Deciding when to extract a cracked tooth is a serious decision that depends on several factors. The most significant factors are the severity and extent of the crack, the overall health of the tooth and surrounding tissues, and the feasibility of preserving the tooth through other treatment options. When the crack compromises the tooth beyond repair or when other treatment modalities are unlikely to succeed in preserving the tooth's function and health, extraction may be the only solution to the myriad problems that having a cracked tooth can cause.
There are certain kinds of tooth fractures that require far more complicated treatment than others. Vertical root fractures, for example, are cracks that progress vertically through the tooth’s root, where they can’t be seen to the naked eye. Without routine dental examinations, vertical root fractures can extend into the root canal, inviting infection into the rich dental pulp inside the tooth’s root. With this infection comes inflammation and pain. If infection in the root canal can’t be effectively treated with a root canal therapy, it may be necessary to extract the tooth. Split teeth also pose more treatment complications than other types of tooth fractures. A split tooth is divided into distinct segments by a crack that extends through the entirety of the tooth. Of course, this severely compromises the structural integrity of the tooth, which makes it more difficult to save the tooth, and extraction is the only way to prevent infection and alleviate possibly debilitating pain.
When a tooth is extensively decayed, it may also be necessary to extract the tooth when it becomes cracked. Decayed dental tissue is extremely weak, and fractures in this tissue are highly likely to worsen and invite infection. If infection in a tooth remains untreated and causes an abscess, this can also necessitate extraction of the tooth. Dental abscesses are pockets of pus that collect in a sac around a tooth’s root, where they cause pain and a foul smell and can spread to other tissues in the body if not treated promptly and thoroughly. Following root canal therapy, if infection isn’t adequately removed or if the tooth isn’t sufficiently sealed and the tooth becomes reinfected, the tooth may not be able to withstand this reinfection and will need to be extracted. Adhering to your dentist’s recommendations for aftercare following any dental procedure, including completing a full course of antibiotics if prescribed, can help prevent reinfection, and maintaining a diligent oral hygiene routine will also reduce your risks.
Dentists also consider the overall health of the patient when determining whether extraction is necessary. If there is a high risk of infection spreading, extraction may be recommended so that more serious health issues don’t arise. If the patient has certain medical conditions or a compromised immune system and preserving the tooth would compromise the patient’s health, extraction may be the safest method of treatment. When a patient voices or displays little or no ability to tolerate extensive dental procedures, either due to preference, time constraints, or costs, they may prefer extraction to more invasive or extensive treatments. Dentists strongly recommend replacing any missing teeth, to maintain oral function and to enhance aesthetics, and there are a few different options for replacement that you can discuss with your dentist as you plan your treatment.