Diagnosing Tooth Fractures - Pain
Many dentists have experienced the patient who complains of an unlocateable tooth pain.
Sometimes it is a sharp pain that causes a reflex reaction when chewing or when eating crunchy foods or sweets. In many instances, the most frustrating ones, a radiographic (xray) and clinical examination reveals nothing except healthy teeth with small fillings.
Tiny cracks, fissures or microscopic fractures can occur within a tooth structure that remains hidden from radiographic view.
Bite Pressure Expansion
When there is pain associated with a crack, it occurs because the crack has propagated far enough that the crack itself expands and closes with biting pressure. This opening and closing of the crack affects the nerve within the tooth and creates the perception of pain and/or sensitivity.
Teeth with large fillings can be immediately suspect in having hidden cracks. Large fillings weaken the tooth and as we bite, the cusps of the teeth are flexed in a lateral direction which can lead to cracks and fractures.
For a large number of patients a cracked tooth can be difficult to locate and sometimes goes undiagnosed until the tooth fractures and produces perceptable change or damage to the tooth (exploratory exam or xrays).
In cases where a previous filling has failed, removal of the old filling material may reveal cracks within the tooth structure (source of leakage or contamination causing the failure). In those circumstances treatments can be used to restore the tooth that prevents the crack from getting worse.