One of the things we figure out early in the practice of dentistry is that we want to try as hard as we can to prevent a bad day at the office. Sometimes, someone is going to hurt after a procedure unexpectedly. Sometimes, you can sit and explain to a patient what you see, what you recommend and why, and what they can expect and later you discover they were not listening.

One of these areas is the cracked tooth syndrome. I don't know about you, but I have seen an escalation of these in the past ten years. When someone comes in with a symptomatic tooth, if my diagnosis is cracked tooth syndrome, I take off the gloves and mask and sit facing the patient at eye level and discuss what I see. This is how it goes:

The sharp pain that you sometimes experience when chewing and we reproduced today by selective biting pressure with the bite stick is because there is most likely a tiny crack in the tooth that separates when chewing. This problem can be one of the most frustrating dental problems for the patient as well as for the dentist. This is due to the fact that most times the crack is not obvious and because we do not know the extent of the crack, it is difficult to determine the outcome of treatment. There is a step-wise protocol to attempt to save the tooth. The first attempt to eliminate the problem is to place a crown on the tooth in hopes that the tooth will be stabilized and prevent movement of the segments (which causes dentinal stimulation) and the pain. Many of these teeth require root canal therapy and this is determined by the continued presence of symptoms. Sometimes a patient can continue to have pain even after root canal treatment and it is possible that the only definitive treatment is the removal of the tooth.

I am telling you this because if this happens to be a tooth that cannot be successfully treated and extraction becomes necessary, I do not want you to tell me, "If I would have known that, I wouldn't have spent the time and money on a crown and a root canal!”

We then give them a written handout that covers these points as well. Certainly, there are cases where the first order of treatment is to have the endo done first, depending on the amount of pain they are experiencing or there is a suspicion that the crack is vertical and extensive. It is better for the endodontist to trace the crack internally with the use of the microscope and know right away if the tooth should be extracted.

The purpose of this article is not to teach diagnosis, but to eliminate the frustrations that come with the nature of a cracked tooth. I hope this helps you to keep from having a bad day in the office.