TEETH with cracked tooth syndrome usually have fractures that are too small to be seen on X-rays, unlike teeth with obvious fractures. Sometimes the fracture is below the gum line, which makes it even more difficult to identify.

Cracked tooth syndrome are more often seen in the molars, usually lower molars, which absorb most of the forces of chewing.

Teeth with large fillings or teeth that have undergone root canal treatments are weakened and may be more likely to crack. People with one cracked tooth are more likely to have other teeth that crack at the same time or in the future.

People who grind or clench their teeth may be more susceptible to cracked tooth syndrome because of the constant forces put on their teeth. Sometimes a person’s normal bite causes certain molar cusps (the highest points of the tooth) to exert so much pressure on the opposing tooth that it cracks.

What are the symptoms?

Pain may be experienced in the tooth when you bite or chew. However, it may not happen all the time. The tooth may be painful only when you eat certain foods or when you bite in a specific way. You will not feel a constant ache, as you would if you had a cavity or an abscessed tooth, but the tooth may be more sensitive to cold. If the crack worsens, the tooth may become loose. How long symptoms last depends somewhat on how quickly a cracked tooth can be diagnosed. Even then, treatment may not always completely relieve the symptoms.

How is it diagnosed?

Diagnosis of cracked tooth syndrome is often difficult because the symptoms often are not consistent. Your dentist will do a thorough examination of your mouth and teeth, focusing on the tooth in question. He or she may use a sharp instrument called an explorer to feel for cracks in the tooth and will inspect the gums around the tooth for irregularities. Your dentist also may take X-rays, although an X-ray may not show the crack.

Your dentist may use a special instrument to test the tooth for fractures. One instrument looks like a toothbrush without bristles that fits over one part of the tooth at a time as you bite down. If you feel pain, the cusp (the highest point of the tooth) being tested most likely has a crack affecting it.

Your dentist may shine a fibre-optic light on the tooth or stain it with a special dye to search for a crack. If the tooth already has a filling or crown, your dentist may remove it so he or she can better inspect the tooth.

Prevention

If you grind or clench your teeth, talk to your dentist about treatment. Grinding your teeth can increase your risk of cracked tooth syndrome.

Treatment

Treatment will depend on the location, direction and extent of the crack. Cracks vary from superficial ones in the outer layers of the tooth to deep splits in the root affecting the pulp (the centre of the tooth, which contains the nerves).

If the crack affects one or more cusps of a tooth, the tooth may be restored with a crown. If a crack affects the pulp, you will need root canal treatment. About 20 per cent of teeth with cracked tooth syndrome will require root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it may still respond to pressure. This means that if you felt pain when you bit down before the root canal, you probably will not feel it as intensely as before, but you may feel it from time to time.

In some severe cases, the tooth may need to be extracted. Some cracks extend into the root of the tooth under the bone and there’s no way to fix the tooth. If your dentist decides on an extraction, you may have it replaced with an implant or a bridge.

Prognosis

Treatment of cracked tooth syndrome is not always successful. Your dentist should inform you about the prognosis. In some people, a restoration with a crown will relieve all symptoms. In others, root canal treatment solves the problem. Some people continue to have occasional symptoms after treatment, and may need to have the tooth extracted.

When to call a professional

If you experience pain upon biting or chewing, see a dentist right away.

Back to school

The Dental Place Cosmetix Spa will be giving away free backpacks and composition books for children with their cleanings. Limited supply so it is on a first come, first serve basis.

Dr Sharon Robinson DDS has offices at the Dental Place Cosmetix Spa located at Shop #5, Winchester Business Centre, 15 Hope Road, Kingston 10. For the month of August, Dental Place Cosmetix Spa will be offering FREE dental exams with your cleanings. Dr Robinson is an adjunct lecturer at the University of Technology, Jamaica School of Oral Health Sciences. Dr Robinson may be contacted at 630-4710 or visit the website www.dentalplace4u.com.