When the bite is released the "segments" snap back together sharply increasing the pressure in the intradentin nerves causing pain.

If untreated, CTS can lead to severe pain, possible pulpal death, abscess, and even the loss of the tooth.

[1] According to one theory, the pain on biting is caused by the 2 fractured sections of the tooth moving independently of each other, triggering sudden movement of fluid within the dentinal tubules.

Another theory is that the pain upon cold stimuli results from leak of noxious substances via the crack, irritating the pulp.

There are a variety of habits which predispose patients to CTS including chewing ice, pens and hard sweets etc.

Recurrent occlusal adjustment of restorations due to discomfort may also be indicative of CTS, alongside a history of extensive dental treatment.

However other clinical signs which may lead to the diagnosis of CTS includes wear faceting indicating excessive forces perhaps from clenching or grinding or the presence of an isolated deep periodontal pocket which may symbolise a split tooth.

Transillumination is best performed by placing a fibre optic light source directly onto the tooth and optimal results can be achieved with the aid of magnification.

This is due to the fact that cracks propagate in a direction which is parallel to the plane of the film (Mesiodistal) however radiographs can be useful when examining the periodontal and pulpal status.

Different tools can be used when carrying out a bite test which produce symptoms associated with cracked tooth syndrome.

Definitive options include:[8] Teeth originally presenting with CTS may subsequently require root canal therapy (if pain persists after above) or extraction.