Cracked Tooth Syndrome

Cracked Tooth Syndrome (CTS) occurs when a tooth is partially cracked but has not yet broken off. Occasionally, it is referred to as a greenstick fracture. Due to the wide variety of symptoms, it is a notoriously difficult disorder to diagnose.

cracked tooth syndrome

How to Fix Cracked Tooth Syndrome?

This sort of crack can’t be repaired. Implants and bridges may be used to replace a missing tooth. Your dentist may make a night guard (a plastic bite piece) stop you from grinding your teeth. This will alleviate the discomfort caused by grinding.

The term “Cracked Tooth Syndrome” encompasses all degrees of a crack. A broken tooth usually needs a more extensive procedure than a chipped one. Root canals may be recommended if the break goes beyond the surface of the tooth.

A crown may then be placed. After that, we’ll watch the restoration to see how the tooth reacts to be safe.

If you have a broken tooth, the most typical treatment is as follows:

  • The damage isn’t too bad, but a dental crown is needed to protect and repair the tooth.

  • In cases of moderate severity, we may recommend a root canal operation followed by a crown on the tooth to restore its appearance and functioning.

  • Tooth extraction may be necessary if the break extends into the root of the tooth.

  • In the worst-case scenario, however, we will do all we can to save your natural teeth and heal the harm that has been done.

  • A dental implant may be used to replace your missing tooth if extraction is the best course of action.

Cracked Tooth Syndrome Pain

There is a wide range of reported symptoms, and many of them go on for months before they are finally recognized.

The following are examples of symptoms that have been reported:

  • Sharp discomfort while chewing on a specific tooth may worsen if the applied biting power is increased. Seeded bread is an example of a food that may cause discomfort while biting since it is soft yet contains harsh ingredients.

  • If you consume fibrous foods, you may experience “rebound pain,” which refers to a brief, acute pain that occurs as you release the power of your bite.

  • Bruxism caused by grinding the teeth back and forth and side-to-side is painful.

  • Sharp pain is experienced when cold drinks or foods are consumed, yet no pain is felt when heated stimuli are applied.

  • When consuming sugary foods or beverages.

  • As a rule, the discomfort may be pinpointed to one or two teeth. However, it might be challenging to pinpoint the specific location.

  • Symptoms of pulpitis, necrosis and periapical periodontitis may be present if the fracture extends into the pulp, and these conditions are permanent.

Cracked Tooth Syndrome Classification

The craze line, a fractured cusp, a cracked tooth, a split tooth, and a vertical root fracture—the American Association of Endodontists has divided broken teeth into five distinct types:

Craze Lines

Most adult teeth have craze lines, which solely affect the enamel. Craze lines may be seen on the buccal and lingual surfaces of the back teeth and across the marginal ridges. Craze lines that are long and vertical are standard in the front teeth.

Fractured Cusp

When an intra-coronal repair compromises the marginal ridge, fractured cusps are often the outcome. When the crack runs mesiodistal and buccolingual, it usually involves one or both marginal ridges, as well as a buccal or lingual groove, and finishes in the cervical area, either parallel to or somewhat subgingival to the gingival margins.

Cracked Tooth

A cracked tooth is one in which the occlusal surface of the tooth has developed a crack that extends to the apex without separating the two halves. Typically, the fracture runs mesiodistally across the middle of the rock, involving one or both of the marginal ridges.

Split Tooth

A split tooth is one in which the mesiodistal ridges of both marginal ridges have been cracked, causing the tooth to be exhaustively divided into two halves. For this to exist, the tooth must have a core fracture propagated from an initial crack.

Vertical Root Fracture

Bucco-lingual is the most common orientation in which vertical root fractures begin. In most cases, the fracture is complete. However, it might be partial and affect one surface. The whole root may be cracked, or simply a section of the root may be cracked.


One of the probable reasons for dental pain may be a sort of dental trauma known as cracked tooth syndrome. “A fracture plane of uncertain depth and direction running through tooth structure that, if not already involved, may develop to interact with the pulp and periodontal ligament” is one description of fractured tooth syndrome.


Diagnosis Cracked Tooth Syndrome

According to Cameron’s 1964 definition, a cracked tooth syndrome (CTS) is “an incomplete fracture of a vital posterior tooth that involves the dentin and occasionally extends to the pulp,” and more recently, “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 periodontal ligament.”

Even the most expert dentists have difficulty diagnosing fractured tooth syndrome. Variable symptoms include sinusitis, temporomandibular problems, headaches, and ear discomfort that may be mistaken for sinusitis, temporomandibular disorder, or odontalgia (persistent idiopathic facial pain).

Dentists look at a variety of indicators when determining whether a patient is suffering from fractured tooth syndrome. Prompt identification is essential for successful treatment and a favorable prognosis in the management of broken teeth.

If you have a comprehensive medical history, you may notice discomfort when you release pressure during eating or when you eat or drink anything cold. A range of behaviors, including chewing ice, pencils, and hard sweets, may lead to CTS.

A history of effective dental treatment may also indicate the presence of CTS if the patient requires occlusal adjustments owing to pain.

Diagnosing CTS may be done in a variety of ways, some of which are detailed here.

Physical Examination

A clinical evaluation may be hindered by the inability to detect cracks. Nonetheless, additional clinical symptoms of CTS include wear faceting, which indicates excessive pressures from clenching and grinding, or the appearance of an isolated deep periodontal pocket, which may represent a fractured tooth.

The procedure can be carried out only after the patient has given their informed agreement, since removing a restoration may be of slight diagnostic advantage. With a pointed probe, you may also do a tactile examination to help diagnose.

Gentian Violet or Methylene Blue Stains

Using Gentian Violet or Methylene Blue Stains Dyes may assist in the detection of fractures. A temporary repair may be necessary after 2–5 days of treatment. This practice may degrade the structure’s structural integrity, causing cracks to spread.


A fiber optic light source should be placed directly on the tooth, and magnification is essential for the best outcomes. Dentine cracks reduce the amount of light that may get through. There are certain drawbacks to employing transillumination, including more giant fissures and a loss of color.


Fractures can’t be seen on radiographs. When analyzing periodontal and pulpal health, radiographs may be beneficial, although they are not ideal for assessing the direction of fracture propagation (Mesiodistal).

The Bite Test

The symptoms linked with broken tooth syndrome may be caused by various equipment while doing a biting test. Immediately after chomping down, patients release a quick burst of pressure.

When pressure is released, discomfort signals the presence of CTS. Biting on particular cusps may be used to identify the cusp in question. Denbury Fractfinder and Professional Results Inc’s Tooth Slooth II (Professional Results Inc., Laguna Niguel CA, USA) are commercially accessible instruments.


A fracture’s location and size influence how quickly it may be diagnosed. The most usually impacted teeth are the mandibular second molars, mandibular first molars, and maxillary premolars. In many cases, the tooth has undergone substantial intracoronal work.


Cracked Tooth Syndrome V/S Vertical Root Fracture

When it comes to deciding what treatment to use, the position, direction, and size of a crack are critical.

The following is a description of the two forms of longitudinal tooth fractures for the sake of uniformity in this newsletter:

Cracked Tooth Syndrome Vertical Root Fracture
There are two types of shattered teeth: those with a fractured crown that extends into the subgingival and those with a fractured crown that extends into the root. It is considered a “genuine” vertical root fracture if it is entirely or partially fractured at any level, often buccolingually.
The fracture may spread from the proximal surfaces to the marginal ridges. One or both of the proximal surfaces (buccal and lingual) may be fractured, depending on the location of the injury.
The fracture may be limited to the tooth’s crown, or it may extend to the proximal root of the tooth. The fracture is limited to the root section of the tooth and may extend toward the cervical periodontal attachment on the other side of the tooth.
Incomplete (greenstick) fractures are used to characterize cracked teeth, which also defines their shape. Vertical root fractures have just been reviewed in a new publication.
It is more prone to produce pulpal and periapical disease since it spreads apically than a broken cusp, which is more centralized and apical. VRFs may be long or short, and they can occur at any point along the root.

Frequently Asked Questions

Here are some FAQs related to cracked tooth syndrome (CTS)

1. Cracked tooth syndrome is thought to be brought on by what exactly?

By biting into breakable objects, such as candies, ice, or the kernels of popcorn. Gum chewing, ice chewing, and the like are examples of bad habits. I was having a root canal or having a large dental filling weaken the tooth. clenching and gnashing of teeth (bruxism).

2. What can be done about fractured tooth syndrome?

It’s not possible to repair a break of this kind. An implant or a bridge may be used to replace a missing tooth if it is removed. To stop you from grinding your teeth at night, your dentist may manufacture a night guard (a plastic bite piece).

3. Broken tooth syndrome: Is it bad?

Leaving a broken tooth untreated might lead to much more pain and agony in the future. There may be no symptoms at all if you have a fractured tooth. Cracked teeth are unnoticed by many people. No treatment is needed for certain kinds of cracks.

4. In what ways might fractured tooth syndrome be identified?

Cracks in orange wood may be detected by asking the patient to bite on each cusp individually. This helps to separate the shattered cusp from the surrounding teeth. It is possible to discover fractures by using cotton rollers. The patient is instructed to bite down on cotton rolls and then rapidly remove the pressure.

5. Is it possible to live with a broken tooth?

It’s possible to get by with a chipped tooth. Fractured teeth may not cause you any discomfort, but they may have a long-term impact on your dental health if you don’t have them fixed. When a tooth is damaged or has a weak point, it might break or fracture.

6. Is a fractured tooth an emergency?

If, for example, you have a chipped or broken tooth that is very painful or has left behind sharp shards that cause harm within your mouth, you should see a dentist immediately. If the chipped tooth is not painful, you may put off seeing your dentist.

7. Is it possible for earache to be caused by a fractured tooth?

If you’ve ever had a painful throat because of an abscessed wisdom tooth, you’ll know that an abscessed molar may elicit the same symptoms. Additional symptoms should be sought out to discover whether you have an infection in your teeth.

8. When a tooth is shattered, what can a dentist do to fix it?

The degree of the fracture will dictate the kind of treatment needed. Your dentist may prescribe a crown, root canal, or extraction. However, if a crown is not the best option, a filler substance may patch up the fracture. Your dentist may recommend a root canal if your tooth’s pulp is infected or if the root canal is necessary to remove the infected tissue.

9. Is an x-ray able to detect a broken tooth?

X-rays aren’t always helpful in determining whether a patient has a broken tooth. The following signs and symptoms might assist your dentist in determining the source of the issue. There is no constant pain associated with a broken tooth, as with a cavity or an infection.

10. Is it possible to go on living with a broken tooth for a long time?

Once a tooth is decayed or injured, it will eventually die. In some instances, a tooth might die within a few days or even a few months after being damaged.


When a patient complains of pain or discomfort during chewing or biting, the potential of CTS should always be explored. Even though CTS is a problematic diagnostic issue, dental practitioners should be aware of it to avoid future crack propagation and the related consequences.

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