Atypical Manifestation of a Tooth Crack

Abstract

A patient presented with severe pain in the area of teeth #2 and #31. Prior to seeking dental care, the pain had been so severe together with other clinical manifestations that the patient sought medical attention for a heart attack. After elimination of the occurrence of a m.i., the pain was thought to be dental in origin and dental care was sought. No carious lesions or endodontic problems were found upon radiographic examination. However, careful oral examination revealed the presence of a crack transcending tooth #31. Following tooth extraction and immediate implant placement, no further pain was experienced by the patient. DOI: 10.32474/MADOHC.2018.03.000158 Mod App Dent Oral Health Copyrights@ Von Fraunhofer JA, et al. Citation: Massa L, Von Fraunhofer JA. Atypical Manifestation of a Tooth Crack. Mod App Dent Oral Health 3(2)2018. MADOHC.MS.ID.000158. DOI: 10.32474/MADOHC.2018.03.000158. 243 Figure 2: Intra-oral photograph of affected tooth. Figure 3: Intra-oral photograph of the affected tooth. Figure 4: Crack on the distal aspect of tooth #2. Treatment Regimen In consultation with the patient, it was decided that the affected tooth could not be salvaged, and it was extracted under local anesthesia. Because the extraction site was infection-free, the periodontal condition was satisfactory, and the bone was solid and well-vascularized, an immediate implant was placed, (Figure 5). Figure 5: Immediate implant placed following extraction. Prognosis After extraction of tooth #31 and resolution of local anesthesia, the pain was immediately eliminated. Satisfactory healing and osseo-integration are projected for the affected area. Conclusion Cracks in teeth weaken them and pain from cracked teeth can be felt in areas remoted from the affected tooth. What was unusual in the present case is the pain was experienced on the other side of the mouth from the affected tooth and intensified to the point that the patient suspected a myocardial infarction. Although tooth crack-induced pain often can be experienced in areas remote from the affected tooth, the existence of pain, so severe that it mimicked a heart attack, and occurring on the other side of the mouth was unusual. This particular case reinforces the need for clinicians to carefully examine all facets of the dentition of patients presenting with oral pain. Cracks in enamel do occur and, as in the present case, may originate from a defective restoration. However, crack progression to the tooth apex and sudden, sharp onset of pain is unusual. Even more unexpected is that the pain was experienced on the opposite jaw to the affected tooth. References 1. Geurtsen W, Schwarze T, Günay H (2003) Diagnosis, therapy, and prevention of the cracked tooth syndrome. Quintessence Int 34(6): 409417. 2. Kahler W (2008) The cracked tooth conundrum: terminology, classification, diagnosis, and management. Am J Dent 21: 275-282. 3. Lubisich EB, Hilton TJ, Ferracane J (2010) Cracked teeth: A review of the literature. J Esthet Restor Dent 22: 158-167. 4. Hilton TJ, Funkhouser E, Ferracane JL, Gordan VV, Huff KD, et al. (2018) Associations of types of pain with crack-level, tooth-level and patientlevel characteristics in posterior teeth with visible cracks: Findings from the National Dental Practice-Based Research Network. J Dent 70: 67-73. Mod App Dent Oral Health Copyrights@ Von Fraunhofer JA, et al. Citation: Massa L, Von Fraunhofer JA. Atypical Manifestation of a Tooth Crack. Mod App Dent Oral Health 3(2)2018. MADOHC.MS.ID.000158. DOI: 10.32474/MADOHC.2018.03.000158. 244 5. Seo DG, Yi YA, Shin SJ, Park JW (2012) Analysis of factors associated with cracked teeth. J Endod 38(3): 288-292. 6. Patel DK, Burke FJ (1995) Fractures of posterior teeth: A review and analysis of associated factors. Prim Dent Care 2(1): 6-10. Modern Approaches in Dentistry and Oral Health Care Assets of Publishing with us • Global archiving of articles • Immediate, unrestricted online access • Rigorous Peer Review Process • Authors Retain Copyrights • Unique DOI for all articles This work is licensed under Creative Commons Attribution 4.0 License To Submit Your Article Click Here: Submit Article DOI: 10.32474/MADOHC.2018.03.000158