When it Hurts to Bite, but the Tooth Doesn’t Feel Broken

So you are sitting in front of the television watching America’s favorite pastime or perhaps you are in a movie theatre enjoying one of Hollywood’s new releases all the while munching on freshly popped popcorn when you are suddenly seized by severe pain in your mouth that stops you in mid-chew. OW!!! You just cracked your tooth.

This all too familiar scenario happens countless times a day sending people by the hundreds if not thousands to their dentist for an emergency visit. Interestingly, people often break their teeth on “soft” food like popcorn or spinach salad happily chewing away until their teeth gnash against some unanticipated hard object like an un-popped popcorn shell or a piece of sand.

As I have written about in a past blog, the just described dental mishap commonly leaves a tooth “temperature sensitive” with a large chunk missing and a curious tongue that relentlessly probes the jagged void (which of course can lead to a sore tongue). My discussion today is not about the obvious broken tooth, but rather the more elusively detected and diagnosed cracked tooth.

“Cracked Tooth Syndrome” is a diagnostic phenomenon in which the only symptom is pain upon biting.  There is no sensitivity to hot, cold, or sweets. There is no spontaneous or persistent discomfort that leaves someone seeking out pain medication that is typical of a classic toothache. And while these symptoms can appear later on, the chief complaint of the patient seeking relief is intermittent or consistent pain on chewing.

X-ray detection of a cracked tooth can be challenging. Being a two dimensional image of a three dimensional object, an X-ray is often not helpful in identifying the problem. If the crack is not displaced (meaning that the tooth is not visibly separated into pieces) or if the crack is running in the same plane as the radiograph, it will not show on the radiographic image. Cracked teeth generally look normal on X-ray.

Oftentimes “bite testing” can isolate a cracked tooth; namely, having a patient bite down on a special instrument or stick one tooth at a time until the patient’s ouch moment is elicited (as opposed to the dentist’s aha moment when he identifies the culprit tooth is and the diagnosis is confirmed). Sometimes, biting sensitivity cannot be provoked during the dental exam because the crack hasn’t propagated enough.

Think about a car’s windshield for a moment. A pebble strikes the glass and a small ding or is formed. As the car drives along, the vehicle vibrations cause the craze line to “run” in the glass forming an overt crack that can spread from one end of the windshield to the other. Tooth structure is not unlike glass. A small craze line can form in the body of the tooth or along its root.  Initially symptoms can be mild and erratic.

Repeated chewing can cause the defect to spread and in doing so make symptoms more pronounced and frequent. When the crack has spread sufficiently to compromise the tooth’s integrity, painful biting is the norm and localizing the affected tooth is readily accomplished. If the crack works its way towards the tooth’s pulp (nerve), more persistent symptoms may prevail like thermal sensitivity or spontaneous pain.

Treatment for a cracked tooth usually involves fabricating a restoration that supports and reinforces the compromised dental structure such as a crown or an onlay. If the crack does compromise the pulp, root canal therapy is necessary prior to finalizing any permanent restoration. Should the crack run through the root of the tooth, an extraction is often the only treatment option.

Any tooth can display cracked tooth syndrome. I have seen perfectly healthy teeth sans fillings or crowns (what we in the trade call “virgin teeth”) become cracked. More commonly, teeth with large fillings are especially vulnerable to sudden unexpected force. Unanticipated olive pits have claimed more than a few teeth among my patients.

Lastly, improperly and inadequately restored teeth, which had root canal treatment, are especially vulnerable to fracture. In fact, the number one reason that a tooth with root canal needs to be extracted is that it was not properly protected with an onlay or crown.

If you are experiencing is pain upon biting, but see no outward indication of a crack, it’s still very important to visit your dentist as soon as possible. That little bit of pain may be the indication of something that can become more serious over time.

Dr. Michael Sinkin is a NYC dentist that has been in practice for over two decades. He truly cares about the experience his patients have and takes great pride in making them feel relaxed and comfortable during every visit. Come in for an appointment and experience a different kind of dental practice. To find out more about Dr. Sinkin, please click here.