A cracked tooth can be a painful problem with an unpredictable future. Cracks can be very superficial and cause no symptoms or can be so extensive that a tooth extraction is required.
Generally speaking, cracks always progress and worsen, but the rate of progression varies. We tend to see cracks associated with large fillings, but unrestored and unworn teeth can also crack due to stresses that teeth encounter over time. A strong bite, habits such as ice chewing, and repeated cycling of hot and cold over the years can lead to cracks. When a crack is detected, it is often a good idea to try to remove the crack and restore the tooth.
If we are unable to completely remove the crack and place a filling, a determination whether or not to provide more protection in the form of a crown or onlay must be made. Crowns or onlays can often stop the progression of a crack, but not always. It a tooth has become symptomatic to temperatures or pressure due to a crack, the likelihood that the tooth will need a root canal (despite restoring the tooth) increases significantly.
If a crack in a tooth extends below the bone and causes bone loss or progresses into the pulp of the tooth causing inflammation, the long-term prognosis is greatly compromised. At that time, one should consider removal of the cracked tooth and a tooth replacement option such as a dental implant, bridge, or removable partial denture.