Epidemiological data reveal that splits or fractures are the third most common cause of tooth loss in industrialized countries.
WRITTEN BY
Roxanne P. Benison, DMD, MS
Epidemiological data reveal that splits or fractures are the third most common cause of tooth loss in industrialized countries. This finding indicates that the cracked tooth syndrome is of high clinical importance.
Roxanne P. Benison, DMD, MS
Epidemiological data reveal that splits or fractures are the third most common cause of tooth loss in industrialized countries. This finding indicates that the cracked tooth syndrome is of high clinical importance.
Cracked tooth syndrome (CTS) was defined as 'an incomplete fracture of a vital posterior tooth that involves the dentine and occasionally extends to the pulp' by Cameron in 1964 and more recently has included '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/or periodontal ligament'. 'Crack baby' was a term coined to describe children who were exposed to crack (freebase cocaine in smokable form) as fetuses; the concept of the crack baby emerged in the US during the 1980s and 1990s in the midst of a crack epidemic. Other terms are 'cocaine baby' and 'crack kid'.
Etiology
![Carcinoid Carcinoid](/uploads/1/2/8/1/128163380/596420595.jpg)
Cracked teeth can be one of the most difficult sources of dental pain to diagnose. When the pain is referred to, patients often find it difficult to pinpoint the source of pain to a specific quadrant, frustrating both the clinician and patient. In 1964, Cameron 1 coined the phrase “cracked tooth syndrome” (CTS), describing the pain as originating from a hairline or incomplete fracture of the tooth. A lack of awareness about the condition, coupled with its various clinical features, can make diagnosis of CTS difficult2 CTS usually causes pain when occlusal forces are placed upon portions of the tooth, causing dentin involved in the fracture to be exposed momentarily, resulting in a change in hydrostatic pressure within the dentinal tubules.
Figure 1 |
Cracks or fractures can be the result of a variety of habits. Grinding, clenching, and ice chewing over extended periods of time can cause extensive damage to the teeth, with cracks being a common result. Cracks can also be the result of an isolated incident such as biting into an olive pit or bone, or an accident resulting in trauma to the teeth. Although any tooth can be affected by a crack, the mandibular molars are the most prone to fracture. Heavily restored teeth or those with extensive decay are especially subject to cracks. One study evaluated the incidence of CTS in a general practice and found a far higher incidence of CTS in teeth that had the marginal ridge restored than those that had not.3 However, unrestored, noncarious teeth have also exhibited cracked tooth syndrome. Many morphologic, physical, and iatrogenic factors such as deep grooves, pronounced intraoral temperature fluctuation, poor cavity preparation design, and improper selection of restorative materials can predispose posterior teeth to an incomplete fracture (see Figure 1).4
Diagnosis
Whenever a patient has a complaint of intraoral pain and an obvious cause for that pain cannot be detected, it is prudent for clinicians to perform a comprehensive oral evaluation on these patients, since cracked teeth have frequently been associated with referred pain. Patients often report the pain as originating from a certain quadrant; however, vitality testing and radiographs are nonremarkable. Examination of the opposing quadrant may reveal the source. Performing a comprehensive examination can help eliminate misdiagnosis and/or mistreatment.
Historically, diagnosis of CTS has been primarily symptom based. 5 Visualization of cracks intraorally with the naked eye has proven difficult. Clinicians would encounter patients who complain of sharp shooting pains when they bite, or upon release of biting. Symptoms may also include sensitivity to cold food or drink. The problem with waiting for symptoms to develop before a diagnosis is made is that at this point the crack is usually at what is referred to by Clark5 as end-stage crack progression, requiring more aggressive treatment.
Syndrome Capgras
The emergence of the dental microscope has been a tremendous aid in the diagnosis and treatment of cracked teeth. The routine, methodical examination of the teeth with the microscope may help detect cracks in the early stages. When cracks are detected early they can be treated more conservatively and hopefully prevent the onset of symptoms. In addition to the microscope, many other tools are great aids in the diagnosis of cracked tooth syndrome, including (but not limited to) a bite stick, transillumination, and vitality testing.
A complete dental history is also sometimes informative. When patients are unable to identify the offending tooth or quadrant involved, the dental history can reveal numerous dental procedures with unsatisfactory results.2 This is sometimes a clue that the patient may be suffering from an undiagnosed cracked tooth. Furthermore, patients may recall an incident when they bit on a hard object that directly triggered the painful symptoms.
A fiber-optic wand or a handpiece equipped with a fiber-optic light can be useful in the detection of cracks. By holding the wand or handpiece horizontally at the gingival sulcus in a dimly lit room, the suspected crack may become more visible. Composite curing lights are generally too bright for this purpose and are not recommended.
If a tooth has a large restoration, it may be necessary to remove it to expose the crack. Methylene blue dye can sometimes be helpful. The dye should be applied to the occlusal surface of the tooth with a cotton roll or cottonwood stick. Have the patient bite down and move from side to side. The excess dye is then removed with alcohol. Further inspection may reveal the elusive fracture. The bite stick (Tooth Slooth or Crackfinder) is also an important tool in the diagnosis of cracks. The stick should be placed over each cusp and the patient should be instructed to bite down firmly; usually upon the release of pressure the patient will experience pain. Finally, vitality testing should be used to try and reproduce the patients’ symptoms and confirm your diagnosis.6
Figure 2 |
Radiographs usually are not helpful in the detection of cracks. They tend to be unremarkable in most cracks, because these fractures usually run mesiodistally and are not in the plane of the X-ray beam. Sometimes, however, the presence of a complete vertical root fracture can be seen radiographically (see Figure 2). These are cases where the crack extends beyond the crown of the tooth and down into the root. Here you may see a radiolucency involving the lateral aspect or halo surrounding the entire root. This can be differentiated from other radiolucencies by the fact that it surrounds the root uniformly, rather than being located at the portal of exit of the apical foramen or lateral canal. These cases are usually associated with a probing depth corresponding to the extent of the crack. This is the case when the crack is more extensive, long-standing, and the pulp is necrotic. Therefore, there will be no sensitivity to cold or sharp pain, only a dull ache on biting or pressure.7
Treatment
Figure 3 |
Treatment of the tooth depends on the degree of pulpal involvement and the extent of the crack. Those cracks, which are visualized but remain asymptomatic and clinical testing (such as percussion, palpation, mobility, probing, and thermal testing) is within normal limits, should be treated with a crown or some other form of complete cuspal coverage (see Figure 3). This is to prevent further propagation of the crack and the onset of symptoms. However, if a patient exhibits more extensive symptoms from the start, including increased sensitivity to thermal provocation and percussion/biting, root canal therapy should be performed prior to placement of a crown. These are considered incomplete vertical root fractures. A study by Kahler8 showed that all symptomatic cracks in teeth appeared to extend right through the dentin to the dentino-enamel junction and were extensively contaminated by bacteria. Hence, root canal therapy and crowning for all symptomatic cracks are recommended.
Upon initiation of root canal therapy, the tooth should be examined under a microscope to further evaluate the extent of the crack. Teeth that are considered restorable are those where the crack is confined to the crown portion of the tooth, coronal to the mucogingival complex. Cracks that extend across the furcation of the tooth, or those extending below the osseous crest, and/or are associated with a corresponding narrow deep pocket are complete vertical root fractures and have a poor prognosis. Zte mf110 drivers for mac. Teeth with complete vertical root fractures are considered nonrestorable and should be extracted (see Figure 2).9,10
Iliotibial Band Syndrome Crack Sound
This war of mine: stories - the last broadcast (ep.2) for machine learning. Patients who have been diagnosed with cracked tooth syndrome in more than one tooth should be counseled in strategies to prevent cracks in other teeth. These strategies may include discontinuing habits such as chewing ice and/or fabrication of a mouthguard.
When a clinician is unable to make a definitive diagnosis, the patient should be referred to a specialist who deals with these situations more frequently. Treatment should never be performed when a diagnosis cannot be made. Following this protocol will result in higher satisfaction for both patient and practitioner.
Prognosis
The sooner cracks are detected and treated, the more favorable the long-term prognosis. Epidemiologic data reveal that splits or fractures are the third most common cause of tooth loss in industrialized countries.2 This finding indicates that the cracked tooth syndrome is of high clinical importance. When at-risk teeth are treated early by complete cuspal coverage, the long-term prognosis is great. Furthermore, those symptomatic cases that receive root canal treatment and crowns before the crack propagates too far also have a favorable prognosis. ■
References:
1. Cameron CE. Cracked tooth syndrome. J Am Dent Assoc 1964; 68:930.
2. Lynch CD, McConnell RJ. The cracked tooth syndrome. J Can Dent Assoc Sept. 2002; 68(8):470-5.
3. Homewood CT. Cracked tooth syndrome-incidence, clinical findings and treatment. Aust Dent J Aug. 1998; 43(4):217-22.
4. Geurtsen W, Schwarze T, Gunay H. Diagnosis, therapy, and prevention of the cracked tooth syndrome. Quintessence Int. Jun. 2003; 34(6):409-17.
5. Clark DJ, Sheets CG, Paquette JM. Definitive diagnosis of early enamel and dentin cracks based on microscopic evaluation. J Esthet Restor Dent 2003; 15(7): 391-401.
Deus ex: mankind divided - system rift download free version. 6. Maxwell EH, Braly BV, Eakle WS. Incompletely fractured teeth: a survey of endodontists. Oral Surg Oral Med Oral Pathol 1986; 61:113.
7. Benenati FW. Coping with cracked tooth syndrome. J Okla Dent Assoc Winter 1996; 86(3): 16-8.
8. Kahler B, Moule A, Stenzel D. Bacterial contamination of cracks in symptomatic vital teeth. Aust Endod J Dec. 2001; 26(3):115-8.
9. Liu HH. Cracked teeth, treatment rationale and case management: case reports. Quintessence Int July 1995; 26(7):485-92.
10. Gutmann JL, Rakusin H. Endodontic and restorative management of incompletely fractured molar teeth. Int Endod J Nov 1994; 27(6):343-8.
Roxanne P. Benison, DMD
Dr. Benison received her DMD from Southern Illinois University School of Dental Medicine and her master’s in endodontics from Saint Louis University Center for Advanced Dental Education. She currently is in private practice in Edwardsville, Ill., and is on the adjunct faculty in endodontics at Saint Louis University.
Dr. Benison received her DMD from Southern Illinois University School of Dental Medicine and her master’s in endodontics from Saint Louis University Center for Advanced Dental Education. She currently is in private practice in Edwardsville, Ill., and is on the adjunct faculty in endodontics at Saint Louis University.
Contents
- What is cracked tooth syndrome
Cracked tooth syndrome may be defined as a tooth fracture plane of unknown depth, which originate from the crown, passes through the tooth structure involving the dentine and occasionally extends into the pulp and extends subgingivally, and may progress to connect with the pulp space and/or periodontal ligament . Cracked tooth syndrome presents mainly in patients aged between 30 years and 50 years . Men and women are equally affected . Mandibular second molars, followed by mandibular first molars and maxillary premolars, are the most commonly affected teeth . While the crack tends to have a mesiodistal orientation in most teeth, it may run buccolingually in mandibular molars .
Two classic patterns of crack formation exist . The first occurs when the crack is centrally located, and following the dentinal tubules may extend to the pulp; the second is where the crack is more peripherally directed and may result in cuspal fracture. Pressure applied to the crown of a cracked tooth leads to separation of the tooth components along the line of the crack. Such separation in dentine results in the movement of fluid in the dentinal tubules,stimulating odontoblasts in the pulp as well as the stretching and rupturing odontoblastic processes lying in the tubules,3thus stimulating pulpal nociceptors. Ingress of saliva along the crack line may further increase the sensitivity of dentine . Direct stimulation of pulpal tissues occurs if the crack extends into the pulp.
Cracked tooth syndrome is probably one of the hardest dental condition to diagnose. This is because of the fact that the patient often finds it hard to point out where exactly the pain is coming from, hence the difficulty of the dental professional to make a definitive diagnosis. In order to pinpoint the problem, your dentist will need to make thorough examination of the area where the pain is coming from.
Even with X-rays, these are hard to find since these cracks are usually too fine to be seen on these. Sometimes, these are also hard to locate due to their being found underneath a person’s gums. If this is left untreated, the damage to the person’s tooth will progress to bigger and oftentimes more painful dental problems. These often happen in the lower back areas of your mouth, where the lower molars can be found. These cracks happen due to a number of reasons, such as constant clenching or grinding, or even due to the habit of chewing ice. These cracks can also appear due to accidents like biting into something hard unexpectedly (a bone or a pit) or because of a recent trauma. Whatever the case may be, these can and do occur, and if left unchecked, can result in a broken tooth, infection, and even more pain.
The most common tip dentists give patients who suffer from these cracks is, in order to avoid or prevent more of these from happening, they will need to rid themselves of such habits as chewing ice, clenching and grinding. They will also be advised to try and be careful when eating or chewing since biting down on hard substances that are in food can also crack a person’s tooth.
Treatments for cracked tooth syndrome are not guaranteed to solve it or relieve the person of it. Treatments will also depend on where the cracks can be found, how deep these are, and how large such cracks are. Some of the more common treatments include the use of crowns on such teeth, and root canals. You may also find your dentist removing such a tooth, if the damage is too extensive, and they may also suggest an implant to replace the missing tooth.
If you suspect that you have cracks in your teeth, you should consult with your dentist as soon as possible to prevent the worsening of such a problem. Pain when you chew or when you bite are indicators of such a dental issue. If you are constantly grinding and clenching your teeth, having your dentist check your teeth for cracks is also a must.
Cracked tooth syndrome causes
Causes of cracked tooth syndrome:
- Natural wear: Over the years, the repetitive everyday use of the teeth for biting and chewing may cause cracks on teeth.
- Clenching or grinding teeth (bruxism) is one of the major causes of fractured tooth syndrome. Grinding and clenching puts teeth under excessive pressure making them more susceptible to cracks.
- Bad chewing habits such as biting pencils or chewing on hard foods.
- Trauma to the mouth.
- Large fillings can weaken the teeth resulting in tooth fracture.
- Untreated extensive tooth decay.
- Complications during/after endodontic therapy. Sometimes the pressure applied on a tooth during root canal treatment may cause a crack. After a root canal treatment teeth become brittle and they are more susceptible to cracked tooth syndrome.
Restorative procedures
- Inadequate design features
- Over-preparation of cavities
- Insufficient cuspal protection in inlay/onlay design
- Deep cusp–fossa relationship
- Stress concentration
- Pin placement
- Hydraulic pressure during seating of tightly fitting cast restorations
- Physical forces during placement of restoration, e.g., amalgam or soft gold inlays (historical)
- Non-incremental placement of composite restorations (tensile stress on cavity walls)
- Torque on abutments of long-span bridges
Occlusal
- Masticatory accident: Sudden and excessive biting force on a piece of bone
- Damaging horizontal forces: Eccentric contacts and interferences (especially mandibular second molars)
- Functional forces:
- Large untreated carious lesions
- Cyclic forces
- Parafunction: Bruxism
Developmental
- Incomplete fusion of areas: Occurrence of cracked tooth syndrome in unrestored teeth of calcification
Miscellaneous
- Thermal cycling: Enamel cracks
- Foreign body: Lingual barbell
- Dental instruments: Cracking and crazing associated with high-speed handpieces
Historically, cracked tooth syndrome was associated with the placement of“soft gold” inlays (Class I Gold) that were physically adapted to the cavity using a mallet . Nowadays, common causes include masticatory accidents, such as biting on a hard, rigid object with unusually high force or excessive removal of tooth structure during cavity preparation . Parafunctional habits such as bruxism are also associated with the development of cracked tooth syndrome .
Commonly, the tooth has been structurally compromised by removal of tooth substance during restorative procedures . Occlusal contact occurring on extensive occlusal or proximo-occlusal intracoronal restorations (either cast metal or plastic restorations) subject the remaining weakened tooth structure to lateral masticatory forces, particularly during chewing . Such cyclic forces result in the establishment and propagation of cracks . Deep cusp–fossa relationships due to over-carving of restorations or cast restorations placed without proper consideration for cuspal protection , also render the tooth vulnerable. Cameron describes a case where he fitted a gold inlay on a molar tooth that subsequently developed symptoms of cracked tooth syndrome. The patient complained of pain on application of pressure to the tooth. Having repeatedly performed occlusal adjustments over a one year period, complete relief of symptoms did not occur until a distal cusp fractured off the tooth .
Excessive condensation pressures, expansion of certain poorer quality amalgam alloys when contaminated with moisture, placement of retentive pins and extensive composite restorations placed without due care for incremental technique (resulting in tensile forces in the tooth structure due to polymerization contraction) predispose to fracture formation . Other iatrogenic causes of cracked tooth syndrome include excessive hydraulic pressure in luting agents when cementing crowns11or bridge retainers . Long-span bridges exert excessive torque on the abutment teeth, leading to crack generation .
The higher incidence of cracked tooth syndrome in mandibular second molars may be associated with their proximity to the temporo-mandibular joint , based on the principle of the“lever” effect — the mechanical force on an object is increased at closer distances to the fulcrum . Eccentric contacts expose these teeth to significant occlusal trauma in this manner . Functional forces on teeth that have untreated carious lesions can also lead to crack formation .
Cracked tooth syndrome has been reported in pristine (unrestored) teeth or in those with minor restorations, which has led to the suggestion that there may be developmental weaknesses (arising within coalescence of the zones of calcification) within those teeth . This contrasts with the findings of Cameron, who claimed that the teeth involvedwere usually quite heavily restored . Thermal cycling and damaging horizontal forces or parafunctional habits havealso been implicated in the development of enamel cracks in such unrestored teeth, with subsequent involvement of the underlying tooth . There are reports in the recent literature of the generation of such cracks associated withlingual barbells .
Cracked tooth syndrome prevention
Most tooth fractures cannot be avoided because they happen when you least expect them. However, you can reduce the risk of breaking teeth by:
- Trying to eliminate clenching habits during waking hours,
- Avoiding chewing hard objects (eg bones, pencils, ice),
- Avoiding chewing hard foods such as pork crackling and hard-grain bread
Awareness of the existence and cause of cracked tooth syndrome is an essential component of its prevention . It is very important to preserve the strength of your teeth so they are not as susceptible to fracture. Try to prevent dental decay and have it treated early. Heavily decayed and therefore heavily filled teeth are weaker than teeth that have never been filled. Individuals who have problems with tooth wear or “cracked tooth syndrome” should consider wearing a nightguard while sleeping. This will absorb most of the grinding forces. Relaxation exercises may be beneficial.
Cavities should be prepared as conservatively as possible . Rounded internalline angles should be preferred to sharp line angles to avoid stress concentration. Adequate cuspal protection should be incorporated in the design of cast restorations . Cast restorations should fit passively to prevent generationof excess hydraulic pressure during placement . Pinsshould be placed in sound dentine, at an appropriatedistance from the enamel to avoid unnecessary stress concentration . The prophylactic removal of eccentric contacts has been suggested for patients with a history ofcracked tooth syndrome to reduce the risk of crack formation, though there is little clinical evidence to support this practice .
Cracked tooth syndrome symptoms
Pain when you chew or when you bite are indicators of cracked tooth syndrome. If you are constantly grinding and clenching your teeth, having your dentist check your teeth for cracks is also a must. The crack will expose the inside of the tooth (the ‘dentine’) that has very small fluid filled tubes that lead to the nerve (‘pulp’). Flexing of the tooth opens the crack and causes movement of the fluid within the tubes. When you let the biting pressure off the crack closes and the fluid pressure simulates the nerve and causes pain.
Symptoms of cracked tooth syndrome include:
- Tooth sensitivity to hot and cold temperatures.
- Pain in the tooth upon biting or chewing. Pain is not constant as that in case of tooth decay or tooth abscess. The tooth may be painful only when eating certain foods or when chewing in a specific way. If the pain is usually experienced upon release of biting pressure, it is a sign that it is a case of cracked tooth syndrome.
- If the crack is severe, there may be signs of increased tooth mobility.
Cracked tooth syndrome diagnosis
Successful diagnosis of cracked tooth syndrome requires awareness of its existence and of the appropriate diagnostic tests . The history elicited from the patient can give certain distinct clues. Pain on biting that ceases after the pressure has been withdrawn is a classical sign . Incidences usually occur while eating or where objects such as a pencil or a pipe are placed between the teeth . The patient may have difficulty in identifying the affected tooth (there are no proprioceptive fibers in the pulp chamber) . Vitality testing usually gives a positive response and the tooth is not normally tender to percussion in an axial direction . Significantly, symptoms can be elicited when pressure is applied to an individual cusp . This is the principle of the so-called “bite tests” where the patient is instructed to bite on various items such as a toothpick, cotton roll, burlew wheel, wooden stick or the commercially available Tooth Slooth . Pain increases as the occlusal force increases, and relief occurs once the pressure is withdrawn (though some patients may complain of symptoms after the force on the tooth has been released) . The results of these “bite tests” are conclusive in forming a diagnosis of cracked tooth syndrome.
The tooth often has an extensive intracoronal restoration . There may be a history of courses of extensive dental treatment, involving repeated occlusal adjustments or replacement of restorations, which fail to eliminate the symptoms. The pain may sometimes occur following certain dental treatments, such as the cementation of an inlay, which may be erroneously diagnosed as interferences or “high spots” on the new restoration . Recurrent debonding of cemented intracoronal restorations such as inlays may indicate the presence of underlying cracks . Heavily restored teeth may also be tested by application of a sharp probe to the margins of the restoration. Pain evoked in this manner can indicate the presence of a crack in the underlying tooth, which may be revealed upon removal of the restoration .
Patients with a previous incidence of cracked tooth syndrome can frequently self-diagnose their condition. Diagnosis should exclude pulpal, periodontal or periapical causes of pain . Galvanic pain associated with recent placement of amalgam restorations should also be considered in this differential diagnosis . Such pain occurs on closing the teeth together but decreases as full contact is made, unlike cracked tooth syndrome where the pain increases as the teeth close further together, due to increasing occlusal force . The medical history should also be considered to exclude incidences of orofacial pain or psychiatric disorders .
Visual inspection of the tooth is useful, but cracks are notoften visible without the aid of a microscope, specialized techniques such as transillumination or staining with dyes such as methylene blue . Particular attention should be paid to mesial and distal marginal ridges . Cracks are sometimes stained by caries or food and are visible to the unaided eye. Not all stained and visible crack lines lead to the development of cracked tooth syndrome. Other clues evident on examination include the presence of facets on the occlusal surfaces of teeth (identifies teeth involved in eccentric contact and at risk from damaging lateral forces) , the presence of localized periodontal defects (found where cracks extend subgingivally) , or the evocation of symptoms by sweet or thermal stimuli . Radiographic examination is usually inconclusive as cracks tend to run in a mesiodistal direction .
Cracked tooth syndrome treatment
A decision flowchart of cracked tooth syndrome treatment options is presented in Figure 1. Immediate treatment of the tooth depends on the size of the involved portion of the tooth. If the tooth portion is relatively small and avoids the pulp, it may be fractured off and the tooth restored in the normal way . If, however, the portion is very large or involves the pulp, the tooth should be stabilized immediately with an orthodontic stainless steelband . Stabilization, along with occlusal adjustment , can lead to immediate relief of symptoms. Care should betaken to prevent microleakage along the crack line, as this could result in pulpal necrosis . A high success rate has been reported when full-coverage acrylic provisional crowns were used to stabilize the compromised tooth . The tooth should be examined after 2 to 4 weeks and if symptoms ofirreversible pulpitis are evident, endodontic treatmentshould be performed .
Figure 1. Cracked tooth syndrome treatment flowchart
[Source ]
Ultimately the tooth needs to be restored with protection and permanent stabilization in mind . This can be achieved with an adhesive intracoronal restoration (e.g., bonded amalgam, adhesive composite restorations) or a cast extracoronal restoration1 (e.g., full-coverage crown,onlay or three-quarter crown with adequate cuspal protection) to bind the remaining tooth components together . While there has been a lot of interest in the benefits of such adhesive restorations, there is, as yet, little clinical evidence in the literature to support their use. As for extracoronal restorations, certain modifications of tooth preparation have been suggested for cracked teeth, such as including additional bracing features in the area of the crack, i.e.,extending the preparation in a more apical direction, bevelling the cusps of the fractured segment more than usual to minimize damaging forces, using bases to prevent contactwith the internal surface of the casting, and using boxes andgrooves on the unfractured portion . Cracks extendingsubgingivally often require a gingivectomy to expose themargin;3however, an unfavourable crown–root ratio may render the tooth unrestorable.
Where vertical cracks occur or where the crack extendsthrough the pulpal floor or below the level of the alveolarbone, the prognosis is hopeless and the tooth should beextracted .
It is worth remembering that it is possible for a crack to progress after placement of an extracoronal metal restoration or crown, when occlusal forces are particularly strong.
If you think you grind your teeth at night, ask your dentist if a nightguard or a splint will be of use to you.
References [ + ]
Syndrome Rachidienne
1. | ↵ | Hasan S, Singh K, Salati N. Cracked tooth syndrome: Overview of literature. Int J Appl Basic Med Res. 2015;5(3):164–168. doi:10.4103/2229-516X.165376 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606573 |
2. | ↵ | Ellis SG, Macfarlane TV, McCord JF. Influence of patient age on the nature of tooth fracture. J Prosthet Dent 1999; 82(2):226-30. |
3, 5, 13, 14, 16, 47, 56, 57, 61, 75. | ↵ | Türp JC, Gobetti JP. The cracked tooth syndrome: an elusive diagnosis. J Am Dent Assoc 1996; 127(10):1502-7. |
4, 22, 30, 34, 42, 45, 46, 62, 63, 64, 65, 67, 69, 73. | ↵ | Ehrmann EH, Tyas MT. Cracked tooth syndrome: diagnosis, treatment and correlation between symptoms and post-extraction findings. Aust Dent J 1990; 35(2):105-12. |
6, 17, 28, 32, 49, 51. | ↵ | Cameron CE. Cracked-tooth syndrome. J Am Dent Assoc 1964; 68(March):405-11. |
7. | ↵ | Stanley HR. The cracked tooth syndrome. J Am Acad Gold Foil Oper 1968; 11(2):36-47. |
8. | ↵ | Ritchey B, Mendenhall R, Orban B. Pulpitis resulting from incomplete tooth fracture. Oral Med Oral Surg Oral Pathol 1957; 10(June):665-70. 6. Sutton PRN. Greenstick fractures of the tooth crown. Br Dent J 1962; 112(May 1):362-3. |
9, 18, 19, 21, 25, 26, 39, 40, 54, 55. | ↵ | Rosen H. Cracked tooth syndrome. J Prosthet Dent 1982; 47(1): 36-43. |
10, 12, 44, 60, 66, 71. | ↵ | Bales DJ. Pain and the cracked tooth. J Indiana Dent Assoc 1975; 54(5):15-8. |
11. | ↵ | cracked tooth syndromeBales DJ. Pain and the cracked tooth. J Indiana Dent Assoc 1975; 54(5):15-8. |
15, 36, 72. | ↵ | Bearn DR, Saunders EM, Saunders WP. The bonded amalgam restoration — a review of the literature and report of its use in the treatment of four cases of cracked-tooth syndrome. Quintessence Int 1994; 25(5):321-6. |
20. | ↵ | Trushkowsky R. Restoration of a cracked tooth with a bonded amalgam. Quintessence Int 1991; 22(5):397-400. |
23, 27. | ↵ | Hiatt WH. Incomplete crown-root fracture in pulpal-periodontal disease. J Periodontol 1973; 44(6):369-79. |
24. | ↵ | Swepston JH, Miller AW. The incompletely fractured tooth. J Prosthet Dent 1986; 55(4):413-6. |
29. | ↵ | Ellis SG. Incomplete tooth fracture — proposal for a new definition. Br Dent J 2001; 190(8):424-8. |
31. | ↵ | DiAngelis AJ. The lingual barbell: a new etiology for the crackedtooth syndrome. J Am Dent Assoc 1997; 128(10):1438-9. |
33. | ↵ | Snyder DE. The cracked-tooth syndrome and fractured posterior cusp. Oral Surg Oral Med Oral Pathol 1976; 41(6):698-704. |
35. | ↵ | Rosen H. Cracked tooth syndrome. J Prosthet Dent 1982; 47(1) 36-43. |
37. | ↵ | Agar JR, Weller RN. Occlusal adjustment for initial treatment and prevention of the cracked tooth syndrome. J Prosthet Dent 1988; 60(2):145-7. |
38, 70. | ↵ | Lynch, C.D., & Mcconnell, R.K. (2002). The cracked tooth syndrome. Journal, 68 8, 470-5. |
41, 43, 53. | ↵ | Gibbs JW. Cuspal fracture odontalgia. Dent Dig 1954; 60(April): 158-60. |
48, 50. | ↵ | Goose DH. Cracked tooth syndrome. Br Dent J 1981; 150(8):224-5. |
52, 58, 59. | ↵ | Abou-Rass M. Crack lines: the precursors of tooth fractures — their diagnosis and treatment. Quintessence Int 1983; 14(4):437-47. |
68. | ↵ | Guthrie RG, DiFiore PM. Treating the cracked tooth with a full crown. J Am Dent Assoc 1991; 122(10):71-3. |
74. | ↵ | Casciari BJ. Altered preparation design for cracked teeth. J Am Dent Assoc 1999; 130(4):571-2. |