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Advanced dentistry · Diagnosis
A cracked tooth causes a sharp pain on biting or on release, sensitivity to cold and, often, nothing to see on an X-ray. At Sardinia House in Holborn we find the crack with the operating microscope, dye and a CBCT scan where needed, then repair it with bonding, a crown or root canal treatment depending on its depth. Diagnosis usually takes one visit. Consultation £150.
Consultation
£150, including imaging
Visits
One to diagnose; repair often the same day
Repair
From a bonded filling to a same-day crown
With
All our dentists; microscope assessment with Dr Spencer Richman
Who it is for
The classic sign is a sharp pain on biting something firm, or as you release, that disappears as quickly as it came. It is often hard to say which tooth it is, which is why it so often goes undiagnosed.
A crack lets cold reach the inner layers of the tooth. A twinge from ice cream that has started recently in a tooth with a large filling is worth investigating before it becomes an ache.
Molars with large old amalgam fillings are the teeth most likely to crack, as the remaining walls are thin and the metal expands and contracts. Grinding and clenching add to the load on them.
When a corner of a tooth breaks away, sometimes while eating something unremarkable, a crack has usually been developing for some time. What remains needs checking for further crack lines before it is rebuilt.
The difference
Under the Zeiss or CJ-Optik microscope a crack line that is invisible to the eye shows clearly, and we can follow where it runs. Whether it stops at the enamel or reaches the root changes the treatment entirely.
Biting on a small instrument tooth by tooth, cold testing and a dye that settles into the crack identify which tooth is responsible. Guessing, and treating the wrong tooth, is exactly what we are trying to avoid.
Cracks rarely show on a flat X-ray. A CBCT scan can reveal bone loss alongside a root or a split that has reached below the gum, which tells us whether the tooth can be kept at all.
Any of our dentists can assess and repair a cracked tooth. If the crack runs deep or the nerve may be affected, Dr Spencer Richman, our endodontist, looks at the tooth under the microscope and tells you whether a crown, root canal treatment, or the two together is the right course.
The process
When it hurts, what sets it off and how long it lasts tells us a great deal. We listen first, then examine, because the pattern of pain narrows the search before any instrument is picked up.
Each suspect tooth is bite-tested and cold-tested, then examined under the microscope, with dye if needed. Digital X-rays and, where helpful, a CBCT scan complete the picture before anything is decided.
A shallow crack can be sealed and bonded. A crack through a cusp needs a crown to hold the tooth together. A crack that has reached the nerve needs root canal treatment as well, and one that has split the root means the tooth cannot be saved.
Because the CEREC mill is on site, a tooth that needs a crown can be prepared, scanned and crowned the same afternoon. A root canal and crown can also be completed in one day when the tooth allows it.
Afterwards
After a crown or bonding, the tooth may be sensitive for a few days and should settle. Avoid very hard foods on that side for a week or so. If you grind, a night guard protects the repair and the teeth around it, and we will suggest one where it is needed. Tell us promptly if biting pain returns, as a crack can occasionally progress.
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Good to know
Pain on biting that comes and goes sharply is most often a crack. As you bite, the two sides of the crack flex apart and irritate the nerve; as you release, they spring back. Other causes include a high filling or an abscess, which is why we test rather than assume.
Usually, if it is caught early. If the crack stays within the visible part of the tooth, it can be sealed, or the tooth crowned. Once a crack has extended down the root and split it, the tooth generally has to be removed, which is why pain on biting should not be ignored.
Rarely. A flat X-ray only shows a crack when it runs in exactly the right direction. The microscope, bite tests and dye are more reliable, and a CBCT scan can show the bone changes that a deep crack causes.
The consultation at Sardinia House is £150 and includes imaging. The repair depends on what we find: a bonded filling from £399, a same-day crown from £1,250, or root canal treatment from £1,200 if the nerve is involved. Everything is quoted in writing first.
The diagnosis involves biting on a small instrument and cold tests, which can reproduce the pain briefly so that we can identify the tooth. Repairs are made once the tooth is numb; you may notice pressure, but not pain.
Only if the crack has reached the nerve, or the nerve has become inflamed beyond recovery. Many cracked teeth can be crowned without it. We assess the nerve before deciding, and we tell you if there is a chance it may be needed later.
Replace large old fillings before they fail, avoid chewing ice and hard sweets, and wear a night guard if you grind. Regular check-ups with a scan let us watch teeth that are at risk and act before they break.
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