Cracked teeth bring about holiday misery
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By George Malkemus  December 13, 2013 12:00 am

The holidays came rapidly this year. Thanksgiving is barely over and Christmas is almost here.

Sonoma County is a wonderful place to live. We have so much to be thankful for, and we should take time to appreciate it, particularly in this joyous holiday season. But with our increasingly rapid pace, the holidays can be a stressful time, being ‘merry’ while doing shopping, decorating and partying while having to continue the daily routine. 

It can be particularly stressful for the many who are losing their homes and jobs and for the many people who are alone for the holidays. Giving to those in need can be the most rewarding time spent during the holidays and throughout the year.

Holiday stress can often lead to cracked teeth. Every year around the holidays, I see many patients with toothaches related to the extra stresses of grinding or clenching their teeth. This can lead to a common problem called cracked tooth syndrome.


Cracked tooth syndrome

When a cusp of a tooth cracks and begins flexing upon biting, it can cause sharp pain. This is called cracked tooth syndrome. Sometimes the sharp pain will only occur occasionally when the cusp is bitten at just the right angle. Often cold, hot or sweets will also cause the sharp pain by seeping into the crack. 

Cracked tooth syndrome is corrected by putting a crown over and around the tooth to hold the tooth together. If left untreated, the cusp will eventually fracture, causing the possible need for root canal therapy or even extraction.

Often times, the cracks are very fine and cannot be seen. So to determine cracked tooth syndrome, I have the patient bite on a dental bite stick on each cusp in a particular area until the cracked cusp is identified. 

As long as the tooth pain goes away immediately on release, it can be treated with a crown. However if the tooth pain lingers with a dull ache, then the nerve is dying and the tooth needs root canal therapy.

A cracked tooth cannot heal itself. At first a crack may be small and unobtrusive. But if it is left untreated, the crack may progress further across the tooth or deeper into the tooth. Therefore, the sooner the crack can be treated, the more likely the tooth can be saved.


Types of cracks

• A craze is a surface crack that shows as a line on the tooth enamel. Although it may not look very attractive, a craze usually does not need treatment. If there are cosmetic reasons, the tooth with the crazed enamel can be treated with a veneer or bonding.


• A fracture is a crack, usually through the cusp of a tooth that causes part of the tooth to grow weaker and even break off. A fractured cusp usually can be restored with a crown. However if the fracture extends into the nerve or the jawbone, then a root canal or extraction will be necessary.


• A split is a vertical crack that extends so deeply into the tooth that it can separate into pieces. Depending on the location and severity of the split, the tooth may be saved or need removal. Last month, I had a 45-year-old male patient that split his upper bicuspid in half. The two halves were removed and a dental implant placed under sedation dentistry. The patient never had any discomfort and could not tell he ever had a missing tooth.


• A root fracture is a crack that begins in the root of the tooth and slowly extends upward. This type of crack may not be noticed until the surrounding gum and bone show signs of infection. In this situation, the tooth usually needs removal.


Symptoms of a cracked tooth

Symptoms of a cracked tooth may include: pain when you bite down; sensitivity to hot or cold foods and beverages; discomfort when the tooth is exposed to air; and toothache for no apparent reason.

Sometimes there are no symptoms at all, only visual evidence of a crack. Other times a crack may be more difficult to identify, even with examinations or x-rays. Also, the pain or sensitivity may be intermittent, usually a sign of cracked tooth syndrome. 


Cracked tooth prevention

• Do not chew on hard items (ice, unpopped popcorn kernels, pens, pipes, etc.).


• Do not use your teeth for gripping or tearing, like opening bottles or tearing bags. 


• Do not clench or grind your teeth.


• Use a bite splint or night guard to help alleviate clenching and grinding.


• Use a mouth guard to protect your mouth when participating in sports.


A number of years ago, I saw an electrician who was continually stripping wire with his teeth. On numerous occasions, I repaired fractures of the edges of his upper front teeth with cosmetic bonding. He would confess the fractures occurred from stripping wire with his teeth. 

He knew that he should use wire strippers, but was always in a rush and could not easily find the tool. I recommended he have many wire stripping tools everywhere; it would be much better and cheaper. 

After his fifth time, I jokingly offered to drill different gauge grooves in his teeth to help him easily strip different sized wire. He laughed and began using the wire stripping tools more often.

By following these prevention tips and having regular dental checkups to monitor any emerging cracks, you can help preserve your teeth in good health. Have a great stress free holiday season.

Enjoy life and keep smiling.


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ Visit Dr. Malkemus’ website at

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