Cracked Tooth Syndrome (Fractured) – Symptoms, Treatment, Diagnosis, Crown

Key Facts

Cracked Tooth Syndrome (CTS) refers to a crack or fracture in a tooth that is not large enough to be visible on X-rays.

It is also known as split tooth syndrome or incomplete fracture of posterior teeth.

CTS often affects molars, predominantly the lower ones.

Symptoms can vary and may come and go.

Diagnosis can be challenging due to the invisibility of the crack.

Treatment options depend on the location and extent of the crack.

If untreated, CTS can lead to complications such as pulp infection, tooth loss, and abscess.

Prevention strategies include wearing mouthguards during sports, avoiding hard foods, and maintaining good oral hygiene.

What is Cracked Tooth Syndrome?

Cracked Tooth Syndrome (CTS for short) is a dental condition where a tooth has developed a crack that is too small to show up on X-rays, or is under the gum and challenging to identify. It does not usually affect the tooth structure to the point of breakage. This condition often causes discomfort or pain when chewing and sensitivity to hot, cold, or sweet foods.

Epidemiology of Cracked Tooth Syndrome

Cracked Tooth Syndrome is relatively common, but accurate statistics are challenging to obtain due to its complex diagnosis. It is generally more prevalent in adults over the age of 50, though it can occur in younger individuals due to physical trauma or tooth grinding. Lower molars, specifically the second molars, are most commonly affected due to their involvement in grinding and chewing.

Causes of Cracked Tooth Syndrome

The causes of Cracked Tooth Syndrome can vary, but they typically involve some form of trauma to the tooth. Common causes include:

Chewing hard foods or objects: Consistently chewing or biting on hard substances like ice, nuts, hard candies, or even non-food items like pens can cause tiny cracks in the teeth.
Bruxism (teeth grinding or clenching): This habit, often stress-related and occurring during sleep, places significant pressure on the teeth, which can cause them to crack over time.
Large fillings: Teeth with large fillings are more susceptible to cracks as the filling can weaken the overall structure of the tooth.
Abrupt changes in temperature in the mouth: Consuming very hot food followed immediately by very cold food can cause thermal stress, leading to cracks.
Aging: Teeth naturally wear down and weaken with age, making them more prone to cracks.

Diagnosis of Cracked Tooth Syndrome

Diagnosis of Cracked Tooth Syndrome can be complex due to the nature of the cracks. They are often not visible on X-rays and may not even be immediately visible to the naked eye.
A dental professional will typically start with a thorough history taking, asking about symptoms, when they occur, and if there are any triggers. They will then proceed with a clinical examination, including visual inspection and palpation, biting tests, and thermal and electric pulp tests. They might use a dental explorer to feel for the crack or a dental dye to make it visible.
Transillumination, where a bright light is shone through the tooth, can help detect the crack as it interrupts the light passage. A periodontal probe may also be used to inspect the gum around the suspicious tooth for any signs of inflammation or pockets, suggesting a crack extension.
The most accurate diagnostic method is the use of a dental microscope, which allows for magnification and improved lighting, and has increasingly been adopted in endodontics. This method combined with Cone Beam Computed Tomography (CBCT) offers the best accuracy for diagnosis.

Signs & Symptoms of Cracked Tooth Syndrome

The symptoms of Cracked Tooth Syndrome can vary and might come and go over time. They often get worse when eating or drinking certain foods. Common signs and symptoms include:

Pain when chewing or biting, especially when releasing the bite.
Sensitivity to heat, cold, or sweetness.
Swelling of the gum around the affected tooth.
Discomfort that comes and goes.
Unexplained pain in seemingly healthy teeth.

Is My Tooth Pain From a Crack?

Tooth pain can be due to a variety of reasons, including cavities, sinus infections, gum disease, deep filing, or a cracked tooth. If the pain is triggered by biting, releasing a bite, or changes in temperature, it may be due to a cracked tooth. However, accurate diagnosis should be made by a dental professional.

Types of a Cracked Tooth

There are several types of tooth cracks, each with different characteristics:

Craze lines: These are tiny cracks that only affect the outer enamel. They are common in adults and usually cause no symptoms.
Fractured cusp: This occurs when a piece of the tooth’s chewing surface breaks off, often around a filling. It typically doesn’t affect the pulp and is not very painful.
Cracked tooth: This involves a crack extending from the chewing surface towards the root. If untreated, the tooth may split, leading to more severe issues.
Split tooth: This is often the result of an untreated cracked tooth. The crack has progressed so far that the tooth is literally split into two distinct segments. This can often lead to the tooth needing extraction.
Vertical root fracture: These are cracks that start in the root and extend towards the chewing surface. They often have minimal symptoms but can lead to severe problems.

Treatment Options for Cracked Tooth Syndrome

Treatment options depend on the location, depth, and extent of the crack, as well as symptoms:

Bonding: This involves using a plastic resin to fill the crack, restoring the tooth’s look and function.
Crown: For more substantial cracks, a dental crown may be needed. This cap is placed over the affected tooth, providing it with strength and stability.
Root Canal: If the crack extends into the pulp, a root canal may be necessary. This procedure removes the damaged pulp and nerves, relieving pain and preventing the spread of infection.
Tooth Extraction: In severe cases, where the tooth is beyond repair, extraction may be required. The tooth can be replaced with an implant or a dental bridge.

How Long Will My Broken Tooth Repair Take?

The length of the repair process depends on the severity of the crack and the chosen treatment method. Simple bonding can often be completed in a single visit, while a crown or a root canal can require two or more visits over a few weeks. Tooth extraction and replacement can take a few months to allow for healing and implant placement.

Outlook for a Fractured Tooth

With proper diagnosis and treatment, the prognosis for a cracked tooth is generally good. Most teeth can be saved, and pain and discomfort alleviated. However, some teeth may continue to be sensitive after treatment, or the crack may progress, requiring further treatment.

Complications of Cracked Tooth Syndrome

If left untreated, Cracked Tooth Syndrome can lead to various complications, including:

Pulp death: If the crack extends into the pulp, it can cause the pulp to die, leading to a painful abscess.
Tooth loss: Severe cracks can lead to tooth loss if not adequately managed.
Spread of infection: An infected tooth can spread infection to surrounding teeth and tissues, causing more extensive damage.

Prevention of Cracked Tooth Syndrome

Preventing CTS involves taking steps to reduce undue stress on your teeth:

Avoid chewing hard foods or objects.
Wear a mouthguard during sports activities.
If you grind your teeth, consider a night guard.
Regular dental check-ups can catch a small crack before it becomes a larger issue.
Maintain good oral hygiene to keep teeth strong.

Related Conditions to Cracked Tooth Syndrome

Cracked Tooth Syndrome may be associated with several conditions:

Bruxism: This is a condition where you grind or clench your teeth, usually during sleep, which can cause cracks.
Temporomandibular Joint Disorder: People with TMJ disorders may clench or grind their teeth, leading to CTS.
Large Dental Fillings: Large dental fillings, particularly amalgam fillings, can expand over time, causing the tooth to crack.

Which Teeth Are Most Likely to Fracture?

The molars, particularly the lower molars, are the most likely to fracture. This is because they take on the bulk of the force during chewing, especially when grinding or clenching.

Can I Treat a Fractured Tooth at Home?

While minor discomfort may be managed at home with over-the-counter pain relievers, it is crucial to see a dental professional for proper diagnosis and treatment. Ignoring a cracked tooth can lead to more severe problems, including tooth loss and infection.

Can a Cracked Tooth Heal?

While the tooth itself cannot heal, the pain and discomfort caused by a cracked tooth can often be effectively managed or eliminated with appropriate dental treatment. The earlier a crack is diagnosed and treated, the better the chance of preserving the tooth.

When Should I See My Healthcare Provider About a Fractured Tooth?

You should see your healthcare provider or dentist if you experience pain when chewing, sensitivity to heat or cold, or unexplained toothache. These could be signs of a cracked tooth or other dental problems that require treatment.

Is a Cracked Tooth an Emergency?

While a cracked tooth might not always be a dental emergency, it should not be ignored. If you have severe pain, a large visible crack, or signs of infection like swelling and redness, seek immediate dental care.

Crown for Cracked Tooth Syndrome

In some cases, your dentist may decide that dental crown is the right approach to treat Cracked Tooth Syndrome. A dental crown is a cap that covers a cracked tooth, protecting it from further damage and preserving its functionality. The crown is custom-made to fit your tooth and match the color of your surrounding teeth, providing a natural look. This treatment can alleviate pain, reduce sensitivity, and prevent further cracking. The process usually takes two dental visits: one to prepare the tooth and take an impression for the crown, and another to place the permanent crown once it has been created. Keep in mind that a dental crown is a more invasive procedure than bonding or veneers as it requires some healthy park of your tooth to be removed. This is why it should be considered a treatment of the last resort when classic and more conservative approaches failed.

This article is complete and was published on June 7, 2023, and last updated on August 25, 2023.

Key Facts