 Hello everyone, welcome back to another session of Dentistry and more. Today we have a topic from Consolidated Dentistry that is crack tooth syndrome. So crack tooth syndrome, the name itself gives an idea that the tooth has a fracture in it, there is a crack present within the tooth. So while talking about the longitudinal tooth fractures, they may have various types of fractures such as craze line, fractured cusp or the crack tooth, split tooth and vertical tooth fracture. But we are focusing only on the crack tooth syndrome. Okay. So crack tooth is nothing but an incomplete fracture of vital tooth. It can be an anterior tooth or a posterior tooth, which involves dentine and possibly the dental pulp. So what are the etiology of crack tooth syndrome? It can be classified the first one as occlusion. Etiology it could be a masticatory accident, mastication such as sudden excessive biting force on a piece of bone or it can be a damaging horizontal force such as eccentric contacts and interference or it can be a functional force like large untreated carry solution and it can be a para functional force such as braxism or clenching and functional force and the horizontal force. So these all comes under occlusion etiology. Then the restorative procedures also can be etiology for the crack tooth syndrome such as inadequate design features, the over preparation of the cavity, insufficient cusp protection in on lay design and deep cusp-fosa relationship and the stress concentration. One is the design problem. Okay. Next is a stress problem. That is the pin placement and the hydraulic pressure during seating of tightly fitting cast restorations and physical forces during the placement of restorations such as amalgam and gold in less we apply lots of pressure in such materials. So that can be another classification which comes under restorative procedures and also it can be the developmental reasons such as incomplete fusion of areas of calcification and dental instruments also can be a etiology dental instruments. Okay. So it is when we use high speed hand pieces, they can be cracking and grazing on the tooth. So all these are the etiology. So it comes with occlusion forces, restorative procedures, developmental reasons and the dental instruments. So what are the symptoms of crack tooth syndrome? So obviously there will be pain. Sometimes it will be acute pain on mastication of grainy foods or a sharp brief pain with cold and it can also be slight to very spontaneous pain. So it can also be associated with irreversible pulpitus, pulp necrosis, apical periodontitis and even an acute apical abscess with or without swelling or draining sinus tract may be present if the pulp has undergone necrosis. So how do we do testing for crack tooth syndrome to do the diagnosis? So most commonly periapyrical test but usually pain is not elicited with percation or palpation if the pulp is vital. Okay. So directional percation is also advocated direct inspection such as microscope is useful. Also it can be done with staining with methylene blue. Methylene blue staining is a useful tool and also we can use iodine and the light we can use that is trans illumination. We can clearly see the crack. In methylene blue there will be a blue line will be visible where the crack is present and biting test with cotton application rubber wheel or tooth sloth. So biting test can also be done and obviously we can go with radiographs. Radiographs will clearly highlight the radio opaque line. So these are the objective tests. So the diagnosis involves first one is the history taking then the visual examination then we can go for tactile examination then the bite test can do periodontal probing then we can use the staining or trans illumination or radiographs or we can remove the restoration and also we can do with surgical assessment that we remove the flap and directly visually see the problem within the bone. So how do we manage it? So management is basically done by first thing is identifying the proper etiology but the problem with crack tooth syndrome is we need to very clearly understand the location and extent of the crack. So the location and extent of the crack should be very vital in getting a good prognosis of the problem. So the first thing what we can do is immediate therapy where we can splint the tooth and stabilize the tooth using any of our wire method or the materials we use for bonding. So first thing we need to stabilize the tooth. So treatment we have options like RCT treatment plus crown it would be the most safest one because if we are not clearly locating the extent and location if you are doing without addressing the pulpal issue the pain may persist even after the initial treatment. So if it is very difficult to identify the extent of this crack and if it is involving pulp so always we go for root canal treatment and to be on a safer side we keep a crown over it and also we need to think about the aesthetic part if it is on an anterior side we need to put a aesthetic crown which is not a metallic crown on posterior teeth we can go for a metallic crown. So crack tooth syndrome is nothing but a fracture a hairline fracture which might be involving dentine and pulp so if it is involving pulp we need to think about the pulp treatment in a treatment section. So there are many symptoms mainly the biting pain on biting and we need to diagnose it properly using any of the methods and go for a apt treatment. So that's all about crack tooth syndrome it commonly asked us just as a short note so you can highlight the point in its interaction symptoms its objective test and the diagnosis and the treatment part so I'll come up with a new topic in dentistry and more thank you