Older Man with Mouth PainIf there’s anything good to be said about a broken tooth, it’s that the cause of the problem is pretty obvious. The same can’t always be said when a tooth develops a crack, which is sometimes too small to even be seen with the naked eye. In fact, researchers have compiled case histories to develop a “cracked tooth syndrome” profile.

Who? The potential for crack rises with age. Past 40, enamel tends to grow brittle partly due to reduced moisture. The tooth itself is less resistant to stress, and teeth that have numerous cavities or support large existing restorations are more liable to crack.

Where? Molars are prime candidates, thanks to the stresses these “nutcrackers” face daily. But other teeth can develop fractures that intersect the pulp chamber and challenge the tooth’s vitality.

How? The most common cause is “masticatory accident”—chomping down on a hard foreign object. Chances grow if you stress your teeth with bad habits, like ice chewing.

When? Diagnosis of cracked tooth syndrome is notoriously difficult because it can be present in an apparently normal, cavity-free molar. Often, pain emanates from the entire “mouth area,” not from any specific tooth. Several instruments exist for fracture detection but one of the most effective is transillumination—lighting the tooth from behind makes cracks visible.

Treatment? We have the means to protect a cracked tooth and eliminate the discomfort they can cause. Each fracture is unique and requires a different treatment response, so diagnosis is critical. A crown to surround and support the tooth may be the most reasonable choice.