Why Is My Cracked Tooth Not Hurting?

Introduction

A cracked tooth may not hurt because the crack has not reached the nerve, because it is a shallow surface line that never will, or because the nerve inside is already damaged and can no longer signal pain. Those three situations call for very different responses, which is why a painless crack is worth having looked at rather than worried about. Some need prompt treatment, and at least one type needs none at all.

Not All Cracks Are the Same

The American Association of Endodontists groups cracks into five types, and how much they hurt depends on which one you have.

So a painless crack might be the most benign type on that list or one of the most serious. That is the honest answer to the question, and it is also why guessing from symptoms does not work.

Why the Pain Comes and Goes

When a crack does hurt, the pattern is distinctive. The AAE describes "erratic pain when you chew your food" along with sudden pain from very hot or cold temperatures, and notes the pain may come and go.

The mechanism is simple enough. Chewing moves the cracked pieces, which irritates the pulp, the tissue inside the tooth holding its nerves and blood vessels. The AAE's warning about where that leads is the important part: "Eventually, the pulp will become damaged to the point that it can no longer heal itself." Once that happens, the pain can stop, which brings us to the next section.

When a Painless Crack Is Worth Acting On

The Crack Will Not Heal

This is the AAE's blunt framing, and it applies whether the tooth hurts or not: "Unlike a broken bone, the fracture in a cracked tooth will not heal." Teeth have no mechanism for knitting a fracture back together.

The AAE adds that untreated cracks worsen over time and can lead to tooth loss, which is why it treats early diagnosis as essential for saving the tooth. Our article on leaving a broken tooth untreated covers the same ground for visible breaks.

Pain Stopping Can Mean the Nerve Died

If a crack hurt for a while and then went quiet, that is worth a call rather than relief. Once the pulp is damaged beyond healing, it stops sending pain signals, and the AAE explains what can follow: a pulp that dies and goes untreated leads to infection in or around the root.

An infection there can stay quiet too. The AAE notes an abscessed tooth "may or may not be painful," and the American Dental Association warns that if an abscess is not treated, "it can lead to a serious infection in the jaw bone, teeth and surrounding tissues." Our guide to the signs of an infected tooth covers what to watch for.

A Root Fracture May Only Show Up Through Infection

The AAE's description of vertical root fractures is the clearest case for not waiting on symptoms. These "often show minimal signs and symptoms" and are frequently discovered only after the surrounding bone and gum become infected. A tooth that is not hurting is not evidence that nothing is happening at the root.

And Sometimes It Really Is Nothing

Worth repeating, because the opposite impression is easy to give: if what you are seeing is a craze line, the AAE says these are very shallow, cause no pain, and are "of no concern beyond appearances." Craze lines are extremely common in adult teeth. An exam is how you find out which category you are in, not a formality to confirm bad news.

When Should I See a Dentist About a Crack?

Book an appointment once you notice a crack, whether or not it hurts. The AAE recommends that anyone with these symptoms, or who suspects a cracked tooth, see a dentist as soon as possible, because early diagnosis is essential to saving the tooth.

Call promptly rather than waiting for your next checkup if you notice:

• Erratic pain when chewing, or sudden pain with hot or cold
  
• A sharp edge catching your tongue or cheek
  
• A piece of the tooth breaking away
  
• A crack that looks longer or deeper than it did
  
• Pain that was there and has now stopped
  
• Swelling, gum redness, a bad taste, or a fever, which the ADA lists among the signs of an abscessed tooth

When It Is Urgent

If the tooth has just been broken or knocked by an injury, the ADA's first-aid guidance is to rinse your mouth with warm water, apply cold compresses to the face to keep swelling down, and see a dentist as soon as possible. If your dental office is closed during an emergency, the ADA advises going to a local emergency room.

Go to an emergency room, or call 911, rather than waiting for a dental appointment if you have:

• Difficulty breathing, swallowing, or speaking
  
• Swelling spreading across your face, jaw, or neck
  
• A fever alongside facial swelling
  
• A significant facial injury, or a knocked-out tooth

The ADA's clinical guidance on dental pain and swelling sets the clinical threshold: patients "should be referred for urgent evaluation if their condition worsens, they develop a deep space infection, or sepsis is suspected."

How Is a Cracked Tooth Diagnosed and Treated?

Finding the crack is often the hard part. The AAE acknowledges this directly, noting that with erratic, intermittent pain, "your dentist may have difficulty locating the tooth causing the discomfort." So an appointment for a painless crack is not a waste of anyone's time, and a crack you can see is useful information to bring.

https://www.youtube.com/watch?v=0d2xYfXYEu8

Treatment depends on which type of crack it is, and the AAE describes a different approach for each:

• Craze lines need no treatment, since they affect only the outer enamel
  
• A fractured cusp is usually restored with a new filling or crown. Alpine's broken and chipped tooth repair page covers this kind of work
  
• A cracked tooth that has reached the pulp is treated with root canal treatment and a crown. If the crack extends below the gum line, the AAE says the tooth cannot be saved and has to be removed
  
• A split tooth cannot be saved intact, though the AAE notes endodontic treatment may save part of it
  
• A vertical root fracture may mean removal, or endodontic surgery if taking out the fractured portion can save the tooth

One thing to set expectations honestly: the AAE says some cracks continue to progress despite treatment, and that a crown "does not guarantee success in all cases." It also says that once treated, "most cracked teeth continue to function and provide years of comfortable chewing." Both halves of that are true, and your dentist can say which is more likely for your tooth after examining it.

How Alpine Dental Helps

Alpine Dental provides broken and chipped tooth repair and root canal treatment at our Lakewood and Jackson, NJ offices. If you have found a crack, call and tell us when you noticed it, whether anything triggers pain, and whether it has changed. Bring any piece that has broken off. 

So if you are asking why your cracked tooth is not hurting, the answer sits anywhere from a harmless surface line to a nerve that has already died, and symptoms alone cannot tell you which. An exam can, usually quickly.

Call us at (732) 934-1888 or book an appointment online to have the crack checked.

Frequently Asked Questions

Can a cracked tooth be serious even without pain?

It can, but not always. A vertical root fracture often shows minimal signs and is sometimes found only once the bone and gum become infected, and a tooth whose nerve has died can be infected without hurting. On the other hand, the AAE describes craze lines as shallow, painless, and of no concern beyond appearances. Which one you have is what the exam determines.

Why doesn't my cracked tooth hurt?

There are three common reasons: the crack sits in the outer enamel and has not reached the pulp. It is a type that rarely involves the pulp, such as a fractured cusp, or the pulp has already been damaged past the point of healing and no longer signals pain.

Will a cracked tooth heal on its own?

No. The AAE puts it plainly: "Unlike a broken bone, the fracture in a cracked tooth will not heal." Treatment is about protecting the tooth and the pulp, not about mending the crack.

My cracked tooth hurt and then stopped. Is that good news?

Usually not. Pain stopping can mean the pulp has been damaged beyond healing, and the AAE explains that an untreated dead pulp leads to infection in or around the root. Worth a call rather than relief.

Do all cracked teeth need a crown or a root canal?

No. Craze lines need no treatment at all, and a fractured cusp is often handled with a filling or a crown without any root canal. A root canal and crown come in when the crack has reached the pulp. Some cracks, including a split tooth or certain root fractures, cannot be saved.

Should I still see a dentist if the crack doesn't hurt?

Yes. The AAE advises being seen as soon as possible when you suspect a crack, because early diagnosis is what gives the tooth the best chance. The visit may also confirm that what you are seeing needs nothing done.

SOURCES:

• https://www.aae.org/patients/dental-symptoms/cracked-teeth/
• https://www.aae.org/patients/dental-symptoms/abscessed-teeth/ 
• https://www.mouthhealthy.org/all-topics-a-z/abscess
• https://www.mouthhealthy.org/all-topics-a-z/dental-emergencies/
• https://www.mouthhealthy.org/top-dental-symptoms
• https://www.cdc.gov/antibiotic-use/media/pdfs/ada-treatment-guidelines-508.pdf