Dear Dr. John: Every time I bite into something hard a get a sharp pain in my lower left tooth. It also hurts when I drink something really cold. I saw my dentist, he took an x-ray and did some tests and said he couldn’t find anything wrong. He adjusted my bite and gave me a bill for $200! The tooth still hurts; do you have any ideas?
Candy- Redwood City
Dear Candy: First of all let me start by saying it’s impossible for me to give you a diagnosis without the benefit of examining you. Having said that, I can offer you a bit of insight on what may be the cause of your discomfort. Your symptoms are consistent with those of Cracked Tooth Syndrome.
Teeth may crack when subjected to the stress of chewing hard foods or ice, or by biting on an unexpectedly hard object. Teeth with or without restorations may exhibit this problem; but teeth restored with typical silver-alloy fillings are most susceptible.
Cracked Tooth Syndrome is exactly what it suggests, a tooth that has a crack in it. The phenomena is however not that simple. Teeth can crack in many different ways. They can start out as small craze lines in the enamel, or they can be more severe and involve the inner layers of the tooth, the dentin and the nerve. Unlike teeth with obvious fractures, teeth with Cracked Tooth Syndrome have microscopic fractures that are difficult to see and are usually not evident on x-rays. Diagnosing a tooth with CTS can be very difficult. The dentist has to carefully evaluate all of the symptoms and clinical findings before arriving at a diagnosis.
A common symptom of cracked tooth syndrome is sharp pain upon biting or chewing. The pain is generally not constant, and may only occur when you eat specific foods or bite in a certain way. The tooth may also be sensitive to cold or sweets. Because of the tremendous forces of chewing, molars are more likely to be affected by cracked tooth syndrome.
In diagnosing a crack, transillumination , microscopic evaluation, x-rays, staining techniques, tactile exam with an explorer, and a bite stick are essential. Transillumination helps the dentist to visualize the crack by the difference of the transmitted light through the tooth since the crack blocks light, causing a dark line to appear. Microscopic evaluation helps to clinically detect the extent of the crack when it is near or in the root. X-rays can show the bone breakdown around the tooth, which can help determine the size of the crack. Various stains, such as methylene blue, may also help visualize the crack. An explorer which is shaped like a sharp needle may be used to detect a crack in the surface of the tooth. Lastly, a bite stick could help reproduce the patient’s symptoms and thereby help in locating the crack.
Only after a diagnosis is made, can treatment recommendations be made. Most teeth diagnosed with CTS can be treated with a crown, however if the crack is into the nerve, a root canal may be needed. Sometimes a crack can be so severe that the only course of treatment is an extraction.
The key here is early diagnosis and treatment. A cracked tooth will not heal itself and delaying treatment will only make maters worse. Candy, since you are still having pain, I would suggest you get a second opinion from another dentist.
Better smiles for all.
John J. Russo DDS
