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. 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. 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.
How Can I Prevent My Teeth From Fracturing?
Most fractures cannot be avoided because they happen when you least expect them. However, you can reduce the risk of breaking teeth by:
- Trying to eliminate clenching habits during waking hours
- Avoiding chewing hard objects (eg bones, pencils, ice)
- Avoiding chewing hard foods such as pork crackling and hard-grain bread
If you think you grind your teeth at night, ask your dentist if a nightguard or a splint will be of use to you. It is very important to preserve the strength of your teeth so they are not as susceptible to fracture.
Try to prevent dental decay and have it treated early. Heavily decayed and therefore heavily filled teeth are weaker than teeth that have never been filled.
Individuals who have problems with tooth wear or “cracked tooth syndrome” should consider wearing a nightguard while sleeping. This will absorb most of the grinding forces.
Relaxation exercises may be beneficial.
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.
Types of Cracks
These are tiny cracks that only affect the outer enamel of the tooth. These cracks are more common in adults. These types of cracks are superficial and are usually of no concern.
When a cusp becomes weakened, a fracture may result. The cusp may break off or be removed by a dentist. A fractured cusp rarely permanently damages the pulp and therefore root canal is not necessary. Your dentist will usually restore the tooth with a full crown.
This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. In some cases, the crack may extend below the gum line. It is possible for the crack to extend further into the root. Damage to the pulp is commonplace. In this case, root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth. Therefore, early detection is essential.
A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. This type of tooth can never be saved intact. Yet, the position and extent of the problem will dictate whether any portion of the tooth can be saved. Sometimes, endodontic treatment by the doctors and restoration by your dentist can be used to save a portion of the tooth.
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.
How Does the Dentist Treat a Cracked Tooth?
It depends on the direction and severity of the crack. If the crack is small enough, it may be removed by replacing the filling. Bonded white fillings will hold the tooth together making it less likely to crack.
Sometimes the cracked part of the tooth fractures off during the removal of the filling and this can be replaced with a new filling.
Your dentist may first place an orthodontic band around the tooth to keep it together. If the pain settles, the band is replaced with a filling that covers the fractured portion of tooth (or the whole biting surface). Other options include the placement of gold or porcelain fillings or even a crown.
If the crack goes too far vertically, there is a possibility the tooth may need to be removed and replaced with an artificial one. Your option for replacement is an implant, bridge or removable dentures.
The nerve may sometimes be affected so badly that it dies. Root canal treatment will be required if the tooth is to be saved.
Treatment of cracked tooth syndrome is not always successful. Your dentist should inform you about the prognosis. In some people, a restoration with a crown will relieve all symptoms. In others, root canal treatment solves the problem. Some people continue to have occasional symptoms after treatment, and may need to have the tooth extracted.