Cracked Tooth Syndrome

Cracked tooth syndrome (CTS) was first described by Cameron in 1964 as ‘an incomplete fracture of a vital posterior tooth involving the dentine and occasionally extends into the pulp’. In the late 1970s, many authors used different terms to describe the same condition but Maxwell and Braly (1977) advocated use of the umbrella term ‘incomplete tooth fracture’ which was first described by Ritchey et al in 1957. Some recent literature also proposed a revised definition as ‘a fracture plane of unknown depth and direction passing through the tooth structure that, if not already involving, may progress to communicate with the pulp and/or periodontal ligament’.(Ellis, 2001)

While complete tooth fracture occurs independent of age, ‘cracked teeth’ or incomplete tooth fracture appears to affect mainly middle-aged patients between 30 and 60 years old. (Ellis et al, 1999) ‘Cracked teeth’ is the third most common cause of tooth loss in industrialised countries. (Geurtsen et al, 2003) It is also a common occurrence in dental practice, with an estimated average of 5 per 100 adults affected each year. (Bader et al, 1995) In a more recent study by Krell et al (2007), an incidence rate of 9.7% among 8175 patients who were referred to a private endodontic practice over a period of six years was recorded. Although the figures revealed nearly a two-fold increase in CTS cases, there are limited studies available to validate these findings. Increased awareness about ‘cracked teeth’ and higher number of patients retaining their natural teeth into older age in recent years are possible explanations for the increase in incidences of ‘cracked teeth’ seen in dental practices. Older adults may be more susceptible to CTS due to post-eruptive changes of enamel...

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