Claudia Hoffman
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CRACKED TOOTH is often a mysterious case that can be frustrating for the
practioner and patient. A cracked tooth can present with a bizarre
and inconclusive set of signs and symptoms. The diagnosis in these
cases may be the most difficult phase of treatment. Often the cracks
are not identified until a restoration has been removed or a periodontal
defect is identified.
The following are the typical signs and symptoms that will aid
you in diagnosing a cracked tooth:
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Patients feel inconsistent pain on mastication, particularly when releasing
on biting.
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Patients tend to have trouble articulating their chief complaint and often
have endured a long history of discomfort.
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The teeth may have had some treatment in the past that did not relieve
the symptoms.
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Teeth may have pain on temperature extremes, mostly cold.
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Often there is no pain on percussion.
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If the pulp is involved, there may be signs and symptoms of irreversible
pulpitis or periradicular pathosis.
A patient may present with one or all of the above signs
and symptoms. As with any other case, a thorough history is important.
The patient can provide the practioner with valuable information, such
as a history of trauma in the area, a history of clenching or bruxism,
or an oral habit, such as chewing on hard objects.
During oral examination, the teeth should be dried
carefully to help visualize any cracks. Multiple radiographs should
be taken from different angles including a bite wing; this thorough imaging
helps increase the chances of identifying the crack. Periodontal
probing will identify a crack that has affected the periodontium and created
a periodontal defect. Endodontically treated teeth may present with
symptoms in the periodontium only because there is no vital tissue remaining.
Transillumination, from a fiberoptic light, for
example, can be a valuable diagnostic tool in identifying a cracked tooth.
The light beam should be placed perpendicular to the tooth. Sound
tooth structure will transmit light throughout the crown. In addition,
staining dye can be placed into tooth structure to locate a potential cracked
tooth.
The treatment of cracked teeth will depend on the
severity, location, and extent of the crack or fracture. A craze
line, which is very common and often confused with a fracture, will transmit
fiberoptic light and is considered normal with no treatment necessary beyond
aesthetic concerns. Fractured cusps or cracked teeth should have
full coverage to stabilize and protect the tooth. If the pulp is
involved, temporizing the tooth as soon as the fracture is identified may
be necessary to protect the tooth before endodontic treatment. If
the tooth is split, the split usually is mesiodistal, crossing both marginal
ridges and separating the tooth into two segments. In all cases of
cracked teeth, the patient should be informed that the prognosis is guarded,
and there are no guarantees.
Reference: American Association of Endodontics Colleagues For Excellence.
Fall/Winter 1997.
February-March 2004
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As
with any other case, a thorough history is important.
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