A patient comes into the office and says that he is having discomfort on one side. He has hasn't eaten on that side for months if not years. The culprit tooth has a small filling in it or no filling at all. In the x-ray the tooth looks perfectly normal.
I am most definetly starting to think CRACKED TOOTH!!
I place pressure on each cusp separately. On one of the cusps, as the patient opens from pressing, then the tooth starts to hurt. Yes it is a cracked tooth.
Can you see it on the x-ray? No you can't since the tooth is fractured and not broken. When it is fractured the two sides are close together and an X-ray will not pick up the fracture.
Why is it hurting if the sides are still together? This is because, as you bite down on the tooth, the sides of the tooth are flexing. At that point fluid moves in and out of the tooth causing pain.
So how do you fix it? This is the easy or hard part. It all depends where and how far down the root the tooth is fractured. To fix this problem you need a crown on the tooth. By shaving the tooth down and then covering it with a crown (or cap) all the forces of biting will be directed internally and the fractured parts will be held together thus stopping the pain. To test this, we place a temporary crown on the tooth first. If the symptoms disappear then we can go ahead with the permanent crown and have reasonable confidence in the outcome. If the fracture goes further down the root and beyond the crown then the symptoms may persist. We may need to do a root canal and the symptoms may then disappear. But overall the prognosis is now guarded. When the crown does not encompass the entire fracture the tooth may still be flexing and the long term prognosis is questionable.
Does this happen a lot? Actually it happens quite a bit, even teeth that have never had a filling in them get fractures. This is called wear and tear. If you never use your teeth this will never happen to you. Since most people use their teeth quite a bit and of course many of us also grind our teeth which makes this worse, quite a few of us will experience this throughout our lifetimes.
If you have any questions, you can always send me a note.
All the best
Dr. Ron Barzilay
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