Cracked tooth syndrome

Abstract

Cracked tooth syndrome (CTS) is both a transient and progressive condition. There are numerous factors that may predispose a tooth to varying degrees of a crack. Incompletely fractured teeth are capable of causing great discomfort to the patient and it is also a source of concern for the dental practitioner. Diagnosis of CTS can be difficult. The patient reports with pain, and often the dentist relies on a periapical radiograph to determine the origin of the pain. Because CTS is a vital pulp condition, the periapical radiograph is of limited value as a diagnostic test. As a result, lack of treatment, or inappropriate treatment, will not resolve the symptoms, and the condition can result in the eventual loss of the affected tooth. This article will present the epidemiology, classification, etiology, signs and symptoms, the accurate diagnosis modalities and treatment options, along with prognosis and future prospects for this clinical condition through the undertaking of a comprehensive literature review of contemporarily available data. Through a comprehensive literature review, this article aims to provide an overview of the epidemiology, classification, etiology, signs and symptoms, diagnosis, treatment and prognosis, as well as future prospects of cracked teeth which may be a diagnostic challenge in clinical practice. Materials and Methods Search criteria Inclusion criteria • The search was limited to review articles and case studies involving human subjects • Restrictions were not placed regarding the study design and the language usage • A minimum follow‐up duration of 1 year was selected • All original research articles, review articles, case reports, case series, and pilot studies were included. Exclusion criteria • Publications that did not meet the above inclusion criteria are excluded • Studies conducted on animals. Search strategy A literature review was performed in Pubmed Central, MEDLINE, the Cochrane Library, and the EBSCO host. The articles identified included those published up to November, Introduction Cameron coined the term cracked tooth syndrome (CTS) to define the condition as “an incomplete fracture of a vital posterior tooth that involves the dentin and occasionally extends to the pulp.”[1,2] In recent times, the definition has been modified as follows: “A fracture plane of unknown depth and direction passing through tooth structure that, if not already involving, may progress to communicate with the pulp and or periodontal ligament.”[3] The incidence of cracks in teeth seems to have increased since the last three decades. This is probably because of better health care facilities, people live longer and their teeth last longer too, thus making them more susceptible to cracking, from normal wear and tear. Stress and stress‐related habits such as bruxism and clenching have also become more prevalent, thereby contributing to the increased incidence of cracks. Finally, because dentists are becoming increasingly aware of the existence of cracks, more cracks are being diagnosed than before.[4] Other terms often used interchangeably with CTS include: “incomplete fracture of posterior teeth”.[5] “green‐stick fracture”, “split tooth syndrome.”[6] Department of Conservative Dentistry and Endodontics, Dr. Dnyandeo Yashwantrao Patil Dental College and Hospital, Pimpri, Pune, Maharashtra, India