Cracked Tooth Syndrome

Cracked Tooth Syndrome (CTS)

Cracked Tooth Syndrome or CTS is the separation of the tooth from one whole piece into separate pieces. The separation starts at the crown and eventually extends into the root. 

The diagnosis of CTS usually starts with the patient’s symptoms. The dentist then goes through tests to determine the right tooth because symptoms can overlap with another tooth. 

Cracks are present in all teeth, but not all teeth will have CTS. CTS is a very common dental problem.


The symptoms may start with mild discomfort and sensitivity. It can mimic symptoms of cavity, erosion, abrasion, grinding, use of abrasive toothpaste and acidic diet. As the separation worsens, it will be very painful to biting, hot, cold and unprovoked pain. 

Once the separation starts, there is no way to stop it; the treatment can only slow down the separation rate. 

Signs and Symptoms List

  1. Pain on biting down but more common on releasing it
  2. Can be extremely sensitive to cold and not as sensitive to hot.
  3. Can be very painful to touch.
  4. Constant pain
  5. Rough on the tongue
  6. Cannot chew on the area.
  7. Discoloration along the line of fracture 
  8. Sensitive to sugar
  9. Gum boil
  10. Deep pockets
  11. Bleeding gum

Visually the fracture may be seen with the naked eye, with illumination, with magnification and dye solution. Clinical exams may reveal a worn area, stress area. However, some or all the following tests must be used to localized and verify the tooth with CTS.

Diagnostic Tests

  1. Probing, deep pocket
  2. Cold and hot test 
  3. Tapping test
  4. Electrical test
  5. Biting on a Tooth Slooth (most reliable clinical test)
  6. 2D x-ray
  7. 3D imaging CBCT (2nd most reliable test)

Factors that Cause the Cracking

When the stress applied to the tooth is beyond the capacity of the tooth to rebound and remain intact, it will cause the tooth to crack.

Stress Factors

  1. Large fillings
  2. Weakness in the tooth structure
  3. Misaligned jaw and teeth
  4. Misaligned opposite tooth size 
  5. Heavy set jaw muscles
  6. Sleep bruxism
  7. Sleep apnea.

Consequences of a Cracked Tooth

  1. Pain
  2. Sensitive to cold
  3. Unable to chew
  4. Tooth loss
  5. Jaw pain
  6. Muscle pain
  7. Extensive treatment

CTS have different planes of separation or fractures. Horizontal CTS has a better prognosis than vertical CTS. In other words, if the tooth breaks horizontally in parallel with the gum and above the gum line, you have a better chance of repairing the tooth. It is not possible for a cracked tooth to healing. Therefore it is important to identify the tooth with possible CTS as soon as possible so the treatment options are discussed and carried out on the affected tooth.

Treatment Options (Before Tooth Cracking)

  1. Teeth and jaw alignment
  2. Bite adjustment to minimize the size discrepancy between the opposing teeth.
  3. Use of nightguard to control the bruxism.
  4. Treat sleep apnea
  5. Bite adjustment for the bite discrepancy 
  6. Crowns       

Treatment Options (After Tooth Cracks)

  1. Crowns
  2. Bite adjustment.
  3. Root canal therapy
  4. Extraction and implant 

Cost for Cracked Tooth Syndrome Treatment

The cost for the treatment of CTS may include various procedures such as filling, root canal, crown, gum surgery. Therefore the cost can range from $1200 to $3500. 

Dr. David Cheng

A practicing dentist with over 30 years of experience and more than 3500 hours of continuing studies. He lives in both Toronto, Canada and Seattle, WA. Besides writing for this website, he practices dentistry in different clinics in Canada and mentors other dentists in the USA and Canada.

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