What is Cracked Tooth Syndrome?
Cracked tooth syndrome is a common dental problem that can often confuse people because it shows different symptoms, can seem uncertain, and can change over time, leading to incorrect diagnoses. Even highly skilled dentists can find this condition difficult to manage. It requires a clear plan and careful examination to deal with it.
A cracked tooth is identified by a break in the tooth’s surface. The depth and direction of this break are often unknown. If neglected, this crack can reach the soft, inner part of the tooth (pulp) or the tissue that holds the tooth in place (periodontal ligament). At the start, the crack may only be surface-deep, causing occasional discomfort when biting. However, if left untreated, it can ultimately affect the entire tooth, extend to the bottom part of the tooth, and can even make the tooth irreparable.
Because of how unpredictable this condition can be, it’s really important to give patients as much information as possible to help manage their expectations. Medical professionals also need to be skillful in using the available diagnostic tools, as a correct diagnosis is critical for proper management of cracked tooth syndrome.
What Causes Cracked Tooth Syndrome?
The leading reason for a syndrome called ‘cracked tooth syndrome’ comes from forces that occur when we chew or grind our teeth. However, many other factors can make a tooth more prone to cracking, such as age and restoration work on the tooth.
Different parts of the tooth (the enamel, dentine, and cementum) have different structures and play different roles when absorbing these forces. As we age, these different parts can lose some of their flexibility and hardness (a process known as physiological elasticity). This means they might not be as able to effectively absorb the forces created when we chew or grind our teeth.
Moreover, teeth that have been restored or filled can also be more at risk of cracking. This is especially true when the restoration work has not been carried out perfectly; for example, due to contamination, poor placement, or not following the appropriate steps. These instances can increase what dentists refer to as the “C-factor,” which essentially indicates a higher risk for the tooth to fracture.
The remaining healthy tooth tissue and the size of the cavity also play a role in the risk of a tooth fracture. If the filling is large (greater than a quarter of the chewing surface of the tooth), the risk of tooth fracture increases.
Teeth that have had root canal treatment may show more severe fracture patterns compared to those that have not had the treatment. And finally, factors like tooth shape, deep grooves in the tooth, sharp tooth edges, alterations in how the upper and lower teeth fit together, and changes in the center of the tooth can also increase the risk of cracks in the tooth.
Risk Factors and Frequency for Cracked Tooth Syndrome
Cracked tooth syndrome is usually seen in adults between 30 and 50 years old and is rarely found in students. Men and women both seem to be equally susceptible to it. The most common teeth impacted are the ones towards the back of your mouth, mainly the lower molars, followed by the upper premolars and molars. This happens because certain upper teeth can put extra pressure onto the lower ones, causing them to crack.
Signs and Symptoms of Cracked Tooth Syndrome
Identifying a cracked tooth can be difficult as the symptoms can often seem like other dental issues. This makes it critical to get a thorough history and conduct specific tests. The most common sign of a cracked tooth is a sharp, sudden pain when biting down on the tooth.
Some people may also feel a brief sharp pain when they stop biting down. Sensitivity to cold food and drinks could be another symptom. People often find it hard to pinpoint the exact tooth causing the problem.
If the crack reaches near or into the soft inner part of the tooth (pulp tissue), it can lead to symptoms similar to those of irreversible pulpitis. This condition can cause a constant dull pain that gets worse with exposure to heat and can disrupt sleep. People who have had a cracked tooth before often recognize these symptoms and can self-diagnose.
Testing for Cracked Tooth Syndrome
When trying to diagnose a problem with your teeth, your dentist will gather a detailed account of your symptoms. After this, they’ll use an array of tools to help identify the cause of the problem. They might shine a light source directly into your mouth and examine your teeth thoroughly, looking for any visible fracture lines or other signs of damage. If they suspect that your teeth might be cracked, they can use a technique called Fibreoptic Transillumination (FOTI). In this technique, light enters the tooth and is deflected when it hits a crack, creating a visible change from light to dark and revealing any hidden cracks.
Another technique used to identify the problem is a bite test. They’ll have you bite down on a special tool called a Tooth Slooth that concentrates the bite force onto individual cusps of the tooth, and you’ll then tell the dentist which cusp causes the pain. You may also be given a vitality test, which usually involves applying a very cold substance, like ethyl chloride, to the tooth. The response to this cold test can provide useful information as it can be exaggerated if a crack is close to the dentine – the inner part of the tooth.
If the issue is still not clear, your dentist might use a form of X-ray imaging known as radiography. This can sometimes reveal a thin line if the fracture runs from the cheek side to the tongue side of the tooth. However, it’s less effective if the crack runs from the front to the back of the tooth, which would appear parallel to the X-ray film. If the dentist is still unsure, but still suspects a crack, they might use a more advanced type of scanning technique called cone beam computed tomography (CBCT). This provides a more detailed view of the tooth to help confirm the presence of a crack.
Treatment Options for Cracked Tooth Syndrome
When managing a cracked tooth problem, there is no one-size-fits-all treatment. The way we approach treatment will depend on how severe the crack is and where it’s situated on the tooth. Our first goal is to relieve any pain the patient is feeling. Once we’ve identified where the crack is, we make sure the tooth is stabilized to keep it from flexing under the pressure of biting down.
In instances where the tooth pulp (the innermost part of the tooth) is not involved, we will remove old fillings and any damaged parts of the tooth to eliminate the crack. Then, we usually apply fillable composite material, which acts like a cast that keeps the crack from flexing when the patient bites down, offering immediate relief from pain.
Another method involves using a metal orthodontic band on the impacted tooth. This also keeps the tooth stable and prevents it from flexing under the pressure of biting down. This method is very effective, with over 92% of teeth showing healthy pulp after 2 months. However, this method can be a bit more tricky to maintain since the metal band can trap food particles. For patients who already have gum disease or don’t maintain good oral hygiene, this might not be the best option.
The use of a crown or something similar can also help protect the tooth. It keeps the tooth from flexing and becoming more damaged. Fulfilling this process involves distributing the pressure evenly across the whole tooth, but this method can be more invasive and increase the risk of the tooth losing vitality.
Sometimes the crack may extend into the pulp of the tooth, causing irreversible damage. In such cases, we perform a thorough assessment to see if the tooth can be saved. This involves removing all fillings or old restorations and examining the remainder of the tooth’s structure. If the crack hasn’t reached the floor of the pulp chamber or gone beneath the gum line, it might be possible to save the tooth using endodontic therapy (root canals and other treatments) followed by covering the tooth with a crown or similar restoration. However, this approach could have a poor long-term prognosis. In some cases, extraction may be necessary.
What else can Cracked Tooth Syndrome be?
When patients show a range of symptoms, it can be difficult to pinpoint the exact issue. Sometimes, other conditions can cause similar symptoms, which makes identifying the correct problem a bit tricky. It’s vital to pay close attention to the symptoms and gather all the necessary information on the patient’s medical history. This way, we can avoid misdiagnosing and treating the condition improperly.
For example, a quick, sharp toothache caused by something cold could be a sign of sensitive teeth due to gum recession or cavities. Pain when biting could be wrongly attributed to strain from teeth grinding, particularly if the person grinds their teeth at night or has other similar habits, or if a recent dental procedure has left a spot slightly higher than the rest of the tooth’s surface.
Speaking of recent dental treatment, a small uneven spot can cause mouth trauma. To address this, dentists usually check a patient’s bite using a special type of paper and make adjustments if necessary. In some cases, a recent dental procedure can trigger galvanic pain – this is when two different metals in your fillings or other dental restorations react with the saliva in your mouth to create an electric current. And sometimes, orofacial pain – that’s pain in the mouth, jaw, or face – can play a role in the diagnosis.
So, identifying the exact problem involves considering all these potential scenarios:
- Dental sensitivity due to gum recession or cavities
- Pain from teeth grinding
- Mouth trauma from recent dental treatment
- Galvanic pain from dental restorations
- Orofacial pain
What to expect with Cracked Tooth Syndrome
Catching a cracked tooth early plays a significant role in improving the chances of saving it. What may first appear as a small, harmless crack with minor symptoms could quickly grow into a complex and larger crack that extends into the pulp or the root of the tooth, making it impossible to restore.
The severity, location, and the direction of the crack all play key roles in determining the chance of saving the tooth. If the pulp of the tooth (the innermost part that contains nerves and blood vessels) is still healthy, measures like composite splinting (a method of bonding the tooth together), orthodontic bands (similar to braces to stabilize the tooth), or indirect definitive cuspal coverage (restoring the biting portion of the tooth) can be effectively used.
Lee and colleagues reported a 91% rate of keeping the pulp alive in cracked teeth that were stabilized with bidirectional splinting, whereas Guthrie and colleagues reported an 11% failure rate in crowned cracked teeth that required root canal therapy.
According to a study by Tan and colleagues, teeth with large cracks that reach the pulp – needing root canal therapy and restoration of the biting portion – have a lower chance of being successfully treated and are more likely to fail, often leading to the tooth needing to be extracted.
Possible Complications When Diagnosed with Cracked Tooth Syndrome
Cracked tooth syndrome can lead to various problems, including the death of the tooth’s pulp (the soft part in the center of the tooth) and severe tooth fractures that need the tooth to be pulled out. The situation can get worse for people who have many dental fillings or crowns, and those who have habits like biting their nails or grinding their teeth at night.
Common Problems:
- Pulp death in the tooth
- Severe tooth fracture
- Need for tooth extraction
- Complications for people with numerous dental fillings or crowns
- Complications for people who habitually bite their nails or grind their teeth while sleeping
Preventing Cracked Tooth Syndrome
When a diagnosis of cracked tooth syndrome is made, it’s really important for patients to fully understand the condition. Even if the symptoms seem small or unimportant, it can lead to tooth loss and non-recoverability. Your healthcare provider should make sure to explain the causes and factors that can make the condition worse. It’s also important to know about the long-term negative effects of a cracked tooth. These effects are not just about your health, but also can affect your financial situation.
You should also be aware of the challenges in fixing the tooth and that the outcome can sometimes be unpredictable. Understanding all this information will help manage your expectations and prepare you for the treatment process.
