Introduction:

Age, tooth grinding, and trauma can contribute to a cracked tooth or a fractured tooth. You might not experience any symptoms of a fractured tooth. Sometimes, sensitivity and swelling can also arise. A cracked tooth is described as a partial fracture in the dentin of a back tooth, reaching into the pulp. The term “Cracked tooth syndrome” was first introduced by Cameron in 1964. Teeth consist of two parts:

• Crown

• Root

Both crown and root have several layers:

• Enamel

• Dentin

• Pulp

Teeth fractures can affect any of these layers. The treatment depends upon the site and severity of cracked tooth syndrome.

Causes:

• Age: Many tooth fractures can happen at the age of 50 and beyond

• Chewing hard foods

• Habits such as ice chewing

• Large dental restorations or root canal-treated teeth that can weaken the tooth structure

• Bruxism

• Trauma

Symptoms:

• Recurrent pain while chewing

• Sensitivity to temperature changes

• Swelling

• Toothache

• Tooth is not tender to percussion in the axial direction

      Site:

  Maxillary anterior and mandibular molars are the common sites. Severe injury or trauma can affect multiple teeth. Dental caries can predispose to a high risk of fracture.

Types of tooth fracture:

• Cracked tooth: Vertical crack extending from incisal surface to gum line. It can also extend to the root.

• Craze lines: Small, thin cracks appear on the outer surface of the enamel. These cracks do not cause any pain

• Fractured cusp: A crack is formed around a dental restoration

• Split tooth: A crack extends from below the tooth surface to below the gum line. This fracture splits the tooth into two parts.

• Vertical root fracture: Cracks start below the gum line and traverse toward the biting surface. These fractures do not cause any symptoms unless the tooth is infected.

Diagnosis:

The patient's history, examination, diagnostic tests, radiographs, and surgical exposure are needed to diagnose cracked tooth syndrome.

• Clinical examination: Adequate information from the patient history and clinical examination can be obtained for accurate diagnosis.

• Chief complaint: Patient complaints of pain/sensitivity. One should consider the possibility of infarction if these symptoms are associated with a non-carious tooth.

• History of the patient: Patients should be asked about previous trauma, dietary habits, or bruxism.

• Visual examination: One should inspect for large restoration, steep cusps, wear facets, cracked restoration, etc

• Tactile examination: Crack can be detected by using the tip of a large explorer.

• Periodontal probing: The involved tooth might reveal a narrow periodontal pocket.

• Bite test: Rubber wheel, orange wood stick, and tooth slooth are used for detecting cracked teeth.

• Transillumination: Fiber-optic light can be used to transilluminate a fracture line.

• Use of dyes like methylene blue can aid in diagnosis

• Surgical exposure: A full-thickness mucoperiosteal flap can be reflected for visual examination of the root surface

Management and treatment:

• Non-steroidal anti-inflammatory drugs can be taken to reduce pain and swelling

• Bonding: Plastic resin can be used to fill in the fracture

• Cosmetic contouring

• Porcelain or ceramic crown can be fitted over the fractured tooth

• Extraction

• Root canal treatment

• Veneer

Conclusion:

Cracked tooth syndrome highlights the significance of proactive dental care and timely intervention to safeguard dental well-being and alleviate discomfort. Through awareness of symptoms, prompt evaluation, and adherence to prescribed treatments, individuals can successfully address cracked tooth syndrome and uphold excellent oral health.

References:

1.    Bailey, O; Whitworth, J (2020). "Cracked tooth syndrome diagnosis part 1: integrating the old with the new". Dental Update. 47 (6): 494–499. doi:10.12968/denu.2020.47.6.494

2.    Mathew, Sebeena; Thangavel, Boopathi; Mathew, Chalakuzhiyil Abraham; Kailasam, SivaKumar; Kumaravadivel, Karthick; Das, Arjun (August 2012). "Diagnosis of cracked tooth syndrome". Journal of Pharmacy & Bioallied Sciences. 4 (Suppl 2): S242–S244. doi:10.4103/0975-7406.100219. ISSN 0976-4879. PMC 3467890. PMID 23066261

By Dr. ANJALI KV