Cracked Tooth Syndrome

SCM-COVER-030411-2.inddby Chris Edwards, DDS

April 2011

Sharp Pain, Sensitivity Characterize Condition

CRACKED TOOTH SYNDROME is a condition that has to be identified and treated early enough before the damage puts the tooth at risk. If the crack reaches the pulp chamber of the cracked tooth, the pulp tissue becomes exposed to bacteria and bacterial toxins, and gets inflamed developing a tooth infection.


Cracked tooth syndrome (CTS) is a dental condition in which a crack extends through the dentin, and occasionally through the pulp of a tooth. Sharp pain and sensitivity with chewing without any visible reason is characteristic of CTS. Teeth that cause CTS usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

There are two major causes of Cracked Tooth Syndrome. The first is previous restorations from which the tooth has been weakened by the removal of decay and healthy tooth to restore it. It is particularly true with Silver Amalgam fillings that have no adhesion to the tooth and expand and contract at different rates than the tooth.

The second major etiology for CTS is parafunction, a dental term which refers to unconscious jaw activity at night while sleeping such as clenching or grinding of the teeth. It is not uncommon to see fractures in teeth that have never had a filling but exhibit signs of stress from clenching and/or grinding. Less commonly CTS can develop from trauma such as a fall, blunt trauma to the jaw or sports injury.

Fractures are most common in back teeth, especially molars, and are often not evident because they initially may not cause pain or sensitivity. There is no good way to know when a fracture that is asymptomatic will develop the pain and sensitivity of CTS, split apart or have a piece break off. In a small percentage of cases, the fracture can result in two separate pieces. When this happens extraction is most always necessary.

Consistent Evaluation Critical

Preventing the underlying causes is, of course the best way to avoid fractures and the syndrome. Protecting your teeth from decay avoids fillings and root canal treatment that may cause teeth to lose strength and become brittle.

Parafunction is common and can be a result of many factors including a bad bite or everyday stress. Consistent routine dental evaluation is critical to identify evidence of teeth grinding or clenching. Learning to relax the jaw or becoming mindful when clenching or grinding is not easy. Appliances like bite splints are helpful in protecting the teeth during sleep. Teeth routinely endure a tremendous amount of daily pressure from biting and chewing, and avoiding certain hard foods like hard candy, unpopped popcorn, and chewing ice will help minimize fracturing.

Using a filling to repair a cracked tooth is rarely effective as a long-term solution. The most reliable approach to CTS is to cover the fractured portions with a strong restoration that holds the fractures together. This can be a crown or partial crown (onlay), and usually, but not always, will be effective at relieving the symptoms. If the pulp (nerve) in the tooth has been irreversibly damaged, the tooth may need a root canal treatment, and in a small percentage of cases the affected tooth may need to be extracted.

CTS Restoration

Being proactive and restoring a fractured tooth before it becomes a Cracked Tooth Syndrome is the best chance for the long-term health of the tooth.

Technologies like CEREC, one visit cad-cam dentistry, can create conservative, strong, long lasting all ceramic restorations in one visit to restore fractured teeth.

A local patient had a painful upper molar in a tooth that had a small silver filling and developed a fracture. She was a known night grinder and wore a night guard bite splint. This tooth became infected, most likely from the fracture, and she had to undergo root canal therapy. The Endodontist gave her a guarded long-term prognosis because the fracture was deep into the root of the tooth. The patient proceeded to get a CEREC crown to prevent the tooth from splitting. She could chew successfully and her prognosis improved.

Shortly before her crown restoration, she developed CTS involving a virgin first bicuspid tooth on the opposite side. Upon evaluation, the tooth had split in half and was unsalvageable. The tooth was extracted and an immediate dental implant was placed. The patient wore a temporary crown for three months while the implant was healing, and then a CEREC crown was made for a complete restoration.

This case illustrates that long-term parafunction is often a causative factor in tooth fractures. Proactive evaluation and treatment of the bite with possible bite splints or night guard therapy is always the initial approach in an attempt to prevent fractures.

Restoring teeth compromised by fractures or large amalgam fillings is very effective in preventing CTS. The sooner a tooth that develops CTS is treated, the better the prognosis of stabilizing and preserving it. If you suspect that you grind or clench your teeth, or experience any of the symptoms listed above, get in to see your dentist as soon as possible


Dr. Edwards graduated from the United States Merchant Marine Academy and Temple University School of Dentistry. He completed a general practice residency at the Queens Medical Center in Honolulu. To reach Dr. Edwards you may call 321-751-7775 or visit