Unexplained Tooth Pain? You May Have a Cracked Tooth!

Cracked tooth syndrome is becoming more common as people keep their natural teeth longer.


Cracked tooth syndrome (CTS) is where a tooth has incompletely cracked but no part of the tooth has yet broken off. Fractured 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. The symptoms of cracked tooth syndrome vary, making it a notoriously difficult condition to diagnose.

Causes of CTS

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. Sometimes the pressure applied on a tooth during root canal treatment may cause a crack.
  • After a root canal treatment teeth become brittle and they are more susceptible to cracked tooth syndrome.

Symptoms of CTS

CTS is typically characterized by pain when releasing biting pressure on an object. The pain is often inconsistent, and frequently hard to reproduce. If untreated, CTS can lead to severe pain, possible pulpal death, abscess, and even the loss of the tooth. Reported symptoms may include the following:

  • Sharp painwhen biting on a certain tooth, which may get worse if the applied biting force is increased. Sometimes the pain on biting occurs when the food being chewed is soft with harder elements, e.g. seeded bread.
  • “Rebound pain” i.e. sharp, fleeting pain occurring when the biting force is released from the tooth, which may occur when eating fibrous foods.
  • Pain when grinding the teeth backwards and forwards and side to side.
  • Sharp pain when drinking cold beverages or eating cold foods.
  • Pain when eating or drinking sugary substances.
  • Sometimes the pain is well localized, and the individual is able to determine the exact tooth from which the symptoms are originating, but not always.

Diagnosis of CTS

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). Arriving at a diagnosis may include the following steps:

  • A detailed dental history, focusing especially in history of trauma, bruxism, chewing habits and bite adjustments
  • Identify which tooth has the problem through a biting test. 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.
  • Perform a thorough examination of the tooth, checking for any signs of problem that could explain the symptoms e.g. tooth decay or fractures.
  • 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. 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.

Treatment of CTS

The treatment for cracked tooth syndrome depends on the type, location, and severity of the crack. Treatment aims to prevent movement of the segments of the involved tooth, so they do not move or flex independently during biting and grinding and so the crack is not propagated. Treatment can include:

  • Stabilization or bonding (core buildup). A composite bonded restoration is placed in the tooth or a band is placed around the tooth to minimize flexing
  • Crown restoration, which is a more permanent version of stabilization. Learn more about how crowns can help strengthen your teeth here.
  • A root canal might be necessary if the fracture has reached the center of the tooth and the dental pulp has been infected, or if pain persists after stabilization/crown restoration.
  • In some cases, such as in vertical root fractures (split root) in single rooted teeth, the only treatment option is tooth extraction. If the dentist decides that the tooth needs to be extracted, it must be replaced by an implant or bridge.

Early diagnosis of a fractured tooth can be very important for the future of the tooth. If detected early enough, with the proper treatment, the tooth can be retained for a long time despite the crack. If the crack is left untreated, complications like tooth infection, abscess or breaking of the tooth may lead to loss of the tooth. Repair of any tooth thought to be cracked is always risky, and no guarantees can be made about the outcome.

If you are experiencing unexplained tooth pain, contact Glen Oaks Dental right away. Drs. Craven and Bejarano routinely perform cosmetic and restorative procedures and have developed a thorough approach to determine the best solution for each patient. Our goal is for you to have the highest level of oral health and appearance as well as a comfortable and pleasant dental experience.

photo credit: 13:365 via photopin (license)


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