Image of Cracked Tooth Syndrome-Split tooth

Cracked Tooth Syndrome At It’s Worst
Image Courtesy of Craig Sommer DDS

The Cracked Tooth Syndrome, Is A Crack Or Fracture In Your Tooth And The Wide Variety Of Painful And Annoying Symptoms That Accompany It

It is one of the most common problems seen by dentists when patients, free of cavities, are complaining about pain. To better understand the cracked tooth syndrome, we will look at its symptoms, its causes, the steps used by your dentist to diagnose it, the steps used to confirm the diagnosis and factors helping to decide on the  next course of action.

Symptoms Of The Cracked Tooth Syndrome

A toothache is one of the most common reasons patients seek a dentist’s advice. The symptoms specifically connected to the cracked tooth syndrome or CTS are:

  • Achy pain that comes and goes
  • Biting pressure pain that is difficult to locate
  • Intense sensitivity to cold, that may also be difficult to locate
  • Little sensitivity to hot
  • Intense sensitivity to sweets

The most common teeth affected are the lower jaw back teeth. Starting with the last tooth, the second molar, which is most frequently affected, then the first molar and second premolar in decreasing order of frequency.

So if you’re counting from the front of the mouth the first large molar tooth is the first molar, and the one behind it further to the back is the second molar. In front of the first molar is a tooth called the second bicuspid.

Image of tooth chart showing teeth most at risk for cracked tooth syndrome

Teeth most at risk for cracked tooth syndrome. Lower second molar, first molar and second bicuspid.
Image Courtesy of Craig Sommer DDS

The Most Commonly Affected Teeth

The teeth that are most commonly affected by the cracked tooth syndrome are the lower second molar, the lower first molar, in the second premolar, in that order. All of these teeth seem to have one thing in common. The tongue side biting points lean out over the tongue a bit more than any other teeth in the mouth. When biting pressure is put on these parts of the tooth they tend to develop fractures because they are not well supported by the underlying root. They are cantilevered and structurally are not quite as strong.

The Causes Of Cracked Teeth

The causes of fractures in teeth are quite numerous. Accidents, such as a blow to the chin while-playing sports, tripping and falling, motor vehicle incidents, or even playing with your children are all common causes of cracked tooth syndrome due to the jarring collision of top and bottom teeth.

Football, boxing, judo, MMA or mixed martial arts and all other high-impact sports, where a protective mouthguard is always recommended, are also common causes of cracked teeth leading to cracked tooth syndrome. Even with a soft mouthguard teeth can be damaged. Participating without one is foolhardy.

Cavities And Fillings Both Weaken Teeth

A tooth that is weakened by a current cavity or has a filling from a previous repair is at much greater risk for fracture from any cause.

The foreign object items found in food we eat can cause damage during normal chewing. I encountered a rock in refried beans in a Mexican restaurant that I visited. It was about the same size as a pinto bean and made it’s way onto my plate completely camouflaged.

A legal site mentions restaurant customers breaking teeth on shards of glass, bone in hamburger patties, pieces of plastic in salad and  almonds in ice cream desserts.

Frozen Yogurt Topping Cracks Teeth

Frozen yogurt topping did me in with two teeth being damaged with one dessert because of big fillings and burnt peanut topping. Fortunately, I didn’t lose teeth as a result. By the way I’ve never eaten that topping again.

It’s likely that you’ve encountered something similar, painful for the moment, but it didn’t break the tooth into pieces. It may have, however, initiated a fracture that takes months to years to develop into a sensitive tooth.

What Do Teeth And Windshields Have In Common?

Fractures or cracks in teeth are similar to the cracks or rock chips in the windshield of your car. They can sit without change for a period of time and then suddenly they grow, almost overnight, right across your windshield.

The more a fracture spreads across your tooth, the deeper it goes as well, increasing the chances of you experiencing moderate to severe pain and eventual tooth loss.

Silver Fillings Fracture Lots Of Teeth

Mercury silver fillings implanted in decayed teeth  are responsible for causing fractured teeth.  Some mercury filling products, it turns out, are very sensitive to water exposure during placement in a tooth. They swell up, expanding out of the initial hole they filled up, like toothpaste squeezed out of a tube. Dentists didn’t discover this right away, but years later after countless fractured teeth.

As you can imagine, trying to place a filling into a tooth in your mouth and avoiding saliva puddles, is almost an impossibility for your dentist. Even when a tooth does not have a direct biting partner cause chewing pressure, fractures developed, radiating from these water sensitive expanding mercury silver fillings. Fillings that crack your teeth. Wonderful!

Mercury Fillings Are Malleable

Mercury silver fillings have another physical property that helps them fracture teeth. It’s called malleability. It’s a property that a silversmith takes advantage of as he’s making jewelry. By tapping on a piece of silver with a planishing hammer while it’s resting against a shaped anvil, he can deliberately shape the silver as desired. That’s great for a jeweler or silversmith but it’s not great for fillings meant to protect teeth.

You Hammer Your Teeth With Your Own Teeth

Instead of using a small hammer as the silversmith did, you are using the biting points or cusps of opposing teeth to hammer on the silver fillings in your mouth. Slowly over a period of years as you chew and your teeth come together, the silver fillings change into a distorted shape that spreads the biting points of your teeth apart, fracturing them. It’s similar to using a splitting wedge to split fireplace size pieces of wood from a cut round from a tree.

Image of Like A Wedge Splits Firewood Causing Cracked Tooth Syndrome

Mercury Fillings Split Teeth Like A Wedge Splits Firewood Causing Cracked Tooth Syndrome

Clenching Causes Fractures In Your Teeth

Another common cause of fractures in teeth is clenching, or squeezing your teeth together unconsciously. It often happens when you’re concentrating, or when you are irritated with  demanding traffic situations, and even when you’re asleep and dreaming.

Bruxing, which is both clenching your teeth and rubbing them together simultaneously, puts enough stress on teeth to cause fractures. And you guessed it, leading to cracked tooth syndrome.

Perfectly healthy, virgin teeth are subject to fractures too. So, if your teeth are decayed or contain mercury silver fillings they are already weakened and are prime candidates for cracks or fractures.

Diagnosing Cracked Teeth

One of the first steps to diagnose a cracked tooth is not getting an x-ray. Why? Because, initially, cracks this small are invisible on x-ray images. So your dentist then moves to trying to duplicate the sensitivity or pain.  Great!

Your dentist is not trying to be mean, he’s merely trying to localize the symptoms you’ve described to a particular tooth or group of teeth. He has a number of tricks up his sleeve and special instruments to help him.

Cold Hurts Cracked Teeth

He may try to apply cold to a particular tooth or teeth to determine which one appears to be the offending tooth. A healthy tooth can detect cold applied to it. But your fractured or cracked tooth will be much more sensitive to the cold application. It will let you know in a hurry that he’s found it.

Biting Pressure Hurts Cracked Teeth

Your dentist can also use a plastic instrument  called a Tooth Slooth. It helps him figure out, with your help by gently biting on the plastic instrument, which biting point or cusp seems most sensitive to pressure. Some doctors will use other bite sensitivity investigating techniques that work equally well.

Pain Free Diagnosis Of Fractures

Another aid to diagnosis without reproducing pain is the use of magnification. Your doctor is probably using what are called surgical telescopes with a built-in light source to better see the close-up details of your teeth.

The magnification alone may reveal fractures in characteristic locations. The use of an intra-oral camera and corresponding monitor can allow your doctor to see fractures and show them to you as well.

Transillumination Reveals Hidden Fractures

One more aid to diagnosis is the use of what is called a transillumination light. This will also reveal fractures that may not be visible even when using the intra-oral camera.

Once a crack or fracture has been diagnosed, the next step is to confirm the diagnosis and plan for the next step of treatment. At this point in the process if the tooth contains a filling, the filling is removed as is any decay discovered around the filling edges or entering through the fracture itself.

Fractures-Favorable, Unfavorable, Terminal

Fractures visible in a tooth can be classified into several categories. They can be craze lines, in enamel only, that can often be ignored. They can be fractures that are considered favorable, which means that they can be repaired with a high degree of success using bonded composite resin restorations. and crown restorations.

Then there are fractures that are considered unfavorable, because of their location within the dentin body of the tooth. They have a much greater risk of extending into the nerve branches of the tooth or toward the end  of the root.

These will often require both a bonded composite resin restoration and a bonded or cast crown to strengthen the tooth. The goal is to keep the pieces of tooth on either side of the fracture from moving independently halting it’s progression.

Image of cracked tooth syndrome tooth-with favorable fracture missing the nerve

Cracked tooth syndrome tooth-with favorable fracture missing the nerve
Image Courtesy of Craig Sommer DDS

mage of cracked tooth syndrome tooth-with unfavorable fracture heading toward the nerve

Cracked tooth syndrome tooth-with unfavorable fracture heading toward the nerve
Image Courtesy of Craig Sommer DDS

mage of cracked tooth syndrome tooth-with unfavorable fracture exposing the nerve

Cracked tooth syndrome tooth-with unfavorable fracture exposing the nerve
Image Courtesy of Craig Sommer DDS

Image of cracked tooth syndrome tooth-with terminal fracture spliting the root

Cracked tooth syndrome tooth-with terminal fracture spliting the root
Image Courtesy of Craig Sommer DDS

Don’t Delay Treating Fractures

In spite of our best efforts to diagnose and treat fractures early, the fracture may have already extended deep enough to create the beginnings of nerve death. Often the only way to tell this is through regular continuing care with your dentist and careful follow up with cracked or suspected cracked teeth.

If a delay occurs from the onset of mild symptoms to when you contact your dentist, or if your dentist diagnoses a fracture and you delay following up with recommended treatment until symptoms worsen, you put yourself at risk.

Sometimes Fractures Are Detected Too Late

When an unfavorable fracture results in nerve death you have a difficult decision to make. Have root canal therapy performed on the tooth or remove it.

Root canal therapy is not perfect and will often leave tiny bits of nerve and capillary tissue behind that can later putrefy and create a source of bacterial endotoxins that elicit strong immune responses. (

Tooth Replacement Is Important

Your only alternative then is to remove the tooth and face tooth replacement considerations including  a dental implant, a fixed bridge, a removable bridge or living with a missing tooth.

Missing teeth typically will result in movement of adjacent and opposing teeth since teeth use each other for support. Take one out and it throws everything out of balance. That often adversely affect your appearance and your chewing effectiveness, leading to digestive issues and associated problems.

There is so much to consider when facing a suspected cracked tooth syndrome situation. Speak with your holistic or biological dentist and let them help you arrive at a good course of action.