Etiology, Classification, and Clinical Features of Cracked Tooth Syndrome

Abstract

Cracked tooth or incomplete tooth fracture involves a fracture plane whose depth and direction is not known and extends through tooth structure with current presence or future probability of pulpal and periodontal communication. These cracks, whether symptomatic or asymptomatic, predispose the tooth to pulpal disease. Originally, tooth fractures or cracks were related to the inlay restorations with soft gold which needed to be physically malleated to the cavity for adaption to the tooth surface. Currently, the etiology of cracked tooth syndrome is multifactorial with two primary risk factors implicates in the development of cracks: natural tooth features and iatrogenic factors. A number of classification schemes have been proposed including classification of fractured teeth on the basis of the type of crack, degree and direction of fracture and location of crack. A classic clinical finding of cracked tooth syndrome (CTS) is a history of sharp, localized pain on biting or chewing that stops once the pressure is withdrawn, or while taking hot or cold drinks. Rebound pain a characteristic feature of CTS and particularly happens when a fibrous food is chewed. Moreover, special consideration is required to address vertical root fractures as their presentation may vary widely clinically. Such patients, oftentimes, report a history of discomfort and chronically inflamed gingiva in relation to the affected tooth. Every dental practitioner should have the knowledge of the risk factors, clinical features and different presentations of CTS in the clinic. A differential diagnosis of CTS must be considered when pain or discomfort on chewing or biting is present.