Cracked Tooth Syndrome
By Kent Smith DDS
The Irving Journal
Do you have a tooth that you tend to avoid when chewing? If you have looked closely
in a mirror and can’t see anything wrong, and you are puzzled because your last
checkup did not reveal any cavities, you may be dealing with what we call “cracked
Cracked tooth syndrome (CTS) is a very common problem that affects teeth that have large
fillings in them, although the syndrome can also occur in teeth with no fillings at all.
Typically, CTS may involve either of the following:
- a tooth with a large restoration where the crack runs under a weakened cusp (that raised part of your tooth)
- a tooth with minimal or no filling material where the tooth has been subjected to heavy biting forces or
grinding - After grinding for years, you can wear down your canines (eye teeth), which function to protect
your other teeth when grinding. As this occurs, your teeth will be at an increased risk for CTS.
- teeth that have suffered trauma
Why does your tooth hurt when biting? Assuming this is due to CTS, your tooth is flexing,
which microscopically stimulates the nerve in the tooth. These hairline cracks open when biting
down, and then close upon releasing your bite. This movement applies pressure on tubules that
run down the nerve of the tooth causing fluid to push and pull on the tooth's nerve, resulting
in pain. Additionally, the nerve in the cracked tooth is being exposed to bacterial toxins,
which can allow infection to spread to the nerve and bone tissue underneath, resulting in an abscess.
What symptoms should you be aware of? Pain upon release of biting pressure is the most
likely, although simply biting down (especially when biting on grainy foods) in “just
the right spot” can be the first sign. Temperature changes that create this “zinger”
can also be something to watch for, as well as sweet sensitivity.
The longer a simple cracked tooth is left untreated, the more likely it will become a complex
crack. The pulp inside the tooth may die, and an infection may occur. It will then be necessary to
perform root canal treatment or, in some cases, extract the tooth. Most cracked teeth can be saved.
If a crack is located and treated early, your dentist may be able to prevent the crack from
progressing through the tooth.
If you have never experienced CTS, there are ways to help prevent this from occurring.
If you clench or grind your teeth, your dentist can make a custom mouth guard to wear at
night for protection. Additionally, avoid chewing on hard objects such as ice, hard candy and pens.
Treatment can vary from a simple bonded filling (if the crack is shallow enough) to a
cusp-protected restoration like an onlay or crown (if the crack is deeper) to root canal
treatment (if the nerve has been involved) to extraction (if the crack actually splits the
tooth). Obviously, if you develop any of the symptoms described, the sooner you can have
your dentist check you out, the more likely the treatment can remain conservative.
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