SOME teeth have cracks that are too small to show up on X-rays. Sometimes the cracks are under the gum. These small cracks are known as “cracked tooth syndrome”.

Cracked tooth syndrome is most common in lower back teeth (molars). That’s because these teeth absorb most of the forces of chewing.

Some people grind or clench their teeth. These people may be more likely to have cracked tooth syndrome. Sometimes the way a person’s teeth come together can put too much pressure on one tooth. This can cause the teeth to crack.

Teeth with large fillings may be more likely to crack. Teeth that have undergone root canal treatment are weaker than other teeth and also may be more likely to crack. People with one cracked tooth are more likely to have others, either at the same time or in the future.

Symptoms

The tooth may hurt sometimes when you bite or chew. The sensitivity or pain can be mild or intense. It may last a brief time or a long time. It 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 abscess. The tooth may be more sensitive to cold temperatures.

If the crack gets bigger, a piece of the tooth may break off. You may also develop an infection. This can happen in the gum around the fractured tooth. You may notice a pimple-like bump on the gum near the tooth. Pus may drain from the pimple. This is known as a fistula.

Many people with cracked tooth syndrome have symptoms for months. Cracked tooth syndrome is one of the most difficult dental problems to diagnose because the pain is not predictable. Your dentist may refer you to an endodontist (root canal specialist).

Diagnosis

Your dentist will examine 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. Your dentist also will look at the gums around the tooth. You may have X-rays taken, but X-rays often do not show the crack.

Your dentist may use special tools to test the tooth. One tool looks like a toothbrush without bristles. It fits over one part of the tooth at a time as you bite down. If you feel pain, the part of the tooth being tested most likely has a crack in it.

Your dentist may shine a very bright light on the tooth. He or she may stain it with a special dye. If the tooth already has a filling or crown, your dentist may remove it in order to see the tooth better.

Treatment

Treatments for cracked tooth syndrome do not always relieve the symptoms.

Treatment depends on:

• Where the crack is;

• How deep it is; and

• How large it is.

Sometimes a crack affects one or more cusps of a tooth. These are the highest points of the tooth. In this case, the tooth may be fixed with a crown, also known as a cap. Some cracks affect the pulp — the centre of the tooth — where the nerves and blood vessels are. In that case, the tooth will need root canal treatment.

About 20 per cent of teeth with cracked tooth syndrome will need root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure. If you felt pain before the root canal, you may still feel some pain afterward. It probably will not be as intense or as frequent, but it may still occur.

In some cases, the tooth may need to be removed. Some cracks affect the root of the tooth in the jaw. There’s no way to fix this type of crack. If your tooth is removed, you can have it replaced with an implant or a bridge.

Your dentist can make a night guard (a plastic bite piece) to prevent you from grinding your teeth. This will relieve the pain from grinding. For some people it can stop tooth sensitivity. The night guard can be worn during sleep. It also can be worn at other times if clenching or grinding happens during waking hours.

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