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One of the most difficult diagnoses in dentistry is
As a rule, dentists cannot see any problem |
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The tooth may have no fillings or decay,
or it may have an intact
filling with no visible associated problems. Nothing looks wrong, but
the
patient feels sharp pain when he applies biting pressure to the top of
the
tooth. Symptoms of sharp pain to pressure accompanied by no visible
signs
of problem with the tooth are the hallmarks of cracked tooth
syndrome.
The diagnosis can be further confirmed
when the
dentist uses an instrument that rests on one part of the tooth at a
time.
There is frequently sharp pain when the pressure is applied to only one
particular cusp (the pointed parts of a back tooth), and not to others.
If
the tooth has a crack in it, the pain is caused by movement of the
affected
cusp. The other cusps generally prove to be non painful when the same
pressure is applied. The “movement” of the fragment is usually
microscopic, and not visible to the naked eye.
How can a tooth have a crack, but show
no outward
signs of a crack?
When a real crack occurs in a vital tooth
(one with a
living nerve), the crack frequently does not propagate all the way
through the
tooth. This type of crack is called a greenstick fracture
because,
like a green branch from a tree, the fracture may be mechanically
present, but
the unbroken segments of the branch hold it together.
The crack usually propagates through
sensitive
parts of the tooth (the dentin), many times involving the
living nerve. When pressure
is applied to the cracked piece of the tooth, a tiny bit of movement of
that
piece places pressure on the nerve, or other sensitive tooth structure
and even
though the movement is tiny, it hurts a lot! Since the tooth cannot
heal
itself, the pain is always present whenever pressure is applied to the
biting
surface of that tooth.
The pain will not go away until one of
two things
happen.
-
The cracked piece of tooth may break
off
relieving the pain when pressure is applied to it. When this
happens, the
tooth can usually be repaired with a crown or a simple filling and
the patient (and
tooth) lives happily ever after. -
The nerve may die as a result of the
repeated
assaults placed on it by the moving fragment of tooth. When this
happens, the pain to pressure may stop, but the dead nerve leaves
the
patient vulnerable to a dental abscess unless root canal , and subsequent crown are
done.
