Possible cracked tooth #21 can you please take a look Bryanna?
 

Hi Bryanna,

Can you please take a look at this PA x-ray and digital pic? My wife and I are suspecting her tooth may be cracked/split on the facial side? Amalgam MO filling in 1992 and re-done with MOD composite filling in 2007. Thanks.

Doitashi,

The first xray is of her lower teeth. There is an obvious lesion below the apex of the root canaled pre molar tooth. If you notice the root canal filling material is short of the tip of the root. That could be due to a calcified canal or just an oversight. A conventional dentist will likely tell you one of two things about this pre molar irrelevant of whether she is experiencing any pain or symptoms with this tooth. One: the lesion is benign meaning insignificant. Two: the lesion is present because the root canal procedure was incomplete and needs to be redone.

The truth of the matter is that the lesion below the apex of the pre molar is the result of the tooth being chronically infected irrelevant of how well or how poorly the root canal procedure was done and the lesion itself represents a cyst and/or build up of infection. Re treating this tooth with a second root canal procedure or an apicoectomy surgery will not favorably alter the infection status of this non vital tooth because the dentin tubules (microscopic canals) will remain infected with dead nerve tissue.

Also on the first xray, the canine in front of the pre molar may have a cavity.

The second xray that you posted, which tooth is this? That deep crevice that you see is probably not a fracture. It is an abnormal crevice into the enamel of the tooth. Is this wear a partial denture clips onto? Does she have areas like this one on other teeth? This area may or may not be sensitive to temperature changes.

Bryanna

Thanks Bryanna,

The root canaled tooth #20 has since been extracted (the second molar number #18 was already extracted years ago). The tooth that appears to be split across the facial side is the next one over, her first premolar #21. There have already been two major fillings on this tooth in 1991 (amalgam) and in 2007 (re-do of a 3 surf to a MOD composite). She does not have any partial dentures as of yet. The reason I ask about tooth #21 is that she has symptoms of a cracked tooth with lingering nerve pain that appears shortly after eating and drinking. Also,the left side of her face is swollen and there is pain above this tooth that refers up to the tooth directly above it #12 also after eating, chewing, drinking, etc. Also symptoms of sweating and an inflammatory reaction have been there for a while in conjuction with the lingering nerve pain, etc.

Thanks again


Doitashi,

The first xray is of her lower teeth. There is an obvious lesion below the apex of the root canaled pre molar tooth. If you notice the root canal filling material is short of the tip of the root. That could be due to a calcified canal or just an oversight. A conventional dentist will likely tell you one of two things about this pre molar irrelevant of whether she is experiencing any pain or symptoms with this tooth. One: the lesion is benign meaning insignificant. Two: the lesion is present because the root canal procedure was incomplete and needs to be redone.

The truth of the matter is that the lesion below the apex of the pre molar is the result of the tooth being chronically infected irrelevant of how well or how poorly the root canal procedure was done and the lesion itself represents a cyst and/or build up of infection. Re treating this tooth with a second root canal procedure or an apicoectomy surgery will not favorably alter the infection status of this non vital tooth because the dentin tubules (microscopic canals) will remain infected with dead nerve tissue.

Also on the first xray, the canine in front of the pre molar may have a cavity.

The second xray that you posted, which tooth is this? That deep crevice that you see is probably not a fracture. It is an abnormal crevice into the enamel of the tooth. Is this wear a partial denture clips onto? Does she have areas like this one on other teeth? This area may or may not be sensitive to temperature changes.

Bryanna[/QUOTE]

Doitashi,

Thank you for clarifying.

Tooth #21 has a very deep groove, which I believe is the area that you are referring to as split or crack. A groove like this is often seen in people who are aggressive tooth brushers and/or who use a hard bristle tooth brush. Over time, the enamel wears thin and the groove becomes deep. It is possible for it to become deep enough where it causes tooth pain and/or infection of the nerves in the tooth. It can also progress to the point where the tooth becomes weak due to the loss of tooth structure and the tooth can fracture off at that height.

Tooth #12 may or may not have a similar condition if she aggressively brushes that area too. It is also very possible for her to be having what is called referred pain from the lower jaw up into the upper one.

The pain upon chewing and food temperatures indicate possible decay in the tooth and inflammation of the nerves and periodontal ligament. The swelling occurs as the inflammation increases.

Has she been to the dentist for an evaluation? What is his diagnosis and recommendation?

Bryanna






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