Cracked teeth (CT) are becoming more common and are often difficult to diagnose and/or manage. A crack may be mild and confined to the crown (top) of the tooth, or it may extend into the root. With early diagnosis most cracked teeth can be saved. Left alone, a crack can progress to a vertical root fracture at which point the tooth is usually unsalvageable.
There may be symptoms such as a sharp, brief pain/discomfort triggered by biting or cold, and/or may be episodic in nature. In some cases, the symptoms may be hard to localise. This is why timely referral to a specialist endodontist is desirable as early management improves prognosis.
I have carried out clinical research on the diagnosis of fractured teeth, and am the lead author of the European Society of Endodontology position statement on longitudinal cracks and fractures of teeth (2025), this guidance is used by dentists and specialists across Europe to help them manage these cases. Dentists regularly refer cracked tooth cases to me, and patients increasingly self-refer via friends, family or this website.
How do I know my tooth is cracked?
When you bite down on a cracked tooth in a particular position, the two sides of the crack flex apart and stimulate the nerve inside the tooth. The result is a sharp, instantaneous pain often on one specific part of the bite, and sometimes on release rather than on biting.
In some cases, symptoms may be vague and/or inconsistent: brief, episodic, triggered by cold, and hard to localise to a specific tooth. It is common for patients to see me after months of pain that their dentist(s) have been unable to diagnose.
What is a vertical root fracture?
A vertical root fracture (VRF) is a crack that runs along the root of the tooth, most commonly in teeth that have already had root canal treatment. In the early stages a VRF may cause no obvious pain and show no visible crack on the surface. Often the first sign of trouble is recurrent discomfort or a gum boil (abscess) next to the tooth that keeps returning.
Diagnosing cracks
Cracks and VRFs can be challenging to confirm, even for experienced dentists, because conventional 2D X-rays rarely show them. I use a dental operating microscope together with a high-resolution, small field of view CBCT scan to help me determine the presence of a crack. In my experience this is the most effective combination for finding a crack, establishing how far it extends, and deciding whether the tooth is treatable.
Can a cracked tooth be saved?
Yes! If it is diagnosed early enough. A tooth with a contained crack may simply need a crown to 'brace' the tooth together and reduce the likelihood of the crack progressing further. Root canal (Endodontic) treatment may be needed first, if the crack is close to, or has affected the nerve of the tooth, the tooth would then be restored with a crown to reduce the likelihood of the tooth fracturing.
Research has shown that when cracked teeth are effectively managed using a minimally invasive approach, survival rates of over 95% can be achieved. The sooner the diagnosis, the more options you have and the better the outlook for your cracked tooth.
Vertical root fractures have a poor prognosis. In selected cases the affected root can be resected to keep the rest of the tooth, but in most cases, extraction is the only realistic option. The value of a specialist assessment is finding out which of those situations you are in before unnecessary time and money are spent on treatment.
Can cracked teeth be prevented?
No, but you can lower the risk. Avoid chewing very hard foods, for example, boiled sweets, ice cubes, the crust of sourdough bread, cracking nutshells (yes, people do this!).
You may be clenching your jaw muscles and grinding your teeth at night and also possibly during the day. It is important for your teeth not to be in contact during the day (apart from when you are eating). You should consciously ask yourself if you are clenching your teeth during the day, perhaps when you are sitting in traffic, exercising, concentrating, listening to your partner moaning etc. If you notice that you are clenching during the day, then you must consciously try to avoid this habit. This type of grinding habit is called Bruxism. If you grind your teeth at night, a well-made hard acrylic nightguard protects them. It will help to reduce the likelihood of your teeth, and existing and new restorations, from fracturing in the future.
Teeth which have big and/or deep fillings are weaker than unrestored teeth and therefore more susceptible to fracturing. In these cases, your dentist may recommend a crown to reduce the likelihood of crack initiation and/or an existing crack from worsening, this is especially important if you grind your teeth together and/or have a history of fracturing your teeth.
What is the difference between a cracked tooth and a vertical root fracture?
A cracked tooth involves the crown (the visible part of the tooth) and may or may not extend into the root. A vertical root fracture is confined to the root itself. The distinction matters because the treatment options and prognosis differ significantly: a contained crack caught early can often be managed; a VRF has a much poorer outlook and in most cases requires extraction.
What happens if a cracked tooth is not treated?
An untreated crack can progress deeper into the root over time, eventually becoming a vertical root fracture. At that stage the tooth is usually unsalvageable and extraction is the only realistic option. Early diagnosis gives you the most options and the best outcome.
Why are cracked teeth becoming more common?
Greater awareness, longer-surviving heavily restored teeth, and an increasing prevalence of bruxism all play a role. Also, cracked teeth are being detected more frequently now that 3D CBCT imaging is more widely available in specialist practice.
Do I need a referral?
A referral from your dentist is the usual route. Dentists regularly refer cracked tooth cases to me, and patients also self-refer directly. If you have a specific concern and your dentist is unsure whether to refer, you are welcome to contact me directly.