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.

https://youtu.be/mU8mM8ZNIVU

Watch PS019 on YouTube

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.

Kong Hee: Christmas For Your Discouragement (Candlelight Service 2025)