked and doesn't hurt?

This finding is fairly common when I examine patients, especially those who brux or grind their teeth at night. When I perform a dental examination I look closely at the occlusal surfaces of my patient's teeth. Not only am I on the lookout for caries and broken fillings, but I am also looking for white or black lines that maybe evidence of a vertical crack. Although it is tempting to leave teeth with cracks that are not symptomatic alone, this probably is not the best approach.

Cracks in teeth do not heal themselves and cracks tend to propagate as time goes by. Waiting until a cracked tooth hurts is probably not an optimal approach. I find that the best way to deal with most teeth that exhibit a visible crack is to excavate the tooth. This involves taking out any existing filling in the tooth and also making a channel at the site of the visible crack. This channel is usually approximately 2 mm deep for posterior teeth (premolars and molars) and shallower for anterior teeth. Once the channel is completed and any fillings removed, I shine a bright bonding light on the tooth in order to help detect any residual cracks in the tooth. If there are not remaining cracks in the tooth then the tooth can be either filled with composite or if the amount of missing tooth structure warrants it, a crown can be treatment planned. In the event that I am treatment planning a crown, I place an interim Miracle mix restoration. Not all anterior teeth with cracks require crowns.  Occasionally some anterior teeth (incisors) with cracks can be bonded as a repair.

 Most posterior teeth with cracks that are still visible after an excavation should be crowned. This treatment plan will help distribute the biting forces to the tooth and help prevent cracks from propagating. If the crack is significant, the patient is advised that if the tooth becomes symptomatic after crowning it may require endodontic therapy.