Outcomes of tooth breakage and fracture. -

Various scenarios that may play out with broken teeth, and how they can be repaired.

A dentist will sometimes recommend placing a dental crown on a tooth because they feel that doing so will help to strengthen it (make it less prone to fracture).

As an alternative, sometimes a large dental filling is placed, or, if the tooth is not currently displaying any symptoms, possibly no treatment at all.

However, while these alternatives may seem like viable options, choosing them does come with potential consequences. This page discusses some possible scenarios that might come into play if a tooth that is a candidate for a dental crown doesn't receive one.

Possible outcomes for teeth that aren't protected with a dental crown.

  1. The tooth will crack - The tooth may or may not have pain.
  2. The tooth will fracture - A piece may come off or is loose.
    1. With or without pain.
    2. Can the tooth be rebuilt?
    3. Why periodontal and/or root canal treatment may be required.

[ A red asterisk (*) in our discussion indicates a potentially significant problem that the placement of a dental crown could have prevented.]


A tooth whose filling played a role in it cracking.

The tooth has cracked but no piece has separated off.

A) The tooth will crack (no piece breaks off or becomes mobile).

One possible outcome for a tooth that doesn't receive the protection of a crown is that it will crack. And unlike bones, cracks in teeth don't heal.

In fact, once a crack has formed, it may increase in size over time due to its repeated exposure to heavy biting forces (placing a crown early on may prevent this outcome).

1)* Teeth that crack - Some pain or discomfort is involved.

Cracked teeth can be sensitive. When biting pressure is applied, the portions of the tooth on each side of the crack can shift, thus triggering a painful response.

Here are some of the the classic signs of a cracked tooth:

  • The tooth gives you a sudden, sharp pain when you bite down.
  • The pain subsides immediately once the biting pressure has been released.
  • You may not feel the pain every time you close. Sometimes it takes biting or biting on something, at just the right angle, to trigger the response.

What treatment remedies exist for cracked teeth?

If you have a cracked tooth, there can be a range of solutions.

Uninvolved cases.

If your symptoms are just minor, it's possible that your dentist may determine that your tooth requires little or no treatment. Sometimes just buffing the tooth down so it's a tiny bit shorter than its neighbors provides a lasting solution.

A dental crown placed over a cracked tooth.

A crown can splint a cracked tooth together.

When more major repair is needed.

Especially in the case where your symptoms are persistent or severe, your dentist may determine that a dental crown should be placed (so to splint the tooth together and prevent further cracking).

In the most extreme cases, they may determine that the crack reaches deep into the interior of the tooth and that root canal treatment is required before a dental crown can be placed.

2) Teeth that crack - Little or no pain is involved.

Not all cracked teeth produce significant, or consistent, symptoms. In fact, it can be very difficult for a dentist to diagnose exactly which tooth lies at fault. It may take some period of time, including investigation on your own while at home, to identify which tooth lies at fault.

  • Tooth cracks can be exceedingly difficult, if not impossible, to visualize. Dentists sometimes locate them by applying a dye that seeps into the crack.
  • Obvious "cracks" that produce no symptoms are often just tooth enamel craze lines that require no attention.
  • It's rare that a crack will show up on a dental x-ray. To be visible, the crack would have to lie in perfect alignment with the orientation of the x-ray machine's rays. While possible, this alignment rarely occurs.

B) The tooth fractures (a portion comes off or becomes mobile).

Some tooth trauma results in outright fracture (a portion physically separates). The piece that comes loose may break away cleanly or, if it's still attached to its gum tissue, it may remain relatively in place.

1) Reasons why a fractured tooth might (or might not) hurt.

The amount of discomfort caused by a tooth that has broken will vary depending on the specifics of the situation. Here are some possible scenarios.

A) The tooth may not be painful at all.

Not all teeth that break hurt. The broken fragment might be very small, or off an area that's relatively far from the tooth's pulp tissue ("nerve").

In other cases, the tooth's nerve may already have died or been removed via root canal treatment.

B) The tooth may have sensitivity to hot and cold.

Some fractured teeth hurt, hurt more so, or only hurt when exposed to hot and cold temperature extremes, like those caused by foods and beverages.

  • Having the situation where your tooth is bothered by thermal changes but then immediately settles back down frequently indicates that its nerve is still healthy and once a repair is made, everything will be fine.
  • At the other extreme, a painful response to heat that lingers may indicate that the tooth's nerve is compromised and will require root canal treatment before the tooth can be permanently repaired.
C) Broken teeth can irritate soft tissues.

Sometimes the pain associated with a broken tooth comes from the soft tissues (cheek, tongue, lips) that rub against its sharp edges.

D) The tooth may be painful to biting pressure.

Sensitivity to biting pressure can be an indication of a number of different conditions.

  • It may suggest that beyond just fractured (has a piece missing) the tooth is cracked too. In this case, when pressure is applied, the cracked portions shift, thus causing pain.
  • Another explanation could be that the tooth has fractured but the loose portion is still attached to gum tissue (and therefore hasn't fallen off yet). When pressure is applied, the loose fragment shifts position, thus causing gum-tissue pain.
  • In yet other cases, the tooth may have broken coincident with its need for root canal treatment and the pain is a sign of that underlying condition.
E) Some broken teeth are spontaneously painful.

A tooth that hurts on its own, without any provocation, suggests that its pulp tissue has been significantly traumatized by the tooth's fracture. It's possible that the tooth will require root canal treatment before the tooth can be rebuilt.

A broken tooth.

Fracture where a piece has separated.

2) Most teeth break in a way that is easily repaired.

It's not always a catastrophic event when a tooth breaks. And, in fact, in most cases it usually isn't. However, any tooth that has fracture should always be inspected by your dentist.

Prompt attention is needed.

A stitch in time really can save nine when it comes to teeth that have a piece missing. Broken teeth that are left untreated may fracture further (possibly catastrophically) or, since they now trap dental plaque and debris more easily, develop tooth decay.


It's conceivable that such a small portion of the tooth has fractured off that it only requires some minor smoothing with a dental drill, or possibly just a small filling. At the other extreme, you may find that your dentist recommends the placement of a dental crown.

A tooth that has fractured below the gum line.

Fracture that involves the tooth's root.

3) * Some teeth break in a way that cannot be repaired.

Surprisingly, even teeth that have broken off flat with the gum line can usually be rebuilt.

However, if a crack or break involves a large portion of the root of the tooth (the portion underneath the gum line), a repair may not be possible and instead the tooth will have to be extracted.

a) Cases where periodontal surgery (gum surgery) is required.

If that segment of the tooth that has broken off includes a portion of its root, a type of gum surgery termed "crown lengthening" may be needed before a crown can be placed.

That's because its edge can't lie too far underneath the gum line, or else it will affect the health of the tooth's surrounding gum tissue.

A crowned tooth that has had root canal treatment.

A crowned tooth that has had root canal.

b) Cases where root canal treatment is required.

Deep cracks or extensive breakage can result in nerve (pulp tissue) damage. And in these cases, a dentist cannot simply place a crown on the tooth.

Instead, they must first perform root canal treatment so to remedy the problem with the nerve. Once this has been completed, a dental crown can be placed.

Despite never receiving a crown, some teeth never experience a problem.

Of course, some teeth that receive some type of alternative instead of a crown never experience any problem at all.

Clearly, no dentist can know precisely what set of circumstances will transpire with a tooth. When they make a recommendation for placing a crown, they are simply advising you as to what they consider (based on their years of dental training and clinical experience) to be the most predictable treatment in regard to the long-term health of your tooth.



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