Another theory is that the pain upon cold stimuli results from leak of noxious substances via the crack, irritating the pulp. Diagnosis
Cracked tooth syndrome (CTS) was defined as an incomplete fracture of a vital posterior tooth that involves the dentine and occasionally extends to the pulp by Cameron in 1964 and more recently has included a fracture plane of unknown depth and direction passing through tooth structure that, if not already involving, may progress to communicate with the pulp and/or periodontal ligament. The diagnosis of cracked tooth syndrome is notoriously difficult even for experienced clinicians. The features are highly variable and may mimic sinusitis, temporomandibular disorders, headaches, ear pain, or atypical facial pain/atypical odontalgia (persistent idiopathic facial pain). When diagnosing cracked tooth syndrome, a dentist takes many factors into consideration. Effective management and good prognosis of cracked teeth is linked to prompt diagnosis. A detailed history may reveal pain on release of pressure when eating or sharp pain when consuming cold food and drink. 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. Below different techniques used for diagnosing CTS are discussed. Clinical examination
Cracks are difficult to see during a clinical exam which may limit diagnosis.
Definitive options include:
Bonded intra-coronal restoration
Onlay restoration, either direct or indirectly placed (currently the recommended technique)
Crown restoration (though this is associated with a high incidence of loss of vitality in teeth with CTS)Teeth originally presenting with CTS may subsequently require Root Canal therapy (if pain persists after above) or Extraction

History
The term "cuspal fracture odontalgia" was suggested in 1954 by Gibbs. Subsequently, the term "cracked tooth syndrome" was coined in 1964 by Cameron, who defined the condition as "an incomplete fracture of a vital posterior tooth that involves the dentin and occasionally extends into the pulp." References


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