Sometimes the pain is well localized, and the individual is able to determine the exact tooth from which the symptoms are originating, but not always.If the crack propagates into the pulp, irreversible pulpitis, pulpal necrosis and periapical periodontitis may develop, with the respective associated symptoms. Pathophysiology
CTS is typically characterized by pain when releasing biting pressure on an object. This is because when biting down the segments are usually moving apart and thereby reducing the pressure in the nerves in the dentin of the tooth. When the bite is released the "segments" snap back together sharply increasing the pressure in the intradentin nerves causing pain. The pain is often inconsistent, and frequently hard to reproduce. Pain associated with CTS has been reported to occur more commonly on biting, rather than on release of pressure after biting. If untreated, CTS can lead to severe pain, possible pulpal death, abscess, and even the loss of the tooth. If the fracture propagates into the pulp, this is termed a complete fracture, and pulpitis and pulp death may occur. If the crack propagates further into the root, a periodontal defect may develop, or even a vertical root fracture.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. This activates A-type nociceptors in the dentin-pulp complex, reported by the pulp-dentin complex as pain.
The involved cusp can be determined by biting on individual cusps separately. Tooth Slooth II (Professional Results Inc., Laguna Niguel, CA, USA) and Fractfinder (Denbur, Oak Brook, IL, USA) are commercially available tools. Epidemiology
Aetiology of CTS is multifactorial, the causative factors include:

previous restorative procedures. occlusal factors; patients who suffer from bruxism, or clenching are prone to have cracked teeth. developmental conditions/anatomical considerations. trauma
others, e.g., aging dentition or presence of lingual tongue studs.Most commonly involved teeth are mandibular molars followed by maxillary premolars, maxillary molars and maxillary premolars. in a recent audit, mandibular first molar thought to be most affected by CTS possibly due to the wedging effect of opposing pointy, protruding maxillary mesio-palatal cusp onto the mandibular molar central fissure. Studies have also found signs of cracked teeth following the cementation of porcelain inlays; it is suggested that the debonding of intracoronal restorations may be caused by unrecognized cracks in the tooth. Treatments
There is no universally accepted treatment strategy, but, generally, treatments aim to prevent movement of the segments of the involved tooth so they do not move or flex independently during biting and grinding (stabilisation of the crack) to prevent propagation of the crack. Provisionally, a band may be placed around the tooth or a direct composite splint can be placed in supra-occlusion to minimize flexing.