Cracks in teeth range from the obvious, visible fractures (Figure 1a) to less obvious (frequently invisible) microscopic fractures. Frequently, those that are difficult or impossible to see are more serious. Cracks can occur in the crown of the tooth (the part you can see protruding through the gums), or in the tooth’s root, where they can be difficult to diagnose and are generally more serious. Some cracks are easily repaired with bonded fillings, while some are too extensive to be fixed at all.
A bonded filling can sometimes buy enough time for the patient to plan for the expense of a crown. At the time of the photograph, the tooth in Figure 1b had been successfully restored with a filling for a few years. However, it can be difficult or impossible to achieve ideal tooth contours with such large fillings, increasing the likelihood of an overhanging dental restoration, food compaction injuries and other potential problems.
Considering the risk of a fracture spreading through the tooth, the most reliable protection is generally achieved with a full coverage restoration like a crown or onlay. Both of these restorations are made outside the mouth, where it’s usually easier to achieve ideal contours that will blend smoothly with the tooth. Moreover, without the protection of a full coverage restoration, the patient may be at increased risk of losing the tooth if the crack should spread deeper into the tooth.
Only a dentist is qualified to diagnose and appropriately treat the tooth, taking into account the extent of the crack as well as the patient’s symptoms, history, habits, personal needs, presence (or absence) of an opposing tooth, bite relationship between the teeth; and other factors.
Chipped teeth are more common in children and people who participate in sports. Chips in teeth vary in severity, depending on their cause. In children, front teeth are prone to chips, because they frequently project forward when they first come into the mouth—making them vulnerable to injuries. The teeth generally remain in such a position for a couple of years while the jaws are developing and the primary front (anterior) teeth are being lost. Children of that age often like to roughhouse with their friends and family members, and their teeth sometimes get in the way.
Adolescents and adults who play sports, and don’t use athletic mouthguards or full-face helmets to protect themselves, are also more likely to chip the front teeth.
Back teeth frequently chip, but usually the cause is related to biting or chewing hard foods, like ice or popcorn kernels. This is especially true if the chipped tooth has large, internally-retained dental restorations (for example, dental fillings, inlays) present. Chips that occur at, or above the gumline are generally more favorable than cracks, which can extend deep within the tooth and allow bacteria to get inside the pulp. Also, since dental bonding became available, chips above the gumline are comparatively easy to fix—at least long enough to consider other options.
With chipped teeth, each patient’s situation is unique. The size of the chip, the vitality of the tooth, as well as the patient’s oral habits, age, and general health help determine the treatment options.
There are many different treatment options, including fillings, inlays, veneers, inlays, and crowns.