Cracked Tooth Syndrome

by Beverly Presley-Nelson, D.D.S.

Cracked tooth syndrome is a group of symptoms and occurrences that can be an annoying problem for a patient and a diagnostic challenge for a dentist. At one time this syndrome was called, “Green Stick Fracture” in some dental circles. Imagine trying to break a tree branch that is still somewhat “green” or fresh and will not break all the way through. Teeth can behave this way. A single fracture or several microfractures may occur that cannot be detected by dental x-rays or readily seen with the human eye. They exist, but like the green branch, they are not broken all the way through. A tooth may appear to be intact but may have one or more of these fractures. This is not the same as the tiny “craze” lines that may be observed on the surface of some front teeth. “Craze lines” are shallow and of no consequence. “Green stick” fractures are deeper into the tooth and usually not easily seen.

The first sign of cracked tooth syndrome may be when a part of a tooth actually falls away such as with a broken cusp. This may be a precursor to, or a hint of other unseen fractures within the tooth.

On the other hand, a tooth with a “green stick” fracture may never break apart. Instead they may have symptoms of pain upon biting. This often is a sharp, quick pain that is not easy to reproduce at will. It
may be felt only occasionally when the patient chews just a certain way. Or a cracked tooth may be tender to all pressure or even sensitive to other stimuli, such as cold air. Sometimes it is hard for the patient and the dentist to be sure which tooth is affected.

Sometimes a routine dental procedure will “bring to light” or exacerbate an existing “cracked tooth syndrome”.

A bonded resin restoration often solves cracked tooth syndrome. A crown (cap) usually solves it. Sometimes a crown does not solve it because the dental pulp is irreversibly inflamed and root canal therapy will be necessary. This can be done after a crown is placed by drilling through it. A patient may opt to have root canal therapy before trying a crown to avoid disturbing the crown, “just in case”.

Once in awhile, this syndrome results in recurring problems at the neck of the tooth or in the root of the tooth even after a crown has been placed or root canal therapy performed. These problems include breakage, leakage, or other failures. There can even be a vertical root fracture that eventually necessitates removal of the tooth itself.

It is heartening, however, to know that most teeth with cracked tooth syndrome can be managed with just a bonded restoration or, more likely, a crown.

It has been postulated that cracked tooth syndrome is more common in recent years due to an increase in clenching and grinding, resulting from modern day stress. Dentists can fabricate night guards to help protect teeth from such a habit.