Cracked tooth syndrome diagnosis part 1: integrating the old with the new

Cracked tooth syndrome refers to the signs and symptoms of pain in a posterior tooth with a vital pulp, that is directly attributable to an incomplete fracture involving the dentine, which occasionally extends into the pulp or periodontal ligament.¹ It commonly presents with sharp pain on chewing and thermal sensitivity, and can be difficult to distinguish from other pulpal and periapical conditions² (see later).

A crack has been defined by Oxford Dictionaries as, ‘a line on the surface of something along which it has split without breaking apart’. At this point it could be described as an incomplete fracture (Figures 1 and 2), as there is no visible separation of the segments divided by the crack. Cracks can be symptomatic, which would support a diagnosis of CTS (Figure 1), or asymptomatic, which would not (Figure 2). A complete fracture would demonstrate visible separation and independent movement of one or more segments (Figure 3).