1-SmileLineNewsSUM2021 - Flipbook - Page 22
Treating Odontogenic Pain in the Pandemic
Dr. Lily Kaykha
All of us in the dental community are well aware of the
increase in parafunctional activity over the past year.
Dental literature from around the world is replete with
reports of increased bruxism, clenching, and orofacial
pain during the pandemic. While I do not usually treat
the many manifestations of TMD, I do see with frequency
the elusive and sometimes frustrating “Cracked Tooth
Successful diagnosis of cracked tooth syndrome requires
awareness of its existence and appropriate diagnostic tests.
These teeth often have an extensive intra-coronal restoration, compounded by parafunctional habits such as bruxism.
The most important diagnostic criteria are as follows:
1 - History elicited from the patient - Listening to the patient’s chief complaint is essential (attempt to reproduce the
2 - Tooth Slooth: Pressure applied via occlusal forces
(pain occurs upon release)
3 - Vitality Testing (usually a positive response)
4 - Percussion usually not a positive response in
an axial direction
Methylene Blue Stain of Occlusal Crack
5 - Use of trans-illumination (methylene blue stain can be
very helpful in isolating the problem)
6 - Use of loops and/or microscope to establish the position
and extent of the crack (While cracks are not visible in
conventional radiographs or CBCT, a U-shaped lesion in
the furcation and a J-shaped radiolucency extending from
the apices into the furcation is usually indicative of a
vertical root fracture).
7 - Probing could be one of the most important diagnostic
tools (In a cracked tooth, we are looking for a narrow,
isolated probing defect).
Ultimately the tooth needs to be restored with a protective
restoration such as a full coverage crown, an on-lay, or a
three-quarter crown with adequate cuspal protection.
Depending on the extent of the crack and its direction,
the tooth should be endodontically treated to alleviate the
symptoms prior to the protective restoration placement.
Occlusal Crack Extending Vertically Beyond the Alveolar Bone
www.mbdsdentist.com I MONTEREY BAY SMILELINE – SUMMER 2021