When we think of cracked teeth, we imagine dramatic scenarios: a child biting down on a massive gobstopper or an athlete getting hit so hard in the face that little fragments of tooth fly out. However, the truth is that cracking a tooth is typically a much subtler event, and it happens much more frequently than you might imagine. In fact, it’s possible to crack a tooth and not even realize it. This is the basis of what dentists call “cracked tooth syndrome.” At Dr. Craig Armstrong’s Houston dental practice, we’re dedicated to helping patients deal with all manner of oral health issues. The more you know about your teeth, the better you can take care of them. Read on to learn more about cracked tooth syndrome.
A dental fracture occurs when a tooth breaks or cracks. Fractures can be deep or superficial, and may affect various portions of the tooth. According to Encyclopaedia Brittanica, “fracture, in pathology” is “a break in bone caused by stress… An incomplete, or greenstick, fracture occurs when the bone cracks and bends but does not completely break; when the bone does break into separate pieces the condition is called a complete fracture.” In teeth, then, a complete fracture is one that cracks the tooth into two or more pieces, while an incomplete fracture does not. In many cases, fractures are clearly visible in x-rays. However, this is not always the case, and this brings us to the condition we discuss in this blog.
What is Cracked Tooth Syndrome?
As per a 2012 article in Journal of Pharmacy & Bioallied Sciences, “cracked tooth is defined as an incomplete fracture of the dentine [the deeper portion of the tooth structure beyond the enamel] in a vital posterior [back] tooth that involves the dentine and and occasionally extends into the pulp [the innermost part of the tooth, which includes the nerves, tissue, and blood]. The term ‘cracked tooth syndrome’ (CTS) was first introduced by Cameron in 1964.” As a piece in the Journal of Esthetic and Restorative Dentistry explains: “cracked tooth syndrome is a term applied to a presumptive [assumed] diagnosis of an incomplete tooth fracture.”
Essentially, cracked tooth syndrome describes a radiographically undetectable crack that damages the tooth without completely breaking it. This condition typically occurs in lower molars. Often, the fracture lies below the gum line, which makes it more difficult to discover.
Who is at Risk for Cracked Tooth Syndrome?
While virtually anyone could experience cracked tooth syndrome, some people may be more predisposed to the condition. You are more likely to experience this issue if:
- You chew on ice, hard candy, or other tough substances. This puts undue pressure on your teeth and can lead the chewing surfaces of your teeth to become incompletely fractured. This is why cracked tooth syndrome is more common in the lower molars, which are most impacted from chewing.
- You suffer from bruxism. Grinding or clenching your teeth can wear them down and cause cracks.
- Your bite is improperly positioned. Malocclusion can put too much pressure on opposing teeth and lead to cracked tooth syndrome.
- You have one or more teeth with large fillings. If you are missing a significant portion of your tooth structure, you are at higher risk for an incomplete, imperceptible fracture.
- You have required root canal therapy in one or more of your teeth. If your tooth’s pulp has become infected and needed removal, cracked tooth syndrome is more probable.
- You have suffered from cracked tooth syndrome in the past. Unfortunately, if you’ve ever suffered from this condition, the chances that your tooth will fracture again are higher.
- You’ve experienced an oral trauma. Being hit in or falling on your face could cause cracked tooth syndrome, even if your other injuries are relatively minor.
If you fall into any of the above categories, it’s important to be especially conscientious about the texture of the foods you eat and your overall dental health. Even if you fall into none of these categories, you could suffer from cracked tooth syndrome, so you should look out for the symptoms of this condition.
Symptoms of Cracked Tooth Syndrome
Like many other dental conditions, cracked tooth syndrome tends to worsen and become more severe if left untreated. One of the most problematic components of cracked tooth syndrome is that it is so difficult to detect, so it’s especially important to understand the signs of this condition. You may be suffering from cracked tooth syndrome if:
- You find it uncomfortable to chew hard substances. This puts pressure on the teeth.
- Your teeth are especially sensitive to changes in temperature. As the Journal of Esthetic and Restorative Dentistry notes, cracked tooth syndrome “typically presents with consistent symptoms of pain to biting and temperature stimuli, especially cold.”
- You have difficulty biting at certain angles. Hitting your teeth together in particular ways stresses the angle of the incomplete fracture.
- Your tooth feels loose. The fracture could destabilize it.
- You notice inflammation in the adjacent gums. This swelling could occur as the result of cracked tooth syndrome.
- You have a toothache. This soreness may often be intermittent.
Dr. Armstrong and our team are here to assist you if you experience any of the above. Even if you do not end up having cracked tooth syndrome, all of these are serious symptoms that we urge you to address immediately.
Diagnosing Cracked Tooth Syndrome
As the Journal of Pharmacy & Bioallied Sciences notes, “diagnosing CTS [cracked tooth syndrome] has been a challenge,” since one of its defining features is that it’s difficult to identify. Usually, Dr. Armstrong would tell you have a fracture with an x-ray, but radiography cannot discover cracked tooth syndrome. The article points out that “the ease of diagnosis varies according to the position and extent of the fracture” – larger, more prominent cracks may be more easily seen, while tinier fractures buried beneath the gums are often tougher to find.
If you’re suffering from one or more symptoms of cracked tooth syndrome, Dr. Armstrong will examine your mouth using a tool called an explorer to inspect your tooth and gums. He may also use a special instrument to test your tooth. This device sits over part of your tooth as you bite down. If you feel discomfort during this process, Dr. Armstrong will suspect a crack. We may also stain the tooth with a special dye to find the crack or shine a fiber-optic light on it to reveal any damage. If you have a filling or crown in the affected tooth, we may need to remove the restoration covering the surface in order to diagnose cracked tooth syndrome.
Your Treatment Options
Once Dr. Armstrong and our team have determined that you’re suffering from cracked tooth syndrome, we will design a customized treatment plan to help remedy the condition. The appropriate treatment method will depend on the specific placement, size, type, and severity of your fracture, as well as your symptoms. If the crack splits into the root and affects your tooth’s pulp, this may be considerably uncomfortable and put you at risk for infection. In this case, you may need a root canal. Dr. Armstrong may also recommend placing a dental crown to repair the crack. In some cases, it may be necessary to extract the tooth and replace it with a fixed bridge or all-on-4 dental implants. If you have cracked tooth syndrome but are not suffering as a result, you may not require any treatment at all, but Dr. Armstrong and our team will want to carefully monitor your teeth.
Preventing This Condition
As the old saying goes, prevention is the best medicine. It is far better to avoid causing an incomplete fracture in your teeth than to struggle with the uncomfortable symptoms of cracked tooth syndrome later on. Fortunately, there are a few key, simple steps you can take to ward off a fracture. These include:
- Wearing a night guard or using other techniques to minimize grinding or clenching, if you suffer from bruxism. Dr. Armstrong and our team can assist with this by creating a custom-fit night guard for you.
- Avoiding biting down on hard, brittle foods that could crack your teeth when you bite down.
- Wearing proper protective gear when riding a bike or playing sports. These precautions can help you avoid the kind of oral trauma that can lead to cracked tooth syndrome.
- Coming in for preventive care appointments at least twice a year. During your professional dental exams and cleanings, Dr. Armstrong will look out for signs of potential fracture and provide advice to help you keep your teeth crack-free.
By following these guidelines, you can help minimize your chances of cracked tooth syndrome.
Are You Suffering From Cracked Tooth Syndrome?
If you suspect or know you are dealing with this condition, it’s important to seek appropriate dental assistance as soon as you can. Dr. Armstrong and our Houston dental team want every patient to enjoy a beautiful, healthy, intact smile. We’d be delighted to help you. Contact us today to learn more about cracked tooth syndrome and schedule your next appointment!