Understanding Cracked Tooth Syndrome and the Dental Occlusion Triad – PS019
Description
You’re doing a routine exam when you spot it – a stained hairline crack snaking across the marginal ridge of a molar. Your patient hasn’t mentioned any symptoms… Yet.
Should you sound the alarm? Monitor and wait? Jump straight to treatment?
Cracked teeth are one of dentistry’s most misunderstood diagnoses. Colleagues debate whether to crown or monitor. And that crack you’re staring at? It could stay dormant for years—or spiral into an extraction by next month.
So what separates the teeth that crack catastrophically from those that quietly hold together?
In this episode, I am joined by final-year dental student Emma to crack the code (pun intended) on cracked tooth syndrome.
We break down the easy-to-remember “position, force, time” framework to help you spot risk factors before disaster strikes, and share a real-world case of a 19-year-old bruxist whose molar was saved by smart occlusal thinking.
If you’ve ever felt uncertain about diagnosing, explaining, or managing cracked teeth, this episode will change how you think about every suspicious line you see.
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https://youtu.be/mU8mM8ZNIVU
Need to Read it? Check out the Full Episode Transcript below!
Key Takeaways
- Risk factors include large restorations and bruxism.
- Occlusion plays a significant role in tooth health.
- Diet can impact the integrity of teeth.
- Every patient presents unique challenges in treatment.
- Communication about dental issues is key for patient care.
- Certain teeth are more prone to fractures due to their anatomy.
- The weakest link theory explains why some patients experience more dental issues.
- Patient history is crucial in predicting future dental problems.
- The age and dental history of a patient influence treatment decisions.
- Understanding occlusion is essential for diagnosing and treating cracked teeth.
- The location of a tooth affects the force it experiences during chewing.
- Bruxism increases the risk of tooth fractures.
- Tooth contacts and forces play a critical role in diagnosing issues.
- Opposing teeth can provide valuable insights into tooth health.
- Effective communication is essential in managing cracked teeth.
- Stains on teeth can indicate deeper issues with cracks.
- Monitoring and documenting cracks over time is crucial for patient care.
Highlights of this episode:
00:00 Teaser
00:49 Intro
03:25 Emma’s Dental School Updates
07:18 What is Cracked Tooth Syndrome (CTS)?
10:02 Crack Progression and Severity
12:45 Risk Factors
14:54 Position–Force–Time Framework
21:53 Which Teeth Fracture Most Often?
25:32 Midroll
28:53 Which Teeth Fracture Most Often?
30:37 The Weakest Link Theory
34:05 Diagnostic Tools
37:56 Treatment Planning
39:42 Case Study – High Force Patient
47:27 Communication and Patient Management
51:03 Key Clinician Takeaways
53:03 Conclusion and Next Episode Preview
53:42 Outro
Check out the AAE cracked teeth and root fracture guide for excellent visuals and classification details.
Literature review on cracked teeth – examines evidence around risk factors, prevention, diagnosis, and treatment of cracked teeth.
Want to learn more about cracked teeth? Have a listen to PDP028 and PDP098 – both packed with practical tips and case-based insights.
#BreadAndButterDentistry #PDPMainEpisodes #OcclusionTMDandSplints
This episode is eligible for 0.75 CE credits via the quiz on Protrusive Guidance.
This episode contributes to the following GDC development outcomes:
- Outcome C
AGD Subject Code: 250 – Operative (Restorative) Dentistry
Aim: To help dental professionals understand the causes, diagnosis, and management of cracked teeth through a practical, evidence-based approach. It focuses on identifying risk factors using the Position–Force–Time framework and improving patient outcomes through informed communication and tailored treatment planning.
Dentists will be able to:
- Explain the aetiology and progression of cracked tooth syndrome
- Identify high-risk teeth and patient factors—such as restoration design, occlusal contacts, and parafunctional habits—that predispose to cracks
- Communicate effectively with patients about the significance of cracks, prognosis, and monitoring options, improving patient understanding and consent
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Click below for full episode transcript:
Teaser: Sometimes, you have a tooth position problem. Sometimes you have a tooth force problem, and sometimes you have a tooth contact time problem. So time, force, position. A crack is an end product of overload. So risk factors for cracked teeth, right?
Teaser:
So if we think, again, that is to do with overload, right? When you have a patient who’s got large amalgam restorations, MOD, I don’t remember the last time I removed an amalgam and I didn’t see a crack underneath.
Why is it that maxillary premolars are more likely to crack than mandibular premolars? This is really fascinating. If all you do is remove the crack and put a composite, the composite will also fail through overload eventually. So you must change something about the environment to reduce the crack propagation.
Jaz’s Introduction:
I’ve been involved in dental communities for many years now. I run my own community, the Protruserati, Protrusive Guidance. And one of the questions that keep propping up week by week, month by month, year by year… it’s just all seasons, all time, is about cracked teeth management, diagnosis, cracked tooth syndrome, and getting very patient specific, describing the symptoms and signs, and all the discussions are about cracked teeth.
So there’s still obviously some uncertainty about the best way to diagnose and manage cracked teeth, which is why we created this episode. I know it’s part of the PS, Protrusive Student series, but honestly, the way I ended up explaining cracks in my philosophy and the way I think about how cracks form and how the management very much depends on so many patient factors is pretty unique, I think. I don’t think I’ve ever spoken about cracks in this way, and I think it ended up being a really wholesome episode. Again, thanks to some wonderful questions from our student, Emma.
Now, alongside this episode in the show notes, we’ve put together some essential reading and some great PDF, excellent data and visuals on cracked teeth, and I mentioned a good review, literature review on cracked teeth. That’s also referenced in the show notes. If you are watching or listening on Protrusive Guidance, just scroll below and download it.
And if you haven’t yet joined the community, what are you waiting for? We’re waiting for you on protrusive.app. I really enjoyed recording this episode, Emma, and I hope you enjoy listening or watching it. Oh, and this episode is eligible for CE. There was so much substance. So whether you’re gonna collect CPD hours or CE credits, whoever you are in the world, this episode is eligible again through the Protrusive Guidance app. Let’s catch the main episode.
Main Episode:
Emma, the Protrusive Student. Welcome back to the Protrusive Dental Podcast. It’s so nice to have you. We’re talking about cracked teeth today. Look, I can talk about cracked teeth for days. It’s something when I, in the early episodes, one of the early episodes, it’s titled I Hate Cracked Teeth.
I still hate cracked teeth. We all hate cracked teeth. No one likes cracked teeth. But you know what? Over the years, I’ve learned so much about cracked teeth, and now I’ve got some th
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