The cracked tooth syndrome

The purpose of this article is to review the clinical features, diagnosis and management of the cracked tooth syndrome (CTS). The condition refers to an incomplete fracture of a vital posterior tooth that occasionally extends into the pulp. A lack of awareness of the condition coupled with its varied clinical features can make diagnosis of CTS difficult. Common symptoms include an uncomfortable sensation or pain from a tooth that occurs while chewing hard foods and which ceases when the pressure is withdrawn. The patient is often unable to identify the offending tooth or quadrant involved, and may report a history of numerous dental procedures with unsatisfactory results. Successful diagnosis and management requires an awareness of the existence of CTS and the appropriate diagnostic tests. Management options depend on the nature of the symptoms and extent of the lesion. These options include routine monitoring, occlusal adjustments, placement of a cast restoration and endodontic treatment. A decision flowchart indicating the treatment options available to the dental practitioner is presented.