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Cracked Tooth Syndrome


Cracked Tooth Syndrome

Cracked Tooth Syndrome is a dental condition characterized by symptoms of sharp pain on chewing without any visible reason, which is actually caused by a ‘hidden’ crack of the tooth.

Teeth that cause cracked tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

Cracked tooth syndrome is a condition that has to be identified and treated early enough before the damage puts the tooth at risk. If the crack reaches the pulp chamber of the cracked tooth, the pulp tissue becomes exposed to bacteria and bacterial toxins, and gets inflamed developing a tooth infection. An untreated cracked tooth can result in pulpal necrosis (death of the nerve), and tooth abscess (infection) requiring root canal treatment. In severe cases the tooth can split in two reducing the chances to fix the cracked tooth and usually tooth extraction is necessary.

Causes of cracked tooth syndrome

  • Natural wear: Over the years, the repetitive everyday use of the teeth for biting and chewing may cause cracks on teeth.
  • Clenching or grinding teeth (bruxism) is one of the major causes of fractured tooth syndrome. Grinding and clenching puts teeth under excessive pressure making them more susceptible to cracks.
  • Bad chewing habits such as biting pencils or chewing on hard foods.
  • Trauma to the mouth.
  • Large fillings can weaken the teeth resulting in tooth fracture.
  • Untreated extensive tooth decay.
  • Complications during/after endodontic therapy. Sometimes the pressure applied on a tooth during root canal treatment may cause a crack. After a root canal treatment teeth become brittle and they are more susceptible to cracked tooth syndrome.

Symptoms of cracked tooth syndrome

  • Tooth sensitivity to hot and cold temperatures.
  • Pain in the tooth upon biting or chewing. Pain is not constant as that in case of tooth decay or tooth abscess. The tooth may be painful only when eating certain foods or when chewing in a specific way. If the pain is usually experienced upon release of biting pressure, it is a sign that it is a case of cracked tooth syndrome.
  • If the crack is severe, there may be signs of increased tooth mobility.


Why does a cracked tooth hurt?

The crack will expose the inside of the tooth (the ‘dentine’) that has very small fluid filled tubes that lead to the nerve (‘pulp’). Flexing of the tooth opens the crack and causes movement of the fluid within the tubes. When you let the biting pressure off the crack closes and the fluid pressure simulates the nerve and causes pain.

How can I prevent my teeth from fracturing?

Most fractures cannot be avoided because they happen when you least expect them. However, you can reduce the risk of breaking teeth by

  1. Trying to eliminate clenching habits during waking hours,
  2. Avoiding chewing hard objects (eg bones, pencils, ice),
  3. Avoiding chewing hard foods such as pork crackling and hard-grain bread

If you think you grind your teeth at night, ask your dentist if a nightguard or a splint will be of use to you. It is very important to preserve the strength of your teeth so they are not as susceptible to fracture. Try to prevent dental decay and have it treated early. Heavily decayed and therefore heavily filled teeth are weaker than teeth that have never been filled. Individuals who have problems with tooth wear or “cracked tooth syndrome” should consider wearing a nightguard while sleeping. This will absorb most of the grinding forces. Relaxation exercises may be beneficial.

How does the dentist treat a cracked tooth?

It depends on the direction and severity of the crack. If the crack is small enough, it may be removed by replacing the filling. Bonded white fillings and bonded amalgam fillings will hold the tooth together making it less likely to crack. Sometimes the cracked part of the tooth fractures off during the removal of the filling and this can be replaced with a new filling. Your dentist may first place an orthodontic band around the tooth to keep it together. If the pain settles, the band is replaced with a filling that covers the fractured portion of tooth (or the whole biting surface). Other options include the placement of gold or porcelain fillings or even a crown. If the crack goes too far vertically, there is a possibility the tooth may need to be removed and replaced with an artificial one. (See bridgework, denture, and implant). The nerve may sometimes be affected so badly that it dies. Root canal treatment will be required if the tooth is to be saved.

Will my tooth become better?

Unlike fractures elsewhere in the body, this crack will never heal. There is a small chance that the crack will get worse even with a crown placed. This may lead to the need for root canal treatment, or even removal of the tooth. However, many cracks can be fixed without root canal or tooth removal.

What type of forces cause teeth to crack?


Front teeth usually break due to a knock, an accident or during biting. Back teeth can also be fractured from a knock. They are much more likely than front teeth, to crack from forces applied by the jaws slamming together rapidly. This is why sportspeople wear mouthguards to cushion the blow. Other forces occur during sleep because people grind their teeth with a much greater force than they would ever do while awake. The first sign of problems may be what we call “cracked tooth syndrome” – a sore or sensitive tooth somewhere in the mouth that is often hard for even the dentist to find. In some individuals the grinding, called bruxism, causes tooth wear rather than fracture.