What Can Be Done for a Cracked Tooth? Your Guide to Saving Your Smile

If your tooth is cracked, will you have to get it extracted? Or even need a root canal? The good news is, no, not necessarily! So if you’re wondering what can be done for a cracked tooth, this post is for you, my friends!

What Can Be Done For A Cracked Tooth? The Importance of Diagnosis

The first thing I want to make clear is there is a diagnostic difference between a cracked tooth and what we call a vertical root fracture. Unfortunately, vertical root fractures really do have to be extracted. But cracked teeth? They have a chance!

The trouble is, a lot of dentists use these terms interchangeably, which can lead to confusion as a patient about what’s really going on with your tooth. So if your dentist lets you know your tooth is cracked and needs to be extracted, don’t be afraid to confirm that it’s truly a vertical root fracture, and NOT just a crack. If it is, then their treatment plan for you is right on the money.

If not… Well, your tooth might be saveable with a root canal!

In fact, in some cases, you may not even need a root canal to treat a cracked tooth. When the crack is small enough, a simple crown may be sufficient to keep out bacteria and prevent your tooth from splitting into two pieces.

This is why proper diagnosis through a thorough endodontic evaluation is SO crucial. If your dentist doesn’t take note of your symptoms and history, conduct cold and percussion tests, and take imaging of the tooth before deciding on a diagnosis, you could end up losing a tooth or even receiving a root canal unnecessarily. Having been in this type of situation myself, let me be the first to say that it’s best to do everything you can to avoid these outcomes!

To help you understand the importance of diagnosis and what can be done for a cracked tooth, let me share two real-life tooth stories that resulted in saved teeth—one rescued from being extracted, and the other from needing a root canal altogether.

Tooth Story #1: A Cracked But Saveable Tooth

Our first tooth story showing the possibilities for what can be done with a cracked tooth demonstrates just how helpful root canals can be in making sure your teeth stick around as long as possible!

When the patient came into my office, the first thing I did was conduct an endodontic evaluation, which included gathering their symptoms and history, performing diagnostic tests, and taking imaging. Remember: this part of the process is extremely important to ensuring you get the right diagnosis!

The percussion (or tapping) test found that the tooth was tender, and there was absolutely no response when the tooth was exposed to cold. I also evaluated the gum, and the probings were normal. So, with those data points in mind, I diagnosed tooth #31 with Necrotic Pulp and Symptomatic Apical Periodontitis. 

On the patient’s x-rays, I didn’t spot any super-obvious ways for bad bugs to get into the pulp of the tooth:

Buuuuuut the nerve had died, which only happens due to bacteria. So, I knew there had to be a way the bacteria was getting in there—even if there was just a microscopic crack!

Upon physical examination, my suspicion was confirmed:

This is tooth #31, which is on the lower jaw, and it’s a second molar. If you look super closely, you can actually see a crack in a spot that’s really vulnerable to that sort of thing happening.

Now that I had found a cracked tooth, it was time to decide what could be done about it!

Proceeding to a Treatment Plan

As a self-proclaimed tooth saver committed to rescuing as many teeth as possible from extraction, I didn’t automatically assume the tooth was nonviable. Instead, I talked with the patient about what was going on and what their options were, remaining honest about the fact that while I hoped to be able to save the tooth for the rest of their lives, I might only be able to give it a month. I wouldn’t know until I took a look inside. With all the information laid out on the table, the patient agreed to allow me to access the inside of the tooth so I could continue to get an even better look at the situation.

I cannot stress enough how important this part of the process is! As a patient, it’s vital you have the opportunity to fully understand what’s happening with your tooth, ask questions, and be presented with your treatment options. That way, you’re in the driver’s seat when it comes to your health, and you can feel confident that you’re making a fully-informed decision that’s right for you. 

As part of that, I want you as the patient to understand that a cracked tooth CANNOT be diagnosed from imagining alone in most cases. Your provider must take a look inside to see how big the crack actually is before making a diagnosis and suggesting a treatment plan. So if your dentist insists on extracting your tooth without first accessing it, I urge you to speak up! If that means getting a second opinion from another provider, then so be it. It’s worth it if it means saving your tooth!

Now, back to the story…

Before I opened up the patient’s tooth, I reiterated that there were two ways the treatment would go. Either we’d find that the tooth was saveable through a root canal, or we’d get in there, discover it wasn’t restorable, and I’d have to refer them for extraction.

Luckily, the first scenario is what happened! The root canal was finished successfully, and here’s how it looked after I was done:

Following the procedure, I told the patient to go to their restoring dentist to get a crown on the tooth immediately (instead of the usual two weeks), so the tooth could be prevented from cracking further. This is another reason why endodontic evaluation and proper diagnosis are so crucial. When you catch a crack early and treat it appropriately, you can avoid further complications—including extraction!

Three Cheers for Another Saved Tooth!

A year later, the patient came back for a follow-up. Here’s how it looked compared to the radiograph I took before treatment:

Do you see how the gray shadows under the roots earlier are now totally filled in with bone? That means this is an intact, healthy tooth. Hooray! 

This goes to show that when it comes to what can be done for a cracked tooth, in many situations (although not all), you can seek out endodontic treatment to save it from extraction and keep your natural smile!

Tooth Story #2: Not Every Cracked Tooth Needs a Root Canal

Our second tooth story will probably be music to your ears, because it centers on a very important and lesser-known fact: Not every cracked tooth needs a root canal! 

That’s right—not only is extraction sometimes avoidable, but root canals can be too. It usually depends on the size of the crack and how your dentist proceeds with treatment. As this tooth story will show, if the crack is small and your symptoms are mild, you can sometimes reverse the need for a root canal by simply applying a crown first and waiting to see what happens.

Don’t believe it? Then keep reading!

Getting the Right Cracked Tooth Diagnosis… and Treatment!

The patient was referred to my office by her general dentist, who was adamant she needed a root canal. While she did have some sensitivity to cold and pain while biting (which can suggest the need for RCT), I wasn’t immediately convinced that was the path forward. Her symptoms were pretty mild, so I wanted to do some further investigating before making a diagnosis. 

Here were her preoperative radiographs:

Given everything I had discovered during my endodontic evaluation, I believed she had what we call reversible pulpitis, which is inflammation of the pulp that hasn’t yet killed the tooth’s nerve. If I was right, that meant we could save her tooth without the need for a root canal! 

In situations like this, when there’s a chance the inflammation and symptoms are reversible, I opt to proceed as conservatively as possible by placing a crown FIRST. Why? Because even if she ended up needing a root canal after all, she’d still need the crown, and 50% of the time, the crown alone is enough to get rid of the symptoms. I mean, imagine how angry you’d be to find out that you had spent unnecessary time and money getting a procedure you didn’t actually need. I am NOT about to do that to my patients!

Even so, I always make sure to communicate with them before deciding together what to do for their cracked tooth. First, because it’s YOUR body and YOUR health! You should always be the one calling the shots, even if the decision seems like a no-brainer. And second, because it’s important to discuss the postoperative possibilities. Yes, a simple crown can work in 50% of cases like this, but the other half of the time, the symptoms could stick around or even get worse, which would result in the need for a root canal.

So, I talked with my patient about what was going on and got her stamp of approval before moving forward with the plan.

Pain (and Root Canal) Free

After my cracked tooth diagnosis and suggested treatment plan, the patient went back to her dentist to get her temporary crown. We then waited for about a month to see how the tooth would respond. During that month, it was SUPER important that the patient try to run that tooth through the gauntlet: expose it to hot, cold, crunchy, ANYTHING she would expect to cause symptoms. That’s because if she avoided using the tooth for any reason, we wouldn’t get the information we needed to know if the inflammation was improving.

Fortunately, the patient did what she was instructed to do, and even more fortunately, the treatment worked! When she came back in for her follow-up, I re-tested her tooth for pain and sensitivity, but everything looked good:

(Remember: It’s crucial you keep those follow-up appointments. Even if you feel symptom-free, that doesn’t mean you’re in the clear. It takes evaluation by a dental professional to determine whether you’ll need further treatment or not.)

Since the patient was feeling symptom free and had passed my diagnostic tests with flying colors, we gave her the green light to return to her general dentist and get a permanent restoration. Another tooth saved—and this time without a root canal!

What YOU Can Do for a Cracked Tooth

I hope these tooth stories have shed some light on what can be done for a cracked tooth so that, if it ever happens to you, you know what to expect and feel empowered to ask questions that can help you make informed decisions about your dental care.

As an endodontist, stories like these remind me just how important it is to give teeth a chance. A cracked tooth does NOT mean extraction, and as you saw, it doesn’t even necessarily mean a root canal, either. As dental professionals, we owe it to our patients to make sure we’re doing a proper endodontic evaluation, making the right diagnosis, and choosing the treatment plan that’s going to save them time, save them money, and save them from unnecessary suffering.

But as a patient, is there anything YOU can do when it comes to your diagnosis and treatment?

Absolutely! 

1. If you’re experiencing symptoms, see your dental provider right away. I understand that seeing the dentist can bring a lot of patients anxiety. But seeking prompt evaluation and treatment can not only save your tooth but also prevent you from needing a more expensive and intensive treatment like a root canal.
2. Don’t be afraid to ask questions. Your teeth, your health, your life! You have every right to fully understand what’s going on with your teeth and what your options are for treatment, and don’t let anyone make you feel otherwise. If you’re not sure about what your dentist is telling you, I want you to feel empowered to ask questions and even seek a second opinion if it’s going to give you peace of mind about your path forward.
3. Keep your follow-up appointments! Always, always, ALWAYS keep your follow-up appointments. This is true no matter which treatment plan you and your provider have chosen. Follow-ups are crucial to ensuring your treatment is going, or has gone, according to plan.

Take Control of Your Oral Health

Walk into your next dental appointment feeling calmer and more confident than ever by enrolling in my online, self-paced course Tooth Wisdom: The Empowered Patient’s Guide to Oral Health. Designed especially for patients who want to find a trusted provider, get out of pain, and better understand how to care for their teeth, the course is full of quick, easy-to-understand video lessons and downloadable resources that will help you become your own best advocate at the dentist’s office.

– Sonia