There has been ongoing research on this matter. Till now, there’s no single reason for cracked tooth syndrome. However, these are several types of people that seem to experience it the most:
1) Biting with too much pressure on one tooth. Some people have teeth alignment that is not ideal and thus exerting excessive pressure on one single area, causing the tooth to crack, mostly in a vertical fashion. This might be due to multiple tooth loss and overloading the existing teeth.
2) Individuals who
grind or clench their teeth. You might be surprised that a large number of people have the
habit of bruxism. This bad habit can occur during day or night time. Perhaps due to the stress of modern life, people clench their jaw unconsciously and over time, leads to vertical root fractures (VRF).
3) Teeth with large fillings. If your teeth have existing tooth fillings that are covering most of the natural tooth, some cracks may happen, which sends impulses of pain to the nerve endings near the pulp.
4) The teeth that have undergone
root canal treatment. Dentition that has undergone root canal treatment have their structures weakened. Hence, these teeth are more prone to giving way under pressure of mastication.
How do we diagnose cracked tooth syndrome?
A complete oral examination, dental history, radiographs and the usage of a fiberoptic handpiece can significantly help in the detection of enamel cracks. The most traditional method of detection clinically is using the tooth sleuth.
Tooth sleuth is a bite stick with a thick end, used by general dentists to check for certain symptoms. If the tooth has a vertical root fracture that is not detectable on an xray or clinically in the mouth the tooth sleuth can be the tool to diagnose the cracked tooth syndrome. With the thick end of the tooth sleuth, introduced to the examined tooth cusp, the patient is instructed to bite, squeezing the teeth together for a few seconds. The pressure created by the oposing tooth usually creates slight discomfort due to just two cusps taking the load of the whole bite. If he tooth is healthy and fracture-free there is no sensitivity or pain. If the tooth has a vertical root fracture and patient experiences sharp pain and does not allow the teeth to be in occlusion even for a few seconds.
For an exact detection of VRFs, the tooth sleuth needs to be introduced to every single cusp of the tooth - bucally and palatally for premolars and individually for each cusp in molar teeth.
What the dental practitioner will do is remove existing restorations and stains once the tooth has been localized. This is to enable further visualization of the crack in a proper manner. The use of
rubber dam enhances the probability of visualizing these cracks by isolating the tooth. Following that, a dye will be applied to highlight the crack with a contrasting background. It is crucial to keep in mind to maintain the area free of saliva, and reducing peripheral distractions.
This helps in proper identification of the involved cusp. A simple tool such as the Fracfinder or Tooth slooth can be applied on each individual cusp. After that, the patient will be instructed to bite slowly, thus allowing the placement of selective pressure on one cusp. If there is a pain on biting or release of biting pressure, it is indicative that the cusp is cracked.
There are a few differential diagnoses of cracked tooth syndrome. Some conditions that mimic the symptoms of CTS include sinusitis, temporomandibular joint disorders, headaches, ear pain, or atypical orofacial pain. However, this is not to be confused as often a simple examination such as using a tooth sleuth can remove any doubts regarding the diagnosis.
What is the difference between tooth sleuth and tooth slooth?
There seems to be a slight confusion among the public between the term 'tooth sleuth' and 'tooth slooth'. Tooth Sleuth is the tool used for detecting vertical root fractures , whereas tooth slooth is a brand name.
