Cracked Tooth Syndrome

Dentist New York, NY                                                                                  

Lawrence M Spindel DDS Friday March 16, 2007

Sometimes tooth sensitivity can be part of a  syndrome named “Cracked Tooth Syndrome”.  This often presents as a constellation of symptoms that may include intermitant sensitivity to biting, cold sensitivity and /or hot sensitivity.   Intermitantly,when the patient bites down just right on something hard, they get a “wincing” pain .  What actually has happened is a tooth with a microscopic crack present has “flexed “along the crack fissure.  This momentary opening and closing of the crack stimulates the tooth’s nerve endings and causes pain.

If not corrected in time, the crack can slowly propagate and cause further irritation of the tooth’s nerve and the patient will complain of sensitivity when drinking cold liquids.  Sometimes, even though  the crack is quite severe and the patient will not have this symptom (cold sensitivity) at all.

If the crack propagates into the tooths’ pulpchamber(where the nerve and blood supply are housed) Then it is possible for bactera to get into the pulp and lead to an abcess (infection of the pulp and surrounding tissue).

Cracks can result in teeth needing; root canals, or even result in the eventual loss of the tooth. If the crack does continue to propagate in a vertical direction it can even split a tooth and cracks which extend below the level of the supporting bone are very serious and tend to cause infections in the bone.

So how should cracked teeth be handled?  In my practice, when a patient presents with these symptoms,  I do an examination of the area using a bright light while wearing magnifying glasses and I transilluminate the teeth in the area with a very bright light(my bonding light).  I am looking for tiny cracks, some of which are not detectable without magnification and transillumination.  I also take a small piece of ice to see if any of the teeth in the area are especially sensitive to cold.  I may have the patient try and provoke the pain by biting on a cue tip until they are able to position it in a way that causes pain when the bite on it.

Often I can not see a significant crack but I am able find out which particular tooth is bothering the patient.  Most times this tooth has a significant filling in place and I remove the filling an look under it with my magnification and then transilluminate it.  Most times I do find the crack visible inside the tooth.  It looks like a tiny black or white line.

I recommend that most cracked teeth be protected by the fabrication of a crowns.  The full coverage  of the tooth redistributes the chewing forces on the tooth and tends not to allow the crack to propagate as easily. Many times, when the cracked tooth is covered with a  crown  it  provides the patient with a “happy” tooth that functions in a more normal way.  If a crowned tooth is still sensitive, then a endodontic procedure (root canal) maybe required to eleviate this sensitivity.  In even more severe situations, sometimes an extraction may be required.

Intermitant pain on chewing is a sign that should be reported to your dentist and most likely is a problem that should be addressed before it becomes worse!