What is Cracked Tooth Syndrome?

damaged tooth with cracks and bandaids

Cracked Tooth Syndrome (CTS) is a perplexing condition that can cause discomfort, pain, and sensitivity in teeth that appear healthy or have minimal visible damage. It typically affects molars, largely due to their role in chewing and their susceptibility to stress. Understanding CTS, its symptoms, causes, and treatment options is crucial for maintaining oral health and preventing further complications.

What is Cracked Tooth Syndrome?

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Cracked Tooth Syndrome refers to a tooth’s condition characterized by a crack that is too small to appear on X-rays or is hidden under the gum, making it challenging to diagnose. These cracks can range from superficial ones that affect only the enamel to deep fractures that reach the tooth’s nerve. CTS often occurs in teeth that are weakened by decay, large fillings, or the stress of clenching and grinding. CTS is also more frequently observed in the molars, since they take on the majority of the stress caused by chewing and clenching. 

Symptoms of Cracked Tooth Syndrome

Cracked Tooth Syndrome (CTS) presents a variety of symptoms that can vary widely from one individual to another, depending on the location and severity of the crack. The most common symptoms associated with CTS include:

Pain when biting or chewing: 

One of the hallmark symptoms of CTS is sharp pain or discomfort upon biting down or chewing. This pain often occurs suddenly and can be quite severe. It’s typically localized to the cracked tooth and may subside when the pressure is released.

Sensitivity to temperature: 

Teeth affected by CTS may show increased sensitivity to hot and cold temperatures. Drinking a hot beverage or eating cold food might trigger a brief, sharp pain in the cracked tooth.

Sensitivity to sweet or sour foods: 

Similarly, exposure to sweet or sour flavors can provoke a painful reaction in a tooth with CTS. This sensitivity is due to the crack exposing the inner layers of the tooth, where the nerves and blood vessels reside.

Discomfort or pain when the tooth is exposed to air: 

In some cases, simply breathing in cold air or the act of air passing over the tooth can trigger pain.

Pain that comes and goes: 

Unlike a constant toothache, the pain associated with CTS is often erratic. It may appear suddenly and be quite intense but then disappear, leading to periods of no discomfort at all.

Difficulty pinpointing the source of pain: 

Because the pain can radiate from the affected tooth to other areas of the jaw or teeth, it can be challenging for individuals to identify exactly which tooth is causing the discomfort.

Swelling around the tooth: 

In some instances, the gum around the cracked tooth may swell, indicating inflammation or infection caused by the crack extending into the pulp.

A feeling of something caught between the teeth: Occasionally, individuals with CTS might feel as though food gets caught in or near the cracked tooth more easily, contributing to discomfort or irritation.

Causes of Cracked Tooth Syndrome

Understanding the causes of CTS is pivotal in preventing its occurrence. Factors that can lead to CTS include:

  • Hard Foods: Regularly chewing on hard foods like ice or hard candy can create micro-fractures in the teeth.
  • Accidental Trauma: Blows to the mouth from falls, sports injuries, or accidents can crack teeth.
  • Aging: As teeth age, they naturally lose some of their strength and resilience, making them more susceptible to cracks.
  • Large Fillings: Teeth with large fillings are weakened and more prone to cracking since the natural structure has been significantly altered.
  • Bruxism: Constant grinding or clenching of teeth, especially during sleep, exerts excessive force on teeth, leading to cracks.

Diagnosis of Cracked Tooth Syndrome

Diagnosing CTS can be challenging due to the crack’s often invisible nature. Dentists typically use a combination of visual examination, dental history, and symptoms to diagnose. They may also use special tools like a dental explorer, magnification, or a dye to reveal the crack, as well as tests to determine the health of the tooth’s pulp.

Here is an overview on some of the techniques your dentist may use to diagnose CTS: 

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  • Visual Exam: Dentists look for visible signs of cracks and assess the overall health of the tooth and gums.
  • Symptom Discussion: A detailed conversation about the symptoms experienced can guide the dentist toward suspecting CTS.
  • Special Tools: Devices like dental explorers, magnification tools, or dyes can help highlight cracks. In some cases, a light may also be shined through the tooth to identify cracks. 
  • Bite Test: Biting down on a bite stick or bite paper may cause pain that can help your dentist determine the location of a possible crack. 
  • Dental X-rays: While cracks often don’t show up on X-rays, these images can help rule out other dental issues.

Treatment Options

The treatment for CTS depends on the crack’s size, location, and the extent of the damage. Options may include:

Dental Bonding: 

For minor cracks, dental bonding involves applying a tooth-colored composite resin to the crack. The resin is shaped to restore the tooth’s appearance and functionality, then hardened with a special light. This procedure can seal the crack and prevent it from spreading.

Dental Crown: 

A dental crown is often recommended for teeth with significant cracks. The crown acts as a cap, covering the entire tooth above the gum line. It provides structural support, protects the tooth from further damage, and restores its shape and function. Crowns can be made from various materials, including porcelain, ceramic, metal, or a combination.

Root Canal Therapy: 

If the crack extends into the tooth’s pulp (the inner chamber containing nerves and blood vessels), a root canal may be necessary. This procedure involves removing the damaged pulp, cleaning and disinfecting the inner chambers of the tooth, and filling and sealing the space. A crown is often placed after root canal therapy to protect the tooth.

Tooth Extraction: 

In cases where the crack extends below the gum line or is so severe that the tooth cannot be saved, extraction may be the best option. Following extraction, the dentist can discuss tooth replacement options, such as a dental implant, bridge, or partial denture, to restore function and aesthetics.

Night Guard: 

For patients whose CTS is exacerbated or caused by bruxism (teeth grinding), a custom-fitted night guard may be recommended. The night guard protects the teeth from the forces of grinding and clenching, which can prevent further cracking and relieve symptoms.

Preventing Cracked Tooth Syndrome

Prevention is key to avoiding CTS. Some steps to reduce the risk include:

  • Avoid chewing on hard objects.
  • Wear a mouthguard during sports and if you grind your teeth at night.
  • Maintain good oral hygiene and visit your dentist regularly for check-ups and cleanings.
  • Use a proper technique when brushing and flossing to prevent gum disease and tooth decay.


Cracked Tooth Syndrome is a complex condition that requires prompt attention and care to prevent further dental health issues. If you experience any symptoms of CTS, it’s essential to visit your dentist as soon as possible for a proper diagnosis and treatment plan. With the right approach, it’s possible to manage CTS effectively and maintain a healthy, pain-free smile.

Dr. Sisko

Dr. Gerald Sisko graduated from Ohio State University College of Dentistry in 1987. He is an active member of the American Dental Association, the Ohio Dental Association, and the Akron Dental Society where he is currently holding a council position. He has had the honor and distinction of being awarded “TOP DENTIST” in Akron and Cleveland as well as Northeast Ohio for the last several consecutive years.


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