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Tooth Split In Half Vertically: What To Do

A tooth split in half vertically is the most severe form of a cracked tooth with a non-restorable prognosis, meaning saving it is impossible. Unfortunately, attempting to restore the tooth back to its original form will be futile because there aren't many options left for this condition.


vertically split tooth down to the root
vertically split tooth down to the root

You will require professional treatment in order to fix this catasphrophic occurrence. Trying to treat it at home will be fruitless but you can at least temporarily manage the discomfort while waiting for your dentist appointment.


Table of Contents:


Overview

What is a tooth split in half vertically?

A tooth that is split in half vertically is a type of tooth fracture that involves the root.


The way that teeth can crack varies to their extent and severity from mild to severe. Of course, this condition is of catastrophic proportions and is at the most severe end of the fracture spectrum since it involves the enamel, dentin, pulp, and root layers.


Table: Extent & Severity of Cracked Teeth

Type of fracture

Extent

Severity

Enamel only

Small

Mild

Dentin involvement

Medium

Moderate

Pulp involvement

Large

Severe

Fractured off crown

Very large

Very severe

Root fracture (vertical split)

Catastrophic

Catastrophic

What it looks like:

  • Vertical fracture line. A crack line that runs from the tip of the crown towards the gum line and down into the root.

  • Two halves of a tooth. The tooth is essentially split in half and it may look like you have two tooths instead of one.

  • Mobile halves. The pieces can move if you touch it with your finger or tongue. You may notice movement while you're eating or chewing.


tooth split in half vertically
tooth split in half vertically

Symptoms:

  • Toothache. Most commonly, this condition can be extremely painful since the tooth nerve is often split in half.

  • Food getting stuck. Since the tooth cracked in half, food is most likely getting lodged into the separated pieces whenever you eat.

  • Hurts to chew. The two halves of the tooth are mobile and will move around as you chew on them. This can cause a lot of tooth pain during meals.


Vertically split tooth with fractured piece removed
Vertically split tooth with fractured piece removed

Direction of split

A tooth can split in half vertically via two different directions, mesial distally or buccal lingually.


tooth split in half vertically - mesial distally
Mesial distal split

The mesial distal split as shown above runs from the front of the mouth towards the back.


vertically split root canal treated molar
vertically split root canal treated molar

The buccal lingual split as shown below will run from the cheek side towards the tongue side. This type of split is more rare than the mesial to distal split.


tooth split in half vertically - buccal lingually
Buccal lingual split

Other directional splits are possible but they are even more rare. The two splits which we described are the most common types of splits.


How it happens

The most common cause for a tooth to be split in half like this is usually due to excessive biting pressure or trauma. These events can be exacerbated by various oral conditions that increase the risk of it happening.


How the tooth cracks like this:

  • While eating. Most frequently, the time of occurrence for this condition is during the middle of a meal. You were chomping away at your food and all of a sudden you hear a crunching sound.

  • Trauma. If you get into an accident or if you play sports, blunt force trauma will do it.


Risk factors:

  • Untreated cavities.

  • Eating hard foods.

  • Root canal tooth with no crown.

  • Insufficient calcium in diet.

  • Not wearing a mouth guard playing sports.


 

Treatment

The only viable treatment for a tooth split in half vertically would be an extraction. There is no way for your dentist to repair a fracture of this extent. They cannot mend a tooth that is cracked in half back together.


However, after the extraction you do get options for how you want to replace the now missing tooth. Unless you're okay with walking around with a missing tooth.


Replacement options after extraction:

  • Implant. A conservative replacement would be getting a dental implant, which is a titanium screw that is inserted into the jaw bone.

  • Bridge. This is a fixed prosthesis which includes a minimum of three crowns. It does require shaving down the adjacent teeth in order to fit the dental bridge.

  • Flipper. A temporary tooth replacement option typically used immediately after the removal of the cracked tooth.

  • Denture. The least expensive replacement option but it is also removable in that you can take off and put the tooth back in. It is also the least desirable option.


Which is the best treatment for me?

You will need to consult with your dentist about the various replacement options. Ideally, the implant would be the best option but it is also the most expensive. Most people do take into account finances when making such decisions.


Home management

At home management for a tooth fractured in half vertically will be palliative in nature only. That means what you can do on your own can only temporarily alleviate some of the pain.


What you can do at home:

  • Keep area clean. Brush, floss, and rinse with salt water after every meal so that you can keep your mouth and broken tooth clean. Residual plaque and food will cause irritation.

  • Cold compress. Using a cold compress on the swollen side of the face can help control it and relieve some of the discomfort.

  • Pain medication. We'd be surprised if your broken tooth doesn't hurt because chances are it probably does. The best toothache medicine to take is advil dual action.

  • Avoid triggers. If chewing on that cracked tooth hurts, you need to stop. If certain foods bother it, cease consuming that food immediately.


The above are standard recommendations by dentists for what you can do for it at home. If you want to try alternative home remedies, you are doing so at your own risk.


 

Leaving it untreated

An untreated tooth that is vertically split in half will eventually become infected and develop an abscess. The entire structural integrity of the tooth has been completely destroyed and the vulnerable parts of the tooth are now exposed to the oral environment.


Exposed tooth parts that are prone to infection:

  • Pulp. The pulp of the tooth is the innermost layer with the most amount of nutrients, meaning the bacteria love to feast on it. Since the tooth has cracked open, this layer is directly accessible to bacteria thus the time for the tooth nerve to become infected is now expedited.

  • Jaw bone. The alveolar bone is not normally exposed to the oral cavity because the gums cover over it. Since the tooth is fractured in half, there is now direct access to the bone. This is similar to how if you had a laceration on your arm and the humerus is now exposed and can potentially become infected.


Ultimately, these structures are not normally exposed to the oral cavity which are naturally inhabited by bacteria. Now these microbes no longer have to try very hard to reach the pulp and jaw bone, thus causing an infection.


Vertically split in half tooth cannot heal on its own

The risk for infection only increases the longer that you leave it untreated because your body has no way of healing a vertically fractured tooth.


While teeth and bone are made of similar minerals (hydroxyapatite) the main difference between them is that teeth cannot mend themselves while bone can. In other words, a broken arm can repair itself but a broken tooth cannot.


Therefore your tooth that has cracked in half vertically will only get worse if you don't do anything about it. The most likely outcome is an abscess the longer that you wait because it cannot heal on its own.


In conclusion, this condition will require emergency dental treatment.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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