Symptomatic Cracked Teeth: Associations with Patient-Level and Tooth-Level Factors-A Case-Control Study

Aidi Zhang; Zhuping Sang; Xige Zhang; Yu Yang; Zhe Yang; Wei Wang

doi:10.1016/j.jdent.2025.105921

Symptomatic Cracked Teeth: Associations with Patient-Level and Tooth-Level Factors-A Case-Control Study

J Dent. 2025 Jun 25:105921. doi: 10.1016/j.jdent.2025.105921. Online ahead of print.

Authors

Aidi Zhang¹, Zhuping Sang¹, Xige Zhang¹, Yu Yang¹, Zhe Yang², Wei Wang³

Affiliations

¹ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration;National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an 710032, China.
² Department of Health Statistics, School of Public Health, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, P. R. China. Electronic address: tanger_003@163.com.
³ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration;National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, Xi'an 710032, China. Electronic address: weiwang_0510@163.com.

PMID: 40578784
DOI: 10.1016/j.jdent.2025.105921

Abstract

Objectives: To investigate patient-level and tooth-level risk factors associated with symptomatic cracked teeth through a case-control study.

Methods: The case-control study included 100 symptomatic cracked tooth patients and matched controls. Patient-level (demographics and oral behaviors) and tooth-level parameters (type, location, crack location and cuspal inclination) were respectively assessed through questionnaires and clinical examinations. Univariate logistic regression analysis assessed the relationships between patient-level/tooth-level parameters and the occurrence of cracked teeth. Significant parameters (p ≤ 0.1) underwent multivariate analysis. Cuspal angles were compared using an independent samples t-test.

Results: The highest prevalence of cracked teeth occurred in individuals aged 30-39 years, predominantly affecting the maxillary first molar. Significant behavioral risk factors were hard food consumption and unilateral chewing. The tooth-related risk factors included dental caries, deep overbite, Angle's Class II malocclusion and Class I occlusal wear. Cracked teeth in maxillary first and second molars with four cusps were significantly associated with the inclination of the mesiobuccal, mesiolingual and distolingual cusps (p < 0.05). This was also observed in the distobuccal cusp of maxillary second molars with three cusps (p < 0.05). In mandibular first molars, cusp tilting was significantly associated with cracked teeth for all cusps except the distolingual cusp (p < 0.05).

Conclusions: Eating hard food, unilateral chewing, dental caries, deep overbite, Class II malocclusion, wear and a steep cuspal inclination angle were all identified as potential risk factors for cracked teeth.

Clinical significance: The findings may facilitate the development of an effective and results-oriented prevention strategy for cracked teeth.

Keywords: Case-control study; Cracked teeth; Prevention; Risk factors.