ADA patient information sheet series- Cracked tooth syndrome

I've picked up some patient information sheets from work, just going to spend a few posts summarising the key points of these.

-Usually occurs on a molar or premolar (in order of likelihood):
1. Upper premolar
2. Lower molar
3. Upper molar
4. Lower premolar

Symptoms:
-Sharp and erratic pain on chewing or after release of biting pressure. But not all cracks cause pain
 -Pain or discomfort when exposed to cold or hot liquids or food
-Sensitivity to sweet
-Difficulty in pinpointing location of pain
-If the crack extends blow the gum, a periodontal pocket may be present
-Often a history of other cracked teeth

Causes:
-More likely in recent times as teeth are retained for longer with larger restorative cycles and teeth more prone to fracture
-Stress leading to grinding of teeth especially at night
-Time, wear and tear from chewing, grinding and clenching
-Chewing on hard foods e.g ice, sweets or pencils
-Trauma especially if upper and lower teeth have been rammed together

-Dx of Cracked tooth syndrome is difficult because the symptoms aren't consistent.
-Examination may include:
Bite tests: Help in locating the pain. Biting on a hard object that localises one cusp can cause pain on biting or release
Periodontal probing: Sometimes helps to assess the extent of the crack
Xrays: Can rule out other causes of discomfort e.g decay. Cracks rarely show up on xrays but effects may be seen of bone loss around the cracked root of give an appearance of an abscess
Removal of a filling: If the tooth has a filling, removal may allow discovery of the presence, extent and direaction of a crack
Staining: Tests for the presence of a crack
Transillumination: If a crack is present it will block the transmission of light through the tooth
Temperature change: Use of ice or hot water to test which tooth is sensitive

Treatment:
- Early treatment is important:
-Simple cracks:Removal of the weakened cusp and placing a restoration or crown over the tooth. If more than one cusp is fractured then a crown is an effective option. Crowns protect the tooth and can prevent progression. Sometimes a stainless steel band is palced with a sedative dressing (Probably GIC) to see if the pain can be stopped. If it stops then a definitive restoration can be placed. If it does not stop, RCT may be an option.
-Complex cracks: If the crack has progressed to the pulp, RCT may be needed before the crown or filling is placed. If the case is complicated, Specialist endodontic or prosthodontic referral may be needed.

Prevention:
-If the patient is a bruxist-> splint
-Avoid chewing on hard objects e.g ice, hard sweets, pens or pencils
-Mouth guard when playing sports
-Good oral hygiene to avoid restorations