Cracked tooth syndrome (CTS) refers to a tooth with an incomplete fracture. This condition must be diagnosed and treated immediately to prevent further complications. If you think you might have CTS, you have several treatment options—which you can discuss in-depth with one of Flossy’s dentists.
Flossy has compiled this guide with everything you need to know about CTS to give you an overview of this condition. Read on to discover what causes CTS, its symptoms, and how it’s diagnosed and treated by dentists.
Cracked tooth syndrome (CTS) is a tooth fracture of unknown depth. It usually originates in the crown—the visible part of the tooth—and may extend to the root. CTS is often referred to as an “incomplete” fracture.
In many cases, CTS does not present any symptoms. As a result, timely diagnosis of this condition can be difficult. The more time passes without treatment, the higher the risk of complications, such as a deep bacterial infection.
When CTS presents symptoms, it can include several types of pain, such as sensitivity to the cold, pain when biting down, and constant throbbing pain.
In many cases, CTS does not have symptoms. As such, when a patient presents with pain symptoms, it is a sign that the condition has progressed to a moderate-to-mild severity and might require more intensive treatment.
There are various causes of cracked tooth syndrome (CTS), making full prevention difficult. Here is an overview of the different risk factors you should watch out for.
While getting older in and of itself won’t cause you to develop CTS, it can significantly increase your chances of it. The more time that passes, the more likely it is that your teeth have experienced significant “wear and tear.”
As a result, your teeth may be more fragile and prone to breakage. Studies support this by showing that most CTS cases occur in individuals who are over 40 years of age.
While you can’t change your age, you can implement a solid oral hygiene routine that focuses on preserving and restoring your enamel—the hard outermost part of the tooth.
Regularly brushing and flossing your teeth is one of the best ways to ensure that your enamel does not wear away. In addition, you can use products containing fluoride to build up some of the enamel you may have lost over the years.
Genetics is a major predictor of CTS. Your genes determine a large portion of how your teeth develop. As such, some individuals—through no fault of their own—may have structural defects, such as deep grooves in the teeth, which can increase the risk of CTS.
It is also possible for the teeth to not efficiently develop the hard outer layer known as “enamel” and, as such, to be more prone to cracking.
The cuspal inclination refers to the tilt of the tooth. If a given tooth is slightly tilted to the side, it can chip away at the teeth it comes in contact with when biting. This can exert a greater amount of pressure on a small area of the tooth, increasing the likelihood of it cracking.
Fortunately, not all risk factors of CTS are related to characteristics that we were born with. In some cases, our (preventable) habits can influence how likely we are to experience tooth cracking.
Studies show that habits such as chewing on one side all the time, eating extremely hot or cold food, or grinding your teeth can increase your risk of developing CTS.
In addition, constantly chewing on food that is hard in texture—such as candy—can damage the structure of the tooth and increase your risk of CTS.
Individuals with a history of root canals have a higher likelihood of experiencing CTS.
This is because the middle part of the tooth structure—called dentin—experiences increased stress from the tools used to perform the procedure. In addition, the placement of the dental post may further contribute to stressing out the tooth. All of these factors increase the likelihood of developing CTS.
A history of some restorative procedures, such as cavity fillings, can reduce the structural strength of the tooth. In addition, because some restorative procedures are associated with excessive removal of tooth tissue, it can reduce the hardness of the tooth, making it less likely to endure physical stress that’s placed upon it.
As a result, a history of therapeutic procedures can significantly increase the chances of cracking. In fact, studies show that some restorative procedures increase the risk of CTS by as much as 29 times.
In addition to a history of restorative procedures, which type of material was used to restore the tooth plays a role in developing CTS.
Compared to nonmetallic materials—such as porcelain—materials made out of metal are more likely to deform from external forces.
This can lead to an abnormal bite distribution, which—as mentioned above—can exert greater pressure on a small area of the tooth that it comes in contact with. The material used plays a significant role in the risk of developing CTS.
Because CTS presents variable signs and symptoms, which sometimes include none, diagnosing this condition may be hard for even the most experienced dental professionals. Unfortunately, early detection of CTS is crucial and is linked with successful treatment of the condition.
This condition can present similarly to many other diagnoses, including:
This overlap in symptoms can significantly increase the risk of the patient receiving an incorrect diagnosis and treatment.
For this reason, proper diagnostic techniques are essential when faced with the possibility of CTS. The following is an overview of how your dentist can diagnose CTS if you suspect that you may have it.
Due to the various risk factors for CTS, getting a thorough dental history can illuminate an increased possibility that the patient has the condition.
A history of dental restorations and many other types of dental treatments can significantly increase the risk of CTS. In addition, poor oral habits, such as teeth grinding, can also provide a clue into the chances that the patient has the condition.
If your dentist suspects CTS, then they can inject a sharp probe into the margins of the tooth. In most cases, if doing this evokes sharp pain, then CTS is more likely than not. Of course, this examination may also reveal another dental condition that may be confused for CTS.
This type of examination is usually performed before imaging can be done. However, in many cases, CTS does not cause pain in patients. In such patients, this examination may not necessarily lead to the discovery of CTS.
If the patient had any restorative work done, then removing the restorations may be necessary before any cracks are revealed. While this may be a time-consuming examination for some patients, it does have its upsides—even if it does not reveal CTS.
A clinical examination can reveal any risk factors for CTS, such as excessive dental wearing. This can allow the patient to take the proper precautionary measures to ensure that the condition does not progress into something more serious.
A probe is a long, thin instrument that can be inserted into spaces between the teeth. It can be used to determine the type of crack that has occurred is measured by how far it extends into the root.
Determining the severity of the crack is imperative, as deeper cracks cannot be repaired and must lead to the removal of the entire tooth. However, tooth restoration is still possible if the crack is small enough.
A less invasive examination involves the administration of a blue or violet-colored stain. This can highlight a crack in cases where it is not visible to the naked eye. However, there are a few downsides to the dye test.
In the first place, it may take up to five days to be effective. In addition, it may be difficult to remove. It is not the most common technique used in diagnosing CTS.
Pain during biting is considered a classic symptom of CTS. As such, your dentist might administer something known as the “bite test,” which uses a rubber wheel or some other instrument that you can bite down on.
Your dentist might test out the bite on different cusps of the tooth while asking you to use alternating bite pressures. If pain is present when biting down, then it may indicate CTS.
However, in some cases, individuals with CTS might not feel any pain at all. This does not rule out the possibility of a crack. As such, further testing might be required.
If the crack extends deep enough, then it might reach the part of the tooth called the pulp, which contains many nerve endings. One test that may be used to establish CTS involves exposure to cold temperatures. Of course, this test cannot be used to confirm a smaller crack that does not extend to the pulp.
Radiographs are rarely used to diagnose CTS as many cracks cannot be seen on conventional radiographs. However, radiographs may be used in some cases to assess the state of the pulp. If it is abnormal, then it can indicate CTS.
Cracked tooth treatment depends on various factors, such as the degree of the crack, its direction, and its location. After a thorough examination, your dentist might give you a prognosis of “excellent,” “good,” “poor,” or “hopeless.”
If your prognosis is excellent or good, then the crack is fairly small. This makes it quite easy to manage. A small crack can be repaired with a dental filling in most cases. A dental crown may be needed to protect the tooth in rare cases.
If your prognosis is poor, then the crack has likely progressed to the dentin or the pulp. In this case, a root canal treatment may be required. In addition, a crown may have to be placed on top of the tooth to protect it.
If your prognosis is hopeless, then the tooth cannot be repaired. This occurs when a crack extends into the tooth's root beneath the bone. Because this crack cannot be repaired and can lead to significant complications if left untreated, the tooth will need to be extracted. Your dentist might then recommend a dental implant or dental bridge procedure.
Cracked tooth syndrome (CTS) refers to an incomplete tooth fracture, which has variable causes. In many cases, CTS does not present any symptoms. As such, timely diagnosis and treatment may be difficult.
For this reason, it is important to see your dentist regularly and to report any changes in your dental health. A skilled dentist will identify the root cause and start immediate treatment. Check out Flossy’s network of dental professionals to keep your dental health in its best condition.
Stannous Fluoride Effects on Enamel: A Systematic Review | NCBI
Cracked Tooth Syndrome: Characteristics and Distribution among Adults in a Nigerian Teaching Hospital | Journal of Endodontics
Review of Cracked Tooth Syndrome: Etiology, Diagnosis, Management, and Prevention | Pain Research and Management
How biomechanics can affect the endodontic treated teeth and their restorative procedures? | SciELO