Cracked Tooth Syndrome

Last updated: 22nd May 2024

Written by Dr Zaeem Jafri

Causes | Symptoms | Diagnosis | Treatment | Speak to a dentist

Cracked Tooth Syndrome (CTS) is a condition where a tooth has an incomplete fracture or crack, typically originating from the biting surface and extending down towards the root.

This fracture causes a strong sharp pain when biting on the tooth or eating on that side. This pain is typically very strong, comes on very quickly and goes away very quickly aswell. The tooth might also be extremely sensitive to hot and cold substances.

Unlike a completely broken tooth, the fracture in CTS is often too small to be visible on X-rays, and the tooth may appear intact to the naked eye.

This condition is usually caused by factors such as teeth grinding (bruxism), chewing on hard objects, trauma, or large fillings that weaken the tooth structure.

Diagnosis often requires a thorough examination by a dentist, including the use of special instruments to detect the crack.

Treatment varies depending on the severity of the crack and can range from composite bonding and crowns to root canal therapy or even extraction in severe cases.

 

What is Cracked Tooth Syndrome?

Cracked Tooth Syndrome (CTS) is a dental condition characterised by a fracture in a tooth that is typically incomplete and often not visible to the naked eye or on standard X-rays.

The fracture usually starts at the biting surface of the tooth and may extend down towards the root. Patients with CTS frequently experience sharp pain or discomfort when biting or chewing, particularly when releasing the bite.

This pain can be sporadic and may be difficult to pinpoint, often radiating to other areas of the mouth.

Additionally, individuals might notice heightened sensitivity to temperature changes, especially when consuming hot or cold foods and beverages.

The symptoms can vary in intensity and frequency, making CTS a challenging condition to diagnose.

The crack in the tooth can also create pathways for bacteria, potentially leading to further complications like infections or decay if not addressed promptly.

A tooth presenting with typical cracked tooth syndrome symptoms. In this case you can just see a crack forming at the distal (back) wall of the tooth.

Causes of Cracked Tooth Syndrome

Cracked Tooth Syndrome (CTS) can be caused by a variety of factors that weaken the structural integrity of a tooth or subject it to excessive stress. The main causes of CTS include:

Bruxism (Teeth Grinding and Clenching)

Habitual grinding or clenching of teeth, often occurring during sleep, can exert tremendous pressure on teeth. Over time, this can lead to the formation of cracks, particularly in molars that bear the brunt of grinding forces.

Chewing Hard Objects

Frequently chewing on hard substances such as ice, unpopped popcorn kernels, hard candies, or even pens and pencils can cause cracks to develop. These habits put undue stress on the teeth, increasing the likelihood of fractures.

Trauma or Injury

A direct blow to the mouth, whether from a fall, sports injury, or accident, can cause a tooth to crack. Even minor trauma can lead to fractures, especially if the tooth was already weakened by other factors. Using your teeth for things they aren’t deisgned to such as opening bottles can also lead to CTS.

Large Dental Fillings

Teeth that have undergone extensive dental work, such as large fillings or restorations (especially metal fillings), may be more susceptible to cracking. The remaining natural tooth structure can be compromised, making it more prone to fractures under normal biting forces.

Age-related Wear and Tear

As people age, their teeth can naturally wear down, becoming more brittle and susceptible to cracks. The cumulative effects of years of chewing, grinding, and exposure to varying temperatures can weaken teeth over time.

Biting Unevenly

An uneven bite or malocclusion (crowding and spacing) can place excessive pressure on certain teeth. This disproportionate force distribution can lead to cracks, particularly in teeth that are subjected to higher stress levels.

Temperature Extremes

Rapid temperature changes in the mouth, such as consuming hot food followed by a cold drink, can cause teeth to expand and contract. This thermal cycling can create microcracks that may eventually develop into larger fractures.

Dental Procedures

Certain dental procedures, such as root canals or the removal of significant tooth structure, can weaken a tooth and make it more susceptible to cracking. The loss of natural tooth material reduces its ability to withstand normal chewing forces.

Inadequate Restorations

Poorly executed dental restorations, such as ill-fitting crowns or fillings, can create areas of weakness in the tooth. These restorations might not distribute chewing forces evenly, leading to stress points that can crack.

An upper premolar tooth with a large metal filling that has subsequently cracked underneath the filling.

Symptoms of Cracked Tooth Syndrome

Cracked Tooth Syndrome (CTS) presents with a range of symptoms that can vary in intensity and may be challenging to diagnose due to their intermittent nature.

The main symptom is sharp pain or discomfort when biting or chewing, particularly during the release of the bite. This pain is often localised to a specific tooth and can be triggered by certain foods or chewing motions.

You may also experience heightened sensitivity to temperature extremes, such as hot or cold foods and beverages. The discomfort may come and go, making it difficult for individuals to identify the exact tooth causing the problem.

In some cases, the pain may radiate to other areas of the mouth, further complicating diagnosis.

Additionally, there may be signs of swelling or discomfort in the gums around the affected tooth, and in severe cases, a visible crack may be present.

Diagnosing Cracked Tooth Syndrome

Diagnosing Cracked Tooth Syndrome (CTS) can be challenging due to the often subtle and intermittent nature of its symptoms.

A comprehensive approach is required to accurately identify the condition. The diagnostic process typically includes the following steps:

A comprehensive history

The dentist begins by taking a detailed history of the your symptoms, including the onset, duration, and specific triggers of pain. You may be asked to describe the nature of the pain and any patterns you have noticed, such as increased discomfort when biting or sensitivity to temperature changes.

It is worth writing down a log of your pain and specifically noting

  • How it felt (sharp, dull, burning)

  • How severe it was on a scale of 1-10

  • How long the pain lasted for (seconds, minutes, hours)

  • What you were doing when the pain started

Clinical Examination

A thorough examination of the mouth, teeth, and gums is conducted. Your dentist will visually inspect the teeth for any signs of cracks or other abnormalities. This may include the use of magnifying tools or loupes to enhance visibility.

  • Bite Tests: To identify the specific tooth involved and the nature of the crack, the dentist may perform bite tests. This involves asking you to bite down on a special instrument (tooth sleuth) or a cotton roll. Pain upon biting or releasing the bite can indicate the presence of a crack.

  • Transillumination: This technique uses a bright light shone through the tooth to highlight any fractures. Cracks may appear as dark lines within the tooth structure, allowing the dentist to visualise areas that are not visible through standard examination methods.

  • Percussion and Palpation: The dentist may tap on the teeth (percussion) or apply pressure to the gums around the teeth (palpation) to identify any areas of sensitivity or discomfort that could indicate a crack.

  • Dental X-rays: Although standard X-rays often do not reveal small cracks, they are still useful for ruling out other potential issues such as cavities or abscesses that could cause similar symptoms. In some cases, advanced imaging techniques like cone beam computed tomography (CBCT) may be used for a more detailed view.

  • Dye Staining: Applying a special dye to the tooth can help reveal cracks. The dye seeps into any existing fractures, making them more visible to the dentist.

  • Removal of Restorations: In cases where a tooth with a large filling or crown is suspected, the dentist might remove the restoration to better visualise the underlying tooth structure and identify any hidden cracks.

  • Symptom Replication: The dentist may attempt to replicate the symptoms by asking you to perform specific movements or activities that typically trigger the pain. This helps to pinpoint the exact cause and location of the discomfort.

Through these combined diagnostic methods, a dentist can accurately identify Cracked Tooth Syndrome and develop an appropriate treatment plan to address the condition and alleviate your pain.

A tooth sleuth is a device that allows dentists to test each individual cusp of a tooth under pressure to help identify a crack

Treatment of Cracked Tooth Syndrome

Treatment for Cracked Tooth Syndrome (CTS) varies depending on the severity and location of the crack. The primary goals are to relieve pain, restore the function and integrity of the tooth, and prevent further damage. Here are the common treatment options:

Composite Bonding

For minor cracks, the dentist may apply a tooth-coloured resin to fill or cover the crack and restore the tooth's appearance and function. This is a relatively simple and non-invasive procedure that helps stabilise the tooth.

Crowns

If the crack is more extensive, a dental crown may be necessary. The crown, typically made of porcelain, ceramic, or metal, covers the entire tooth, providing protection and preventing the crack from spreading. The dentist will first remove any damaged areas and then place a custom-fitted crown over the tooth.

Onlays and Inlays

A well-trained and modern dentist will provide onlays or inlays instead of a crown. These custom-made restorations fit into or onto the damaged part of the tooth, restoring its shape and function while preserving as much natural tooth structure as possible.

Onlays are usually going to be the best treatment option for your molar tooth which has a crack.

Root Canal Treatment

If the crack has extended into the pulp (the inner soft tissue containing nerves and blood vessels), root canal treatment may be required. This involves removing the damaged pulp, cleaning and disinfecting the root canals, and then filling and sealing them. Afterwards, a crown or onlay is usually placed to protect the tooth.

Extraction

In cases where the crack extends below the gum line or into the root, the tooth may be deemed non-restorable. An extraction is necessary when the tooth cannot be saved by other means. After extraction, options for replacing the tooth, such as dental implants, bridges, or partial dentures, will be discussed.

Orthodontic Treatment

In some cases, orthodontic treatment may be necessary to adjust the bite and prevent further cracking of teeth. This is especially relevant if malocclusion (misalignment of teeth) is contributing to uneven stress and cracks.

Splinting

Temporarily, the dentist may bond the cracked tooth to the adjacent teeth to stabilise it and reduce pain. This is often used as an interim measure until a more permanent solution can be implemented.

2 Molar teeth with large metal fillings and several cracks restored with ceramic onlays

Preventing Cracked Tooth Syndrome

Preventing Cracked Tooth Syndrome (CTS) involves adopting good oral hygiene practices and habits that minimise the risk of tooth fractures. Here are some key strategies for prevention:

  1. Avoid Chewing Hard Objects: Refrain from chewing on hard items such as ice, hard candies, unpopped popcorn kernels, and non-food objects like pens and pencils. These habits can place excessive stress on teeth, leading to cracks.

  2. Wear a Mouthguard: If you grind your teeth at night (bruxism) or participate in contact sports, wearing a custom-fitted mouthguard can protect your teeth from excessive forces and potential trauma. A night guard helps prevent grinding, while a sports guard protects against impact injuries.

  3. Practice Good Oral Hygiene: Maintain regular brushing and flossing to keep your teeth healthy and strong. Use fluoride toothpaste to help strengthen tooth enamel and reduce the risk of decay, which can weaken teeth and make them more susceptible to cracking.

  4. Regular Dental Checkups: Visit your dentist regularly for checkups and cleanings. Early detection of potential issues, such as small cracks or signs of bruxism, allows for timely intervention and prevents further damage.

  5. Address Misaligned Bite: If you have a misaligned bite (malocclusion), orthodontic treatment like Invisalign may be necessary to ensure an even distribution of chewing forces. This reduces the risk of uneven pressure on certain teeth, which can lead to cracks.

  6. Use Teeth for Chewing Only: Avoid using your teeth as tools to open packages, cut thread, or perform other non-chewing tasks. Such activities can place unnecessary stress on your teeth and cause cracks.

  7. Avoid Extreme Temperature Changes: Be cautious when consuming very hot or cold foods and beverages, especially in quick succession. Rapid temperature changes can cause teeth to expand and contract, potentially leading to cracks.

  8. Limit Acidic Foods and Beverages: Reduce your intake of acidic foods and drinks, such as citrus fruits, soda, and wine. Acids can erode tooth enamel, weakening teeth and making them more prone to cracking.

  9. Strengthen Teeth with a Healthy Diet: Consume a balanced diet rich in vitamins and minerals, particularly calcium and vitamin D, which are essential for strong teeth. Dairy products, leafy greens, and fortified foods can help maintain healthy tooth structure.

  10. Manage Stress: Stress can contribute to teeth grinding and clenching. Practice stress-relief techniques such as exercise, meditation, and relaxation exercises to reduce the likelihood of bruxism-related cracks.

By following these preventive measures, you can significantly reduce the risk of developing Cracked Tooth Syndrome and maintain strong, healthy teeth. Regular communication with your dentist about any concerns or habits that might affect your dental health is also crucial for prevention.

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