08 May 2023

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FDI guidance on the treatment of cracked tooth syndrome

Simona Chirico

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Cracked tooth syndrome (CTS) is a common occurrence and can be caused by stress or trauma-related symptoms such as teeth grinding and chewing or biting on hard objects. The prevalence of cracked teeth cases has especially increased during the COVID-19 pandemic due to its stressful nature.

To help dentists and dental teams diagnose and appropriately treat CTS, the FDI World Dental Federation's Dental Practice Committee (DPC) has developed guidelines outlining the etiology, signs and symptoms, prevention methods, diagnosis and treatments available.

A cracked tooth is characterized by an incomplete fracture, i.e., one that runs from the occlusal surface of the tooth towards the root.

Oral health professionals are strongly encouraged to raise awareness of CTS among colleagues and patients and to make early diagnosis to preserve and improve the oral health of their patients. The DPC has also developed a companion infographic, which summarizes the content of the indications, to help dentists more easily share information with their peers, colleagues and patients.

Diagnosis

A tooth is defined as "cracked" when characterized by a fissure that extends from the occlusal surface of the tooth vertically to the root. The tooth may not have split yet, but the crack can gradually spread.

Suggested predisposing factors for cracked tooth syndrome include previous cavity preparation, restorative material compaction or bonding procedures, tooth morphology, loss of cervical tooth surface, function, parafunction, and trauma, psychological stress.

There is often a history of pain when chewing and sensitivity to thermal (mainly cold) stimuli or sweet foods and drinks. There may also be a history of lockjaw, sore facial muscles, temporomandibular (TMJ) disorder, loss or displacement of restorations, abrasion, abfraction, general sensitivity, or tooth movement.

A fracture can lead to secondary involvement of the pulp or the periodontium.

The crack and fracture detector is the tool to diagnose cracked tooth syndrome. With its thick end, introduced into the cusp of the tooth examined, the patient bites down, clenching the teeth for a few seconds. If there is a fracture, the patient feels pain when the pressure is released. The detector is also helpful in diagnosing a cracked tooth is transillumination.

Treatment

A cracked tooth that is left untreated will gradually get worse, eventually leading to its loss.

If the fracture has spread to the pulp, the tooth may be treated with a root canal procedure and a crown to prevent it from spreading. However, if the fracture extends below the gumline it may be more difficult to restore. Therefore, prompt treatment is extremely important.

In some cases, endodontic treatment can be conducted to save part of the tooth.

Despite treatment, some fractures can continue to progress, leading to tooth loss. Placing the crown over a cracked tooth provides the most protection but does not guarantee success in all cases.

Treating a cracked tooth is important because it relieves pain and reduces the likelihood of it getting worse. After the treatment, in most cases the teeth guarantee comfortable chewing for years.

For more information, see "Cracked Tooth Syndrome: An advice sheet for dentists and dental teams."