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
