- Cracked Tooth Syndrome (CTS) is defined as symptomatic incomplete fractures in teeth that are difficult to diagnose by conventional methods. Excessive pressure on teeth is the leading cause of this condition.
- Common symptoms of CTS include sensitivity to pressure and heat, and intermittent severe pain, similar to tooth decay.
- Doctors diagnose CTS with dental explorers, detection solutions, and X-rays taken from different angles.
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Do you suspect you may have CTS? Here's everything you need to know.
Causes of cracked tooth syndrome
Any excessive pressure on teeth can lead to fractures. The force, impact, frequency, and the previous condition of the tooth can determine the severity and type of fractures. It is common for several microscopic cracks to occur over time, eventually leading to CTS.
Common causes of cracked teeth include:
blunt force trauma
biting on hard foods
grinding and clenching
improper teeth alignment (i.e., malocclusion)
Other causes of CTS include oral piercings, such as tongue piercings, and teeth with prior dental procedures, such as root canal treatment and large fillings.
Symptoms of Cracked Teeth Syndrome
Common symptoms of CTS include pressure and thermal sensitivity, and intermittent severe pain. Symptoms are similar to tooth decay.
CTS rarely causes throbbing pain, unless the crack has reached the pulp tissue.
If the crack extends below the gum line, bacteria can be introduced through the crack and eventually lead to decay and/or abscess.
How is CTS diagnosed?
CTS is challenging to diagnose using traditional methods alone, such as radiographs and intraoral photographs. Dental radiographs only detect between 25% and 34% of fracture lines.
”I often explain it like this: think of a microscopic crack in a teacup,” Lee says. ”You cannot see it, but when you press on it, the crack flexes open, and when you let go, it snaps shut. In a living tooth, that flexing motion irritates the delicate nerve tissue inside, causing that signature "zing" of pain,” he confirms, adding that ”because the crack is often a hairline fracture running vertically, it does not show up on a standard two-dimensional X-ray.”
Your dentist may conduct several examination methods to diagnose CTS. Instruments such as dental explorers and toothpicks are used to isolate and detect cracks. Disclosing solutions stain and highlight cracks, making them more visible. Occasionally, radiographs taken from different angles can aid in diagnosis.
Identification and treatment of a fracture may involve removing a prior crown or restoration.
Can a CT scan detect a cracked tooth?
The cone beam CT (CBCT) can create accurate three-dimensional imaging of hard tissue structures. Depending on the type of crack, a CBCT scan can detect up to 70% of such damage. Even with this technology, some fractures are challenging to identify.
Modern dentistry is seeking additional techniques for CTS detection. Some of the promising methods include swept-source optical coherence tomography (SS-OCT) and near-infrared imaging.
Which tooth most often exhibits cracked tooth syndrome?
Lower second and first molars are the most susceptible to cracked teeth syndrome, followed by upper premolars.
Molar teeth are the most vulnerable to CTS because they withstand the most shear force. Molars are also susceptible to decay, which compromises their strength and integrity, because they are located in the back of the mouth, and many people have difficulty maintaining proper hygiene due to their position.
Treatment of cracked teeth syndrome
Superficial cracks can be treated with bonding by using composite resin material.
Deeper cracks require more invasive treatment options such as crowns, overlays, onlays, and root canal treatments. Root canal treatment removes the pulp, nerves, and blood supply to the tooth, which treats the symptoms of CTS. Most teeth receiving a root canal treatment require a dental crown for long-term protection.
Teeth with extensive cracks, which make them untreatable, will need to be extracted. In many cases, a missing tooth can be replaced with a dental implant and an implant crown.
FAQ
What problems can the cracked teeth syndrome cause?
Sensitivity to hot and cold temperatures is the first problem that can occur. The consequence of cracked teeth is the gradual development of extensive tooth decay. This, in turn, leads to sharp pain and extreme tissue damage. Eventually, you will have to deal with a broken tooth. It is also important to find the cause of your CTS. If you suffer from bruxism or misaligned teeth, you will also need to treat these conditions to reduce pressure on other teeth. Avoid the habit of biting on hard foods.
Is cracked teeth syndrome painful?
In most cases, CTS is characterized by sharp, localized pain. However, the degree of pain can vary: You may suffer from occasional symptoms of tooth sensitivity or develop constant pain in your teeth and gums. Your sensations will depend on the severity and location of the cracks.
Harry Lee, DMD
Cracked tooth syndrome is one of the most challenging conditions in dentistry as it is difficult to detect the exact root cause early on, and it can be incredibly frustrating for patients. They describe a sharp, electric shock-like pain when they bite down on something just right, but then it vanishes. They cannot pinpoint the tooth; the X-ray often looks completely normal, and they start to think they are imagining it. I always reassure them that the pain is very real; it is just notoriously difficult to find.