Early detection of tooth fracture. 
Author Message
 Early detection of tooth fracture.

I had a tooth fracture (lower left middle molar) last year that was
not diagnosed until after 6 weeks.
Initial symptoms were pain and then abscess developed. Diagnosis was
not made until after the tooth was visibly cracked several weeks
later.

In retrospect, I remember a "zapping" type of feeling when biting down
on
This was about 2 weeks before the diagnosis was made. I'm thinking
that this was when the tooth fully cracked.

Few days ago, I felt a similar pain (not quite as severe and not so
much of a "zap" feeling but more of a general pain feeling) for a few
seconds when biting down on a soft food. And I felt it again again
today. It is on the lower right side  but I can't narrow it down to a
specific tooth -- maybe the first or second molar. I don't feel any
ongoing pain

Should I go to the general dentist? or periodontist?

What kind of tests can they do to diagnose if it is a fracture?

Can anything else cause these symptoms?



Fri, 28 Aug 2009 16:47:41 GMT
 Early detection of tooth fracture.

Quote:

> I had a tooth fracture (lower left middle molar) last year that was
> not diagnosed until after 6 weeks.
> Initial symptoms were pain and then abscess developed. Diagnosis was
> not made until after the tooth was visibly cracked several weeks
> later.

> In retrospect, I remember a "zapping" type of feeling when biting down
> on
> This was about 2 weeks before the diagnosis was made. I'm thinking
> that this was when the tooth fully cracked.

> Few days ago, I felt a similar pain (not quite as severe and not so
> much of a "zap" feeling but more of a general pain feeling) for a few
> seconds when biting down on a soft food. And I felt it again again
> today. It is on the lower right side  but I can't narrow it down to a
> specific tooth -- maybe the first or second molar. I don't feel any
> ongoing pain

> Should I go to the general dentist? or periodontist?

> What kind of tests can they do to diagnose if it is a fracture?

> Can anything else cause these symptoms?

        Sometimes not easy to do.  I do have a nice, exceptionally low-tech
instrument called a "tooth slooth" (their spelling) that is useful for
isolating any particular areas of fracture.  However, it is sometimes
still difficult to do until some other evidence appears (such as
infection).  I would start off with my general dentist.
        If you are in fact fracturing multiple teeth you should evaluate why
this is happening--large restorations, habits, clenching and grinding, etc.

Steve



Fri, 28 Aug 2009 20:51:34 GMT
 Early detection of tooth fracture.

Quote:
> Few days ago, I felt a similar pain (not quite as severe and not so
> much of a "zap" feeling but more of a general pain feeling) for a few
> seconds when biting down on a soft food. And I felt it again again
> today. It is on the lower right side  but I can't narrow it down to a
> specific tooth -- maybe the first or second molar. I don't feel any
> ongoing pain

> Should I go to the general dentist? or periodontist?

> What kind of tests can they do to diagnose if it is a fracture?

> Can anything else cause these symptoms?

Cracked teeth can be difficult problems.  By the time you reach
middle age, most people have several molars restored with 'fillings'.

The teeth have had structure damaged from the decay and other structure
cut to remove the decay.  They are never as strong as a natural tooth
that has never needed treatment.

Add a couple of decades of use and abuse, and teeth can easily develop
cracks.

With magnification, most molars with 'fillings' have visible crack/craze
lines in several locations.  Some of these may never develop into a
significant problem, but others continue to spread deeper into the tooth
causing sensitivity.  Depending upon the actual direction that the crack
takes, it can lead to a root canal, a piece of tooth fracturing, or
actual loss of the tooth.  But just looking at these lines doesn't tell
the dentist that a tooth is cracked enough to cause symptoms or need
a different restoration immediately.

According to the textbooks, any molar with a filling over 1/3 of the
occlusal width should be treated with a crown or onlay.  Most patients
don't want to spend the money to do this, and most dentists don't
"enforce" this 'rule'.   We place lots of restorations that are
stretching the limits of the materials and remaining tooth structure.

The 'safe' way to treat these problems is to place a crown or onlay when
a restoration is replacing a large amount of tooth structure.  When a
tooth with a large filling begins to get sensitive to biting, it could
be too late for an easy fix.

In this situation, I discuss the possibilities with the patient.
Adjusting the occlusion might help the situation temporarily.  A
crown or onlay might solve the problem for years, but the tooth may
still end up needing a root c{*filter*}(and a small chance that it will
be beyond help).

Some people crack teeth that have never had any decay and teeth with
small restorations.  Evidence of clenching should not be dismissed
and I recommend an NTI in these cases.

D



Fri, 28 Aug 2009 21:28:19 GMT
 Early detection of tooth fracture.


Quote:

>> Few days ago, I felt a similar pain (not quite as severe and not so
>> much of a "zap" feeling but more of a general pain feeling) for a few
>> seconds when biting down on a soft food. And I felt it again again
>> today. It is on the lower right side  but I can't narrow it down to a
>> specific tooth -- maybe the first or second molar. I don't feel any
>> ongoing pain

>> Should I go to the general dentist? or periodontist?

>> What kind of tests can they do to diagnose if it is a fracture?

>> Can anything else cause these symptoms?

> Cracked teeth can be difficult problems.  By the time you reach
> middle age, most people have several molars restored with 'fillings'.

> The teeth have had structure damaged from the decay and other structure
> cut to remove the decay.  They are never as strong as a natural tooth
> that has never needed treatment.

> Add a couple of decades of use and abuse, and teeth can easily develop
> cracks.

> With magnification, most molars with 'fillings' have visible crack/craze
> lines in several locations.  Some of these may never develop into a
> significant problem, but others continue to spread deeper into the tooth
> causing sensitivity.  Depending upon the actual direction that the crack
> takes, it can lead to a root canal, a piece of tooth fracturing, or actual
> loss of the tooth.  But just looking at these lines doesn't tell
> the dentist that a tooth is cracked enough to cause symptoms or need
> a different restoration immediately.

> According to the textbooks, any molar with a filling over 1/3 of the
> occlusal width should be treated with a crown or onlay.  Most patients
> don't want to spend the money to do this, and most dentists don't
> "enforce" this 'rule'.   We place lots of restorations that are stretching
> the limits of the materials and remaining tooth structure.

> The 'safe' way to treat these problems is to place a crown or onlay when
> a restoration is replacing a large amount of tooth structure.  When a
> tooth with a large filling begins to get sensitive to biting, it could
> be too late for an easy fix.

> In this situation, I discuss the possibilities with the patient. Adjusting
> the occlusion might help the situation temporarily.  A
> crown or onlay might solve the problem for years, but the tooth may
> still end up needing a root c{*filter*}(and a small chance that it will
> be beyond help).

> Some people crack teeth that have never had any decay and teeth with
> small restorations.  Evidence of clenching should not be dismissed
> and I recommend an NTI in these cases.

> D

Why doesn't the mouth's natural restoration of the enamel patch the cracks
when they are tiny?


Sun, 30 Aug 2009 09:03:25 GMT
 Early detection of tooth fracture.
Complex answer would take a few pages.  Simple answer is that such a process
cannot repair a crack.

--
/

Amatus

/>

Quote:
> Why doesn't the mouth's natural restoration of the enamel patch the cracks
> when they are tiny?



Sun, 30 Aug 2009 19:00:55 GMT
 Early detection of tooth fracture.

Microscopic remineralization of decalcified enamel is possible.  It is
not a process that can 'weld' over/across a stress related defect.

D

Quote:

> Complex answer would take a few pages.  Simple answer is that such a process
> cannot repair a crack.



Sun, 30 Aug 2009 20:46:33 GMT
 Early detection of tooth fracture.


Quote:

> > I had a tooth fracture (lower left middle molar) last year that was
> > not diagnosed until after 6 weeks.
> > Initial symptoms were pain and then abscess developed. Diagnosis was
> > not made until after the tooth was visibly cracked several weeks
> > later.

> > In retrospect, I remember a "zapping" type of feeling when biting down
> > on
> > This was about 2 weeks before the diagnosis was made. I'm thinking
> > that this was when the tooth fully cracked.

> > Few days ago, I felt a similar pain (not quite as severe and not so
> > much of a "zap" feeling but more of a general pain feeling) for a few
> > seconds when biting down on a soft food. And I felt it again again
> > today. It is on the lower right side  but I can't narrow it down to a
> > specific tooth -- maybe the first or second molar. I don't feel any
> > ongoing pain

> > Should I go to the general dentist? or periodontist?

> > What kind of tests can they do to diagnose if it is a fracture?

> > Can anything else cause these symptoms?

>         Sometimes not easy to do.  I do have a nice, exceptionally low-tech
> instrument called a "tooth slooth" (their spelling) that is useful for
> isolating any particular areas of fracture.  However, it is sometimes
> still difficult to do until some other evidence appears (such as
> infection).  I would start off with my general dentist.
>         If you are in fact fracturing multiple teeth you should evaluate why
> this is happening--large restorations, habits, clenching and grinding, etc.

> Steve- Hide quoted text -

> - Show quoted text -

i went to the general dentist.
the x-rays showed no sign of cavities. he recommended that i have a
cleaning with the hygenist.
he said that sometimes buildup (think he said calculus) can cause pain
when chewing down -- similar symptoms to fractures.

i had read that dentists use  hot/cold sensitivity tests to identify
fractures.
so i asked if there were any tests like that but he said no.

maybe some dentists are more skilled and experienced in the practices
of identifying dractures?

he said that if it is a fracture, it will soon become evident (within
2 months).

in the meantime, i have scheduled cleaning appointment. and so far, i
have not yet experienced the pain when chewing since 10 days.

i forgot to ask about the grinding. i don't know if i grind or not --
maybe i do while sleeping..

is there a test to determine that?



Sat, 05 Sep 2009 07:59:58 GMT
 Early detection of tooth fracture.
If you have visible calculus build-up, the first step should probably be to
get your teeth completely clean no matter what is wrong.  (Unless you are in
severe pain.)

--
/

Amatus

/

Quote:



>> > I had a tooth fracture (lower left middle molar) last year that was
>> > not diagnosed until after 6 weeks.
>> > Initial symptoms were pain and then abscess developed. Diagnosis was
>> > not made until after the tooth was visibly cracked several weeks
>> > later.

>> > In retrospect, I remember a "zapping" type of feeling when biting down
>> > on
>> > This was about 2 weeks before the diagnosis was made. I'm thinking
>> > that this was when the tooth fully cracked.

>> > Few days ago, I felt a similar pain (not quite as severe and not so
>> > much of a "zap" feeling but more of a general pain feeling) for a few
>> > seconds when biting down on a soft food. And I felt it again again
>> > today. It is on the lower right side  but I can't narrow it down to a
>> > specific tooth -- maybe the first or second molar. I don't feel any
>> > ongoing pain

>> > Should I go to the general dentist? or periodontist?

>> > What kind of tests can they do to diagnose if it is a fracture?

>> > Can anything else cause these symptoms?

>>         Sometimes not easy to do.  I do have a nice, exceptionally
>> low-tech
>> instrument called a "tooth slooth" (their spelling) that is useful for
>> isolating any particular areas of fracture.  However, it is sometimes
>> still difficult to do until some other evidence appears (such as
>> infection).  I would start off with my general dentist.
>>         If you are in fact fracturing multiple teeth you should evaluate
>> why
>> this is happening--large restorations, habits, clenching and grinding,
>> etc.

>> Steve- Hide quoted text -

>> - Show quoted text -

> i went to the general dentist.
> the x-rays showed no sign of cavities. he recommended that i have a
> cleaning with the hygenist.
> he said that sometimes buildup (think he said calculus) can cause pain
> when chewing down -- similar symptoms to fractures.

> i had read that dentists use  hot/cold sensitivity tests to identify
> fractures.
> so i asked if there were any tests like that but he said no.

> maybe some dentists are more skilled and experienced in the practices
> of identifying dractures?

> he said that if it is a fracture, it will soon become evident (within
> 2 months).

> in the meantime, i have scheduled cleaning appointment. and so far, i
> have not yet experienced the pain when chewing since 10 days.

> i forgot to ask about the grinding. i don't know if i grind or not --
> maybe i do while sleeping..

> is there a test to determine that?



Sat, 05 Sep 2009 19:46:34 GMT
 Early detection of tooth fracture.

Quote:




>>> I had a tooth fracture (lower left middle molar) last year that was
>>> not diagnosed until after 6 weeks.
>>> Initial symptoms were pain and then abscess developed. Diagnosis was
>>> not made until after the tooth was visibly cracked several weeks
>>> later.
>>> In retrospect, I remember a "zapping" type of feeling when biting down
>>> on
>>> This was about 2 weeks before the diagnosis was made. I'm thinking
>>> that this was when the tooth fully cracked.
>>> Few days ago, I felt a similar pain (not quite as severe and not so
>>> much of a "zap" feeling but more of a general pain feeling) for a few
>>> seconds when biting down on a soft food. And I felt it again again
>>> today. It is on the lower right side  but I can't narrow it down to a
>>> specific tooth -- maybe the first or second molar. I don't feel any
>>> ongoing pain
>>> Should I go to the general dentist? or periodontist?
>>> What kind of tests can they do to diagnose if it is a fracture?
>>> Can anything else cause these symptoms?
>>         Sometimes not easy to do.  I do have a nice, exceptionally low-tech
>> instrument called a "tooth slooth" (their spelling) that is useful for
>> isolating any particular areas of fracture.  However, it is sometimes
>> still difficult to do until some other evidence appears (such as
>> infection).  I would start off with my general dentist.
>>         If you are in fact fracturing multiple teeth you should evaluate why
>> this is happening--large restorations, habits, clenching and grinding, etc.

>> Steve- Hide quoted text -

>> - Show quoted text -

> i went to the general dentist.
> the x-rays showed no sign of cavities. he recommended that i have a
> cleaning with the hygenist.
> he said that sometimes buildup (think he said calculus) can cause pain
> when chewing down -- similar symptoms to fractures.

> i had read that dentists use  hot/cold sensitivity tests to identify
> fractures.
> so i asked if there were any tests like that but he said no.

> maybe some dentists are more skilled and experienced in the practices
> of identifying dractures?

> he said that if it is a fracture, it will soon become evident (within
> 2 months).

> in the meantime, i have scheduled cleaning appointment. and so far, i
> have not yet experienced the pain when chewing since 10 days.

> i forgot to ask about the grinding. i don't know if i grind or not --
> maybe i do while sleeping..

> is there a test to determine that?

        If the pain went away, it is most likely you don't have a fracture.
Other than some kind of test like an electromyograph (I don't know any
dentists who set patients up for that), you look for signs of wear,
abfraction of the teeth, soreness of the peri{*filter*}musculature that
indicate overuse, and the complaints of your bed partner.  ;-)

Steve

--
Mark & Steven Bornfeld DDS
http://www.***.com/
Brooklyn, NY
718-258-5001



Sat, 05 Sep 2009 21:27:51 GMT
 
 [ 9 post ] 

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