Finding a cracked tooth can be difficult since the tooth may be grossly intact. Diagnosis requires a high level of suspicion and persistence.
Patient Presentation
Pain Duration
Usual Association
aching provoked by many stimuli, including percussion
may be prolonged
pulpal damage
sensitive to selective pressure, biting or thermal stimuli
usually short duration
pulp not involved
If the tooth is not immediately obvious, then it must be searched for. Selective pressure or biting on an individual cusp may trigger the pain and indicate the affected tooth.
Means of demonstrating the crack:
(1) radiograph (many negative)
(2) staining
(3) transillumination, preferrably using a highly collimated light source
(4) if a filling is present, removal of restoration and examination of base
Type of Damage
Definitive Treatment
Prognosis
not involving pulp
cast restoration with circumferential reinforcement
excellent
involving pulp but not extending to the root surface or pulpal floor
root canal with cast restoration with circumferential reinforcement
good
involving pulp and extending to the root surface or pulpal floor
extract with prosthesis
good
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