Cracked Tooth Syndrome

“CRACKED TOOTH SYNDROME is a painful condition caused by incomplete fracture of the tooth ,a fracture which is too small to be seen on a X-ray, which occasionally extends into the pulp.”

COMMON SITE: - Lower 2nd molar
Lower 1st molar
Upper bicuspids



SUSCEPTIBILITY: It is mostly seen in
* Persons with habit of BRUXISM
* Persons who apply more pressure while chewing/ Chew hard
substances like nuts, hand candies, pencils, ice sticks….
* Teeth with large fillings/ those which are rootcanal treated. Such teeth have just 30% of
strength… so everytime we grind/chew/ clench the tooth will flex slightly and in such
cases a hairline fracture develops at the bottom of the filling.


SYMPTOMS:

1. Severe pain / sharp uncomfortable sensation only while biting or chewing.(not all the time)
2. Pain might be felt only when the person bites in a specific direction due to difference in the direction, extent and location of the crack.
3. Pain more often experienced to cold stimulus
4. There is no constant pain like in cavity or abscess
5. Pain is severe particularly during the initiation and release of biting pressure
6. Patient is unable to identify offending tooth or the quadrant involved


WHY IT HURTS…?????

On biting tooth flexes which stimulates nerves in the tooth….. the hairline crack opens and closes applying pressure on tubules that run down the nerve causing the movement of the fluid in tubules. When the biting force/ pressure is taken off the tooth…. The crack closes and the fluid pressure stimulates the nerve which causes the pain.


DIAGNOSIS:

Cracked tooth syndrome is one of the most difficult diagnosis in dentistry…..

1. Based on thorough dental history : Bruxism
Clenching
Trauma
Masticatory habits such as chewing ice
2. Clinical / visual examination: check for craze lines on enamel with a sharp explorer check for a cracked restoration using transillumination
3. Diagnostic tests: - 1)a cotton roll is placed and the patient is asked to chew isolating each tooth.
Pain indicates a chance for a crack a rubber wheel or a bite stick can be
used for this purpose. “Tooth sleuth “ is used to check each individual
tooth cusp for a crack.
2)fiber-optic light is used for the detection of a crack
3)tooth staining using a special dye is also useful.
4. Radiographs: these cracks are too small to be seen on a X-ray, hence not very useful.



TREATMENT:

a) if the crack is simple involving - small cusps: restoration with a composite
- larger tooth surface: crown is indicated
b) if the crack is complex involving pulp: RCT is indicated.
c) if the crack extends far down the middle of tooth / root fracture : extraction indicated.



PREVENTION:

Bruxism and other abnormal chewing habits can increase risk to cracked tooth syndrome. Proper habit control methods have to be followed by consulting a dentist.