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Tooth trauma can be a functional and aesthetic disaster. Some trauma can have obvious immediate effects, such as if you knock a tooth out, but long-term trauma can result in a different type of tooth damage called longitudinal fractures. These fractures tend to grow and change, according to the American Association of Endodontists (AAE), and bacteria seek them out, often causing inflammation or infection. Here are the four types that can be diagnosed by your dentist.

Who Treats a Longitudinal Fracture?

Depending on which type of longitudinal fracture you have, different specialists may be required to diagnose and treat your problem. For example, endodontists have additional training in finding the cause of tooth pain and performing procedures on the interior of the tooth, according to the AAE. They may diagnose a longitudinal fracture or perform root canal treatment — which is the removal of the nerves inside the tooth.

Alternately, prosthodontists work on tooth restoration to maintain its health, function, comfort and appearance. They do so by saving and restoring natural teeth or replacing missing teeth with crowns, veneers, bridges or dentures, as the Association of Prosthodontists of Canada describes. When it comes to longitudinal fractures, they would be involved in the restoring the tooth with a filling or crown.

Types of Longitudinal Fractures

1. Craze lines

These only affect the tooth enamel, are apparent in most adults and occur most often in the front teeth, as the AAE explains. They may be caused by teeth grinding, nail biting or changing temperatures in the mouth, reports Penn Dental Medicine. Because these cracks are only in enamel, there is no pain — but aesthetically, they could be concerning. Generally, no treatment is needed.

2. Fractured Cusp

This is a complete or incomplete fracture of the biting surface of the tooth (called a cusp), which extends from the crown of the tooth down beneath the gums, reports the AAE. This can affect all parts of a tooth, including enamel, dentin and even the nerve of the tooth called the pulp. According to a report in the Journal of Clinical & Diagnostic Research, fractured cusps are the most common type of longitudinal fracture and may be caused by a number of conditions, including:

  • Teeth weakened by restorations
  • Large cavities
  • Age
  • Traumatic injuries
  • Abnormal biting habits, such as teeth grinding

Typically, dentists can treat this by removing the damaged cusp and repairing the tooth with a restoration. Sometimes, root canal treatment is needed if the crack affects the pulp or has resulted in irreversible irritation of the nerve, explains the AAE.

3. Cracked Tooth

A cracked tooth is an incomplete fracture from the crown of the tooth, often extending down the middle. This fracture is more extensive than a fractured cusp and, therefore, more likely to affect the nerve of the tooth. Penn Dental Medicine offers several possible causes for a cracked tooth, including:

  • Teeth grinding
  • Dental work that weakened the tooth
  • Trauma to the tooth

Treatment will vary depending on the location and extent of the crack, which your dentist may need to further investigate. If the nerve of the tooth is affected, an endodontist might perform a root canal treatment, explains the AAE. If the crack extends down below the gumline, the tooth may need to be extracted.

4. Split Tooth

A split tooth is a complete fracture from the crown that extends below the gumline through the middle of the tooth. This is usually the end result of an untreated cracked tooth, as the fracture extends over time, notes the AAE. This can happen either suddenly or as a result of long-term growth of the crack. The tooth may require extraction, but in some cases, an endodontist may be able to save a portion of the tooth and complete a restoration to make the tooth functional.

If your dentist diagnoses you with one of these longitudinal fractures, rest assured that there are treatment options available to help make your mouth healthy again. If you experience any sudden pain in a tooth, see your dentist as soon as possible for a diagnosis.