Erratic pain when chewing, sensitivity to hot and cold, and discomfort upon quickly releasing biting pressure upon an object in your mouth, are all symptoms of Cracked Tooth Syndrome (CTS). The parts of a cracked tooth can move very slightly upon chewing and this can upset the pulp within and will ellicit discomfort. If the moving parts are not stabilized, the pulp and nerve can abscess and root canal therapy may become necessary. In the worst case, the tooth could split through or down the roots and necessitate extraction. The above symptoms may be present in other dental conditions also.
Most adult patients above age 30 have fracture lines in their teeth. Some teeth actually have craze lines in them. These are tiny crack lines running in all directions, similar to that of a car windshield which has shattered in the summer heat. In the majority of teeth having cracks, there are no symptoms and no treatment is necessary. If they have symptoms or the crack is significant, a crown is prescribed.
On occasion, one or more of the cusps may fracture completely away which strangely may make the tooth feel better. That is because the parts are no longer moving against one another. Sometimes a crown build-up is necessary to replace the missing parts before a full crown is placed. If for any reason the crack extends through the pulp, usually treatment demands both a root canal followed immediately by a crown. Sometimes a crown is placed in hopes of relieving the discomfort but later a root canal becomes necessary.
Teeth with very large fillings are more likely to crack than others. Also, patients who grind (brux) their teeth are sometimes prone to have CTS. The teeth most likely involved are the back teeth, which are the molars and premolars. These cracks normally cannot be seen on x-ray, but if left untreated, often extend into the pulp which allows bacteria and toxins from the oral cavity to cause infection and a resulting abscessed tooth. Now the situation demands treatment by root canal. Failure to place a crown on a tooth following a root canal usually results in fracturing of this tooth since it loses its internal moisture and becomes brittle. A crown should always be placed over a tooth which has received root canal therapy.
It is important to remember that placement of a crown on a tooth which has Cracked Tooth Syndrome, eliminates the symptoms if over 90% of the cases. The remainder will need root canal therapy.
In summary, one of the more difficult problems for a dentist to diagnose is the Cracked Tooth Syndrome. The cracks are often microscopic and do not show on x-ray film. If they are large enough, the dentist may show them to you on an intra oral camera which enlarges the tooth many fold. The presence of erratic pain upon biting, sensitivity to cold, pain upon quick release of pressure, and other symptoms help in the diagnosis. Often, the dentist may want to place a crown before symptoms arise in order to prevent a fracture, a possible root canal, or even an extraction or implant. Once diagnosis has been made, the treatment options are as follows:
(1) Placement of a crown…to hold the parts of the tooth tightly together and prevent the crack from enlarging. Most often, this is all the treatment required. After a period of time, but only if the sensitivity persists, we progress to the next option.
(2) Root canal therapy…to devitalize the tooth. We prefer not to do this but sometimes the cracking dictates this. The dentist may elect to provide this procedure or refer you to an endodontist. If the crack is severe and beyond treatment by root canal, the final option is:
(3) Removal of the offending tooth…this may be performed in the dental office or you may be referred to an oral surgeon. After a rare removal of the tooth, it may be replaced with a fixed bridge or an implant and crown.
Each situation is different and most patients do not want to lose a tooth and elect to have a crown placed. The important thing for a patient to remember is not to wait if symptoms occur in the tooth.
American Dental Association-Life Member, Fellow of Academy of General Dentistry, American Academy of Implant Dentistry