Dental Fissures: Causes and Treatment

A dental crack can lead to the loss of your tooth. We tell you what to do if you have a crack in your teeth and how to treat it.

Written and verified by the dentist Vanesa Evangelina Buffa.

Last update: 28 September, 2022

Dental fissures can be caused by chewing something very hard, by grinding the teeth or by the body’s own aging. In some cases they causes discomfort and, at other times, they go unnoticed.

Although this type of lesion in the teeth isn’t talked about so much, they’re quite common. In fact, they affect 40% of the population and men and women equally. The age group most affected is usually between 30 and 60 years of age.

Dental fissures are one of the main causes of tooth loss in industrialized countries. But don’t panic, treatments are available to help maintain cracked teeth in the mouth. We’ll tell you all about it.

What are dental fissures?

A dental fissure is a crack without detachment in the dental structure. It’s a crack that opens on the surface of the tooth.

This lack of continuity in teeth can go unnoticed, especially when it only involves the enamel. In these cases, it’s usually found by the dentist during dental checkups. But, on other occasions, the dental fissure causes different complications, such as sensitivity, infections, or even the loss of the tooth.

There is a condition known as cracked tooth syndrome, a pathology characterized by pain when chewing, caused by the presence of a fissure. Because it’s a very small crack and the patient has no history of previous lesions, it’s difficult to detect and diagnose.

Age is an important factor in the appearance of these conditions. As we mentioned, they usually occur in people over 30 years of age, and especially after the age of 50.

However, age isn’t the only element to consider. They can also occur in young people. Let’s look at their causes in detail.

Causes of dental fissure

There are several oral situations that can favor the appearance of a dental fissure. These are the most frequent:

• Bruxism: Clenching and grinding of the teeth weakens them, making them more susceptible to cracks. In addition, the excessive force of this habit is enough to generate spontaneous cracks on the surfaces. This is especially true for molars.
• Large fillings that weaken the integrity of the tooth.
• Biting or chewing very hard food, such as nuts, ice, or candy.
• Trauma: A blow to the mouth can damage the integrity of the tooth. Traffic accidents, a fall, sports injuries, and fights are some situations that can cause this type of trauma to the teeth.
• Abrupt changes in the mouth temperature: For example, when eating something very hot and then trying to cool the mouth by drinking something cold.
• Teeth with root canals: Teeth with root canals, lacking vitality due to a lack of pulp, become dehydrated over time. These structural changes weaken the endodontic elements, increasing the risk of cracking when biting into something a little harder than usual.
• Teeth with temporary fillings: While waiting for the dental laboratory to fabricate a definitive restoration, such as bridges or crowns, the teeth are covered with temporary pastes. When biting down hard on something with these fillings, the teeth can crack, especially if they have already had root canal work. In these cases, root cracks are the most common.
• When a pin is removed: The maneuvers carried out to remove a pin from the inside of the tooth can cause cracking of the root area, which is already weakened by the previous treatment.

Types of dental fissures

Dental fissures can vary in their seriousness, depending on the dental tissues involved, the areas of the tooth that they affect, and their direction. It’s important to study the complexity of the crack in the tooth because, depending on the type of lesion, different treatments will be chosen to solve the problem. According to the tissues involved and the magnitude of the problem, we can distinguish these two types:

1. Superficial dental fissures: These only affect the enamel and don’t cause pain or discomfort to the patient. In general, they don’t require treatment, although dentists often prefer to seal them to prevent the filtration of pathogenic bacteria.
2. Deep dental fissures: Deep fissures are those that extend beyond the enamel, involving the dentin and even the pulp. They cause pain and other discomforts, so different treatments will be necessary to reverse the situation. If the crack extends below the gum line, extraction of the tooth is usually necessary.

As we said, there are also other types of classifications. Depending on the area of the tooth affected, we can distinguish fissures of the crown, of the root, or of both parts.

The shape and direction of the fissure is also important, especially during the etiological diagnosis and when deciding on the treatment. Thus we can classify cracks as horizontal, vertical, or oblique.

Symptoms of dental fissures

Some types of dental fissures don’t produce symptoms and can go unnoticed. Especially when they’re superficial lesions in the enamel.

Other times, cracks in the teeth can be the cause of different types of discomfort. The deeper and more extensive the crack, the greater the symptoms. Although the pain varies from patient to patient.

Acute but discontinuous discomfort, which comes and goes, is one of the common manifestations of these conditions. Pain when chewing or biting, especially at the moment of releasing the bite, is also characteristic.

The pressure of chewing separates the fragments of the fissure, producing pain. Then, when relaxing the bite, the crack closes again quickly, causing a new sharp and very uncomfortable sensation.

Sensitivity to heat, cold, and sweets is another discomfort associated with dental fissures. Swelling and inflammation of the gum surrounding the painful tooth is also quite common. Finally, in some more evident cases, it’s possible to see and notice the crack on the surface of the tooth.

How is a cracked tooth diagnosed?

If you have some of the symptoms mentioned above, you may have a dental fissure. The best thing to do in this case is to go to a dentist for a check-up.

To reach an accurate diagnosis of a cracked tooth, it’s always necessary to go to the dentist. The dentist has several resources, although detecting the disorder can often be difficult.

Firstly, the dentist will ask questions about medical history, habits, and situations that could be associated with a crack in the teeth. A history of a blow to the area, chewing very hard foods on a regular basis, or suffering from bruxism are some causes that can guide the dentist.

Once in the chair, the dentist will check the tooth thoroughly, using good lighting and even a magnifying glass. They may also move a dental explorer over and around the tooth to detect irregularities or edges that may catch on the instruments.

The use of dental stains or dental developers is also useful. These pigmented liquids run down the fissure, making it visible.

Gingival probing is a maneuver that allows the dentist to look for gum inflammation and identify vertical cracks that could be causing it. X-rays aren’t able to reveal small fissures. However, the dentist may resort to this type of test to look for other associated problems.

Dental fissure treatments

Once the dentist diagnoses the dental fissure, they can plan the most appropriate treatment for each case. The procedure to be performed depends on several factors:

• The location of the crack
• The size of the lesion
• The tissues involved
• Whether or not it extends below the gum line
• If the patient has associated symptoms

Based on this data, the dentist may resort to some of the following procedures:

• No treatment: In tiny cracks on the enamel, which don’t affect the appearance or cause pain, it may be better not to touch them and only perform periodic controls.
• Polishing: When the cracks aren’t very deep, the tooth surface can be polished.
• Sealing: In the case of shallow cracks in the enamel, a sealant is applied, which is a fluid resin that runs through the crack and fills it. This prevents bacteria from seeping into deeper areas.
• Fillings: When the crack is more extensive, it’s restored and filled with plastic resins that restore the function and esthetics of the tooth.
• Crowns: Crowns are the solution for cases of very extensive cracks that compromise a large part of the tooth. They’re also used to rehabilitate teeth that have undergone root canal treatment.
• Endodontics: If the dental fissure reaches or affects the pulp, it will be necessary to perform an endodontics procedure. With this procedure the internal tissue of the tooth is removed, the space is sealed with special materials and then the tooth is restored to recover the lost anatomy.
• Extraction: When the fissure is very extensive, affects the root zone, or compromises other neighboring structures, tooth extraction will be necessary. Prosthetic alternatives will then be sought.

What to do if you suspect you have a dental fissure?

If you have hit your mouth, have bruxism, or have felt something strange in your teeth when biting on very hard food, you could have a dental fissure. If you feel tooth pain when biting, or very hot or cold drinks cause you discomfort, it may also be due to a crack.

In these cases, the ideal thing is to go to the dentist as soon as possible to confirm the diagnosis and seek a prompt solution. However, until the dentist can see you, there are some steps that will help you to reduce the discomfort and avoid worsening the problem.

A very useful tip is to avoid chewing on the side where you suspect the crack is. In addition, the ideal thing is to eat soft and easy-to-eat food that doesn’t require much chewing effort.

Avoid hard foods.

If the pain becomes very intense, ask your dentist about the possibility of using an over-the-counter painkiller until you can get an appointment. Never self-medicate, as you could compromise your health.

Complications of a dental fissure

A dental fissure that isn’t treated in time can lead to secondary caries, irritate the dental pulp, or fracture the element. The tooth can even be lost completely.

Cracks can also have complications, causing infections. These can spread to the bone, gums, and, in the most serious cases, to other areas of the body.

If you feel dental sensitivity to cold or heat, a lot of pain when chewing, your gums swell, you have bad breath and a bad taste in your mouth, or you notice swelling in your neck or face, you should see your dentist urgently. Also, if you have fever, palpitations, or difficulty swallowing, speaking, or breathing.

These symptoms indicate an infection in the mouth that should be treated immediately to avoid more serious consequences. Your dentist will seek to drain the pus from the process and prescribe antibiotics.

Prevention of dental fissures

The best way to treat dental fissures is to prevent them. While sometimes it may not be possible, you should know that with some simple practices it’s possible to preserve the integrity of your teeth.

Healthy, strong teeth are less likely to crack. For this reason, a good way is to practice proper dental hygiene.

Brushing your teeth twice a day with fluoride toothpaste, flossing daily, and eating a healthy diet help keep your teeth healthy. Visiting the dentist every 6 months for preventive care and damage control is also important.

In addition, to protect the hard tissues of your teeth and prevent them from cracking, it’s advisable to avoid chewing hard foods. If you practice high-risk sports you should use a mouth guard and, if you suffer from bruxism, mouth guards will also protect your teeth.

Finally, if you notice any symptoms that make you suspect that you may have a dental crack, don’t overlook them. Cracks in the teeth are quite common and the sooner they’re treated, the less risk there’ll be of any complications.

Visit your trusted dentist. As we told you, there are many procedures available to save your tooth and its appearance.