Fractured Tooth: Symptoms, Types, Causes and Treatment

Fractured teeth are a common dental problem that can lead to pain, infection, and tooth loss if not promptly addressed. Understanding the symptoms, types, causes, and treatment options is vital for both patients and clinicians. This article synthesizes the latest clinical research and expert insights to help you recognize signs of a fractured tooth, differentiate between fracture types, understand why they occur, and explore current treatment strategies.

Symptoms of Fractured Tooth

Fractured teeth can present with a range of symptoms, sometimes subtle and easily mistaken for other dental issues. Early recognition is crucial to prevent further damage or tooth loss. Symptoms may vary depending on the type and location of the fracture, as well as whether the fracture has reached the pulp or the root.

Symptom	Description	Common in Fracture Type	Source(s)
Pain on biting	Sharp pain when chewing, especially on release	Cracked/Incomplete fractures	2 5 7
Sensitivity	To hot, cold, or sweet stimuli	Cracked/Vertical fractures	5 7
Swelling	Localized near the affected tooth	Vertical root fractures	1 3
Deep pocket	Isolated deep periodontal probing depth	Vertical root fractures	1 3 7
Sinus tract	Gum pimple/fistula near tooth	Vertical root fractures	3
Difficulty pinpointing pain	Vague, hard to localize discomfort	Cracked tooth syndrome	2 5

Table 1: Key Symptoms

Recognizing Common Symptoms

Cracked teeth often present with pain or discomfort when biting, especially when the pressure is released. This is a hallmark of cracked tooth syndrome (CTS) and can make eating difficult. Sensitivity to temperature changes or sweet foods is also common, particularly if the fracture extends into the dentin or pulp 2 5 7.

Subtle and Chronic Presentations

Some fractures, especially vertical root fractures, may have mild or even intermittent symptoms. Patients might notice a small pimple (sinus tract) on the gums, swelling, or a localized deep periodontal pocket. These signs are often associated with endodontically treated teeth and can be mistaken for gum disease or a failed root canal 1 3 7.

Diagnostic Challenges

One of the greatest challenges in diagnosing a fractured tooth is that symptoms can mimic other dental problems. Patients may be unable to identify the exact tooth or even the quadrant affected. This can lead to a history of unsuccessful dental treatments before the fracture is correctly diagnosed 2 5.

Types of Fractured Tooth

Tooth fractures are not all the same. Understanding the different types is essential for diagnosis, prognosis, and treatment planning. The main categories include: cracked tooth, vertical root fracture, split tooth, fractured cusp, and horizontal root fracture.

Type	Description	Typical Location	Source(s)
Cracked tooth	Incomplete fracture, often extends to dentin	Posterior teeth	2 5 7 10
Vertical root fracture	Crack runs along the root, often after RCT	Endodontically treated	1 3 7 10
Split tooth	Complete fracture with two separate segments	Molars, premolars	6 10
Fractured cusp	One or more cusps break away	Molars/premolars	7 10
Horizontal root fracture	Fracture across the root, often from trauma	Anterior teeth	12 15 19

Table 2: Types of Tooth Fracture

Cracked Tooth

A cracked tooth refers to an incomplete fracture, usually starting from the crown and sometimes extending towards the root. It is most commonly seen in posterior teeth (molars and premolars), often in middle-aged adults. Cracked tooth syndrome (CTS) falls within this category, characterized by pain on biting and sometimes vague, hard-to-localize symptoms 2 5 7 10.

Vertical Root Fracture

Vertical root fractures typically occur in teeth that have undergone root canal treatment (endodontically treated teeth). These fractures run longitudinally along the root and are frequently associated with swelling, sinus tracts, and isolated deep periodontal pockets. They are more common in older adults and can be challenging to detect on radiographs 1 3 7 10.

Split Tooth

A split tooth is the progression of a cracked tooth where the fracture has completely separated the tooth into two distinct segments. This usually results in a poor prognosis and often requires extraction 6 10.

Fractured Cusp

This type involves the breaking away of one or more cusps, usually due to weakened tooth structure from decay or large restorations. The tooth may remain vital and symptoms are often less severe, but it still requires prompt attention 7 10.

Horizontal Root Fracture

These fractures occur across the root, most often due to trauma, especially in anterior teeth. The prognosis depends on the location of the fracture and the type of healing that occurs. Apical and mid-root fractures have a better survival rate than those near the crown 12 15 19.

Causes of Fractured Tooth

Teeth can fracture due to a variety of factors—some sudden and traumatic, others the result of long-term wear or previous dental work. Understanding these causes is fundamental in prevention and management.

Cause	Details	At-Risk Teeth	Source(s)
Trauma	Falls, sports injuries, accidents	Anterior teeth	16 18 19
Chewing forces	Biting hard objects, bruxism, clenching	Posterior teeth	5 7 8 11
Large restorations	Extensive fillings weaken tooth structure	Molars, premolars	7 11 14
Endodontic treatment	Risk of vertical root fracture	Previously treated teeth	1 3 7
Aging	Loss of hydration, fatigue cracks	All, esp. >40 years old	5 10 13

Table 3: Main Causes of Tooth Fracture

Traumatic Injuries

Direct trauma—such as a blow to the mouth during sports, falls, or accidents—is a leading cause of tooth fracture, particularly in children and adolescents. These injuries most often affect the front (anterior) teeth 16 18 19.

Chewing and Functional Forces

Daily chewing, especially on hard foods (ice, unpopped popcorn, hard candy), or habits like bruxism (tooth grinding) and clenching, place teeth under significant stress. Over time, this can result in fatigue cracks, especially in molars and premolars 5 7 8 11.

Restorations and Dental History

Teeth with large restorations (fillings, crowns, inlays) are more prone to fracture due to the loss of natural tooth structure and the creation of stress risers. Nonbonded materials like amalgam or gold inlays have been associated with a higher risk of fracture compared to bonded resin or porcelain 7 11 14.

Endodontic (Root Canal) Treatment

Endodontically treated teeth are at an increased risk of vertical root fractures, particularly years after treatment. The removal of tooth structure during the procedure and the resulting dehydration of the tooth can weaken it over time 1 3 7.

Aging and Tooth Structure

As we age, changes in the microstructure and hydration of enamel and dentin make teeth more susceptible to cracks and fractures. Most longitudinal fractures are seen in patients over 40, with the peak incidence of cracked teeth in the 5th decade of life 5 10 13.

Treatment of Fractured Tooth

The management of a fractured tooth depends on the type, location, and extent of the fracture, as well as the tooth’s vitality and restorability. Early intervention can preserve function and prevent tooth loss.

Treatment Option	Indication	Prognosis/Outcome	Source(s)
Fragment reattachment	Clean, available crown fragments	Good esthetics/function	16 17 18
Restorative (Crown, Onlay)	Incomplete cracks, vital teeth	Good with coverage	2 5 14
Endodontic therapy	Pulp involvement or necrosis	Variable, case-dependent	2 3 15 19
Extraction	Non-restorable splits or root fractures	Tooth replacement needed	6 12 14
Periodontal surgery	To access/restore subgingival fractures	Case-dependent	18

Table 4: Treatment Options for Fractured Teeth

Fragment Reattachment

When the fractured fragment is available and viable, especially in anterior teeth, it can be reattached using adhesive techniques. This approach conserves tooth structure, maintains esthetics (matching color and shape), and can restore function efficiently. The success rate is high, especially in cases where the biological width is not violated 16 17 18. Different reattachment techniques exist, with internal dentin groove preparation providing the best fracture resistance 9.

Restorative Approaches

For incomplete fractures (cracked tooth syndrome), restoration with a bonded crown or onlay can stabilize the tooth and prevent crack progression. Full cuspal coverage is preferred to reduce the risk of further fracture, especially in teeth with large restorations 2 5 14. Routine monitoring and occlusal adjustments may be recommended in early or less severe cases 2.

Endodontic (Root Canal) Therapy

If the fracture involves the pulp or results in pulp necrosis, root canal therapy is indicated. The treatment approach varies:

• For vertical root fractures, prognosis is poor and extraction is often required.
• For horizontal root fractures, treating only the coronal fragment and preserving apical pulp vitality can be successful, especially with regenerative endodontic techniques in young patients 15 19.
• Overfilling or improper filling techniques can reduce healing rates, so careful technique is essential 15.

Extraction

In cases where the tooth is split or the fracture is severe and non-restorable (especially vertical root or cervical root fractures), extraction is the only option. Tooth replacement with implants, bridges, or partial dentures may be necessary for function and esthetics 6 12 14.

Surgical and Multidisciplinary Techniques

For fractures that extend below the gumline, periodontal surgery (crown lengthening) may be required to expose sound tooth structure for restoration. In some complex cases, orthodontic extrusion can be used prior to restoration or reattachment 18.

Conclusion

Fractured teeth are a diverse and complex dental issue, but with early detection and appropriate management, many teeth can be preserved for years to come. Key takeaways include:

• Symptoms can be subtle or mimic other dental problems, making diagnosis challenging.
• There are multiple types of fractures—recognizing the difference impacts treatment and prognosis.
• Common causes include trauma, heavy chewing forces, large restorations, root canal treatment, and aging.
• Treatment ranges from conservative reattachment or restorative work to endodontic therapy or extraction, depending on the extent and location of the fracture.

By understanding the signs, predisposing factors, and evidence-based treatment options, both patients and dental professionals can work together to achieve the best possible outcome for fractured teeth.