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Cracked Cusp Syndrome

Also known as Cracked Tooth Syndrome, this definition identifies teeth which have cracks or fractures that are too small to show up on an x-ray and are hard to identify.  This is mostly seen in molars and is associated with pain.

What are the Symptoms?
  • Pain on biting, which often occurs when you release your bite.

  • Severe sensitivity to temperature.

  • Pain that comes and goes and isn't constant

What causes CCS?

Many things can cause this and it may be hard to pin point how this happened. 

Some causes include:

  • Biting something hard

  • A tooth that has a pre-existing filling

  • Clenching/grinding habit

How do you Diagnose CCS?

This is usually very hard to do as a clear crack or fracture is often not seen.  Diagnosis occurs usually through multiple appointments. Dr. Dickinson will ask if you can pinpoint the source of the pain (sometimes the source is unclear).  A periapical x-ray usually helps Dr. Dickinson see whether there is visible infection between the roots or around the tooth and whether the tooth has lost bone around it.  If the tooth is painful to bite, Dr. Dickinson often checks it with a blue stick.  If the tooth hurts upon biting or on release of biting on the stick, it is a sign of CCS.  He also checks your bite with a piece of articulating paper.  If you have inconsistencies in your bite he may do a bite adjustment (refer to our page on this) to try and relieve the pressure on the tooth in question.  He may ask you to let him know how the tooth feels the next day and whether the pain has subsided once a bite adjustment has been completed.  If the pain does not subside, other treatment options are available.

What are the Treatment Options?

There are a few options available and each case is different.  Sometimes it is very clear that a tooth is fractured, especially if there is visual infection.

  • An orthodontic band can sometimes help a cracked tooth.  It helps to hold the cusps on the crown of the tooth together when biting and can relieve pain.

  • Crowning (capping) a tooth can sometimes help a cracked tooth by holding the crack together.

  • Extracting (pulling) the tooth is the best option in some cases.  This is a hard decision to make.  If the tooth has to be pulled, please ask to see if you are a good candidate for replacing the tooth with an implant.

  • Dr. Dickinson has found that root canals are usually NOT a good choice and eventually end with extraction.

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