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PROLONGED PAIN: Cracked tooth syndrome (CTS)

Updated: Apr 4, 2020

Have you been suffering from tooth pain for months now and haven't been able to find out what the reason could be??

Well the answer to this is that you probably have been suffering from a Cracked Tooth Syndrome / CTS.

It is a type of dental trauma and a possible cause for dental pain. CTS is where a tooth has completely cracked but no part of the tooth has yet broken off. It is when a tooth has a crack that's too small to show up on x-rays or is under the gums and is a challenge to identify.



Definition: A fracture plane of unknown depth and direction passing through the tooth that if not already involving, may progress to communicate with the pulp and/ or the periodontal ligament (structures which support the tooth).

(source: wikipedia)


Cause : As with many conditions of the mouth. there is no one reason for cracked tooth syndrome. However, some common causes include:

1. people who grind their teeth/ bruxism/ clenching

2. when the bite is improper or their is malocclusion of teeth , leading to too much pressure being exerted on one tooth, causing it to crack.

3. teeth which have large fillings are prone to cracking.

4.teeth which have been treated with root canal treatment which involves the removal of the nerve tissue when infected, making it brittle and prone to cracking.


Why do you have pain ??

Generally CTS is characterized by pain when releasing biting pressure. This usually happens when you bite down on something the cracked segments of the tooth move and as soon as you release the bite the segments snap back increasing the pressure in the intradentine nerves causing a sharp pain.



Common signs & symptoms

1. pain and discomfort for months.

2. pain on releasing your bite

3. rebound pain which may occur while eating something fibrous

4. pain while grinding \ clenching your teeth

5. pain while drinking a sweet beverage

6. sharp pain while drinking or eating cold beverage\food

7. sometimes the pain is localized and one can easily tell which tooth is it pertaining too


How can one prevent CTS ?

Firstly it's important that one gets his\her half yearly dental check-ups, so that the dentist can diagnose with you have habits like grinding your teeth which is one of the primary causes of CTS, and advice you with the appropriated treatment.

Be it CTS or any other dental problem, do not wait for months for the signs and symptoms to show. A half yearly dental check-up is advised so that your dentist can help you with early diagnosis of problems that are likely to occur.


Complications

Well if you have not followed up with your routine dental check-ups , be ready to face the consequences of a cracked tooth syndrome. Some complications are listed below:

1. The crack in the tooth may eventually become bigger and may cause a portion of the tooth to break off.

2. Increasing the chances of developing periodontal (supporting structures of the tooth eg. gums) infection around the fractured tooth.

3. Exposure of the pulp( nerve tissue that resides within the tooth providing it with nourishment and keep it alive) causing an infection/ abscess formation.

4. Pain which could get difficult for you to handle.


Diagnosis


Many individuals have the symptoms for months because it is difficult to diagnose. the features are highly variable and many resemble sinusitis, headache, facial pain, temperomandibular joint pain and ear pain. However CTS diagnosis can be aided by the following methods:

1. clinical examination: on examination your dentist will look for wear faceting due to biting pressure or persistent grinding of teeth, presence of periodontal pockets, may remove any old large fillings to expose fracture lines.

2. transillumination done by using fiber optic light source directly on the concerned tooth. Cracks involving the dentine will interrupt with the light transmission.

3. by using dyes like gentian violet, but it takes about 2-3 days to get the results and this method can compromise the structural integrity of the tooth.

4.radiographs or x-rays offer little benefit, however they are beneficial in visualizing periodontal and pulpal status .

5. your dentist may perform a bite test on you , in which you would be asked to bite down on a biting tool followed by a sudden release of pressure / bite. CTS is confirmed by pain on release of pressure.


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