Cracked Tooth Syndrome

Cracked Tooth Syndrome is a dental condition characterized by symptoms of sharp pain on chewing without any visible reason, which is actually caused by a ‘hidden’ crack of the tooth. Teeth that cause cracked tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

The fact that people today live longer and keep their teeth for more years increases the risk of having a fractured tooth and experiencing cracked tooth syndrome problems. 

Cracked tooth syndrome is a condition that has to be identified and treated early enough before the damage puts the tooth at risk. If the crack reaches the pulp chamber of the cracked tooth, the pulp tissue becomes exposed to bacteria and bacterial toxins, and gets inflamed developing a tooth infection. An untreated cracked tooth can result in pulpal necrosis (death of the nerve), and tooth abscess (infection) requiring root canal treatment. In severe cases the tooth can split in two reducing the chances to fix the cracked tooth and usually tooth extraction is necessary.

Causes of Cracked Tooth Syndrome

Cracked tooth syndrome is caused by a crack on the tooth. Fracture teeth are becoming more common as people keep their natural teeth longer. Beside the extended time that teeth are used, the number of dental procedures performed on each tooth is increasing making them more susceptible to cracking.
Cracked tooth syndrome symptoms may be caused by fractures developed due to a number of reasons:

• Natural wear. Over the years, the repetitive everyday use of the teeth for biting and chewing may cause cracks on teeth.  
• Clenching or grinding teeth (bruxism) is one of the major causes of fractured tooth syndrome. Grinding and clenching puts teeth under excessive pressure making them more susceptible to cracks.  
• Bad chewing habits such as biting pencils or chewing on hard foods.
• Trauma to the mouth.
• Large fillings can weaken the teeth resulting in tooth fracture.Untreated extensive tooth decay.
• Complications during/after endodontic therapy.

Symptoms of Cracked Tooth Syndrome

The patient generally experiences sharp pain when he applies biting pressure in a certain area of his mouth, but he frequently cannot tell which particular tooth hurts. Minor tooth fractures are unlikely to cause symptoms, so the problem may exist for a long time before the cracked tooth syndrome symptoms appear.
The symptoms of cracked tooth syndrome include:

• Tooth sensitivity to hot and cold temperatures.
• Pain in the tooth upon biting or chewing. Pain is not constant as that in case of tooth decay or tooth abscess. The tooth may be painful only when eating certain foods or when chewing in a specific way. If the pain is usually experienced upon release of biting pressure, it is a sign that it is a case of cracked tooth syndrome.
• Increased tooth mobility.

Diagnosis of Cracked Tooth Syndrome

Diagnosis of cracked teeth is often difficult, because the crack may not be visible. This is actually the characteristic of cracked tooth syndrome; symptoms of sharp pain without the dentist to be able to see any problem with the tooth, either by clinical examination of the mouth, or sometimes neither by radiography (x-rays).
A detailed dental history, focusing especially in history of trauma, bruxism, chewing habits and bite adjustments, can help significantly in the diagnosis of cracked tooth syndrome.
The dentist will first identify which tooth has the problem. This is done by a biting test using an instrument that rests on one tooth at a time. After the tooth is identified the test is performed on each of the cusps of the tooth in order to have a more precise location of the problem.
The dentist will perform a thorough examination of the tooth, checking for any signs of problem that could explain the symptoms e.g. tooth decay or fractures. A sharp instrument called an explorer is used to feel for cracks on the tooth and probe the gums around the tooth to feel for irregularities under the gum line.
X-rays usually do not show the small cracks that cause cracked tooth syndrome. Only if the cracks are wide enough, they may show up as shadows. In some cases of old vertical root fractures, vertical bone loss parallel to the root fracture can be seen in x-rays.
In case of a cracked root in a tooth with a restoration, it can be quite difficult to verify cracked tooth syndrome without removing the restoration. Sometimes a special dye might be used to temporarily stain the tooth, and check to see if it is fractured. After identifying the cause of the cracked tooth syndrome, the dentist will recommend the most suitable way to fix the cracked tooth.

For further information about this topic, or any other dental topic, contact Dr Slootsky at info@drslootsky.com, or call 954-972-1000