crown on cracked tooth

[sunnyB]

For a couple of years my dental hygenist and dentist have been telling me I have small cracks in my teeth, which they suspected were due to teeth grinding or clenching. I did not have any other symptoms of grinding teeth in my sleep (no headaches, jaw pain, partner not aware of it, etc.), so I didn't take it too seriously. Now I started having a pain in 1 tooth just when I bite down on it. This started only a few weeks after my most recent check-up and X-rays, in which my teeth were pronounced clean, but they warned me again about small cracks. When I talked to my dentist on the phone, she immediately suspected where the pain is without me telling her (after she checked my records -- as she had seen the crack there during my check-up), and said I need a crown (and possibly even root canal work??).  She said this can happen even with just clenching, not necessarily grinding. Is this the only way to treat a crack in a tooth? There is no way to fill it or close it up? And how will it be decided whether a root canal is also needed? Will it have to be decided on the spot? Will there be any chance to think about it? I am 38 and have always had nearly perfect teeth and good hygiene so needing all this work is quite a change for me (and I should add I have now started wearing a night guard).
Thank you for your advice!

[mike1105]

there is a huge difference between a craze line (small squiggly crack lines in the enamel which are very common and do not usually require treatment) and a fracture or crack, which needs treatment. If the fracture does not encroach on the nerve, a crown should suffice. If the nerve is involved, then root canal may be necessary. If the crack goes under the gum line, then a crown lengthening procedure may be necessary-- this procedure helps to expose more of the tooth by repositioning the gum tissue. If the crack goes down the root too far, the tooth may need to be removed altogether. My best advice is not to wait for it to get worse. Cracks are usually not restorable with fillings--the tooth needs to be covered and protected. In fact, filling the tooth may make it worse by actually wedging the tooth into two or more parts. fillings that are too large are a major CAUSE of tooth fracture.

[Matthew Baron, D.M.D.]

Night guard is a good idea.  Start with the crown and if the pain does not go away while in a temp crown go with the root canal at that point.   If the crack is deep then you may need to start the root canal at the time of crown preparation.  Good luck.