Re: pain from cracked tooth after onlay

martin wrote:
Back in 2004 I had a molar (the one nearest the premolars in my lower
left jaw) treated for a crack which ran right through the rear inner
(lingual?) cusp. The dentist gave it a Cerec onlay (which reaches down
about halfway to the gumline), but before fitting the onlay he showed
me the prepared tooth on the monitor, and the crack was still there,
stretching in a curve from the cusp across the centre on the tooth.

He said "I'm not going to chase the crack any further down".

In a visit a couple of weeks later, to polish the tooth, he said I'd
probably always get 'the odd twinge of pain' from that tooth, as not
all of the crack had been removed.

Well, it's held up well for three years, but a couple of months ago, I
began to notice quite a lot of pain on biting. Before I had the onlay
done, the pain happened when I released the bite (a classic symptom of
a cracked tooth, I believe), but now it seems to occur as soon as I
bite. Also, I'm noticing that after the sharp pain, a dull pain
persists for several hours. Sometime the dull pain just starts for no
apparent reason.

I've tested the tooth for sensitivity to hot and cold liquids, and it
doesn't seem abnormally sensitive to either (I get some general pain
holding cold liquids in my mouth, but I have some gum recession, so
it's probably exposed roots).

Any opinions please?


Ordinarily a well-made onlay will prevent the crack spreading further, but your symptoms do suggest either crack or pulpal problems. Distinguishing the two is not so cut and dried as whether there is pressure or rebound pain (my overgeneralization is that biting on a cracked tooth causes sharp pain; biting on an abscessed tooth causes dull, throbbing pain). Of course, one can also have a cracked tooth with pulpal involvement.
These can be difficult cases; it may be perfectly feasible to do a root canal and save the tooth, but if the crack has continued to propagate down the root the tooth may not be worth saving.
Your dentist should evaluate the tooth. It may be necessary to remove the onlay to fully evaluate whether the crack has spread. If the crack extends down the root surface you will eventually get some evidence of this on x-ray, possibly including a periodontal abscess.
Sometimes the course of action isn't clear to me; in these cases I weigh the information to be gained by waiting until the problem becomes clear against the level of discomfort the patient is suffering.

Steve
.

Relevant Pages

  • Re: Metallic taste in mouth and pain after filling replacement
    ... second amalgam filling. ... regular dentist drill out the old filling where the pain was ... I had the tooth refilled yesterday. ... Considering the dentist was able to visualize a crack, ...
    (sci.med.dentistry)
  • pain from cracked tooth after onlay
    ... left jaw) treated for a crack which ran right through the rear inner ... The dentist gave it a Cerec onlay (which reaches down ... stretching in a curve from the cusp across the centre on the tooth. ... began to notice quite a lot of pain on biting. ...
    (sci.med.dentistry)
  • Re: pain from cracked tooth after onlay
    ... Cracks in teeth are NOT due to chewing. ... extends into a tooth without extracting the tooth and sectioning it. ... the crack can act like a "wick". ... will infect the pulp of the tooth and cause pain. ...
    (sci.med.dentistry)
  • Re: My left tooth... again
    ... How can a successfully RCT-ed tooth still cause pain? ... living thing the crack could be touching is the periodontal ligament. ... there may be more evidence if there is a fracture. ...
    (sci.med.dentistry)
  • Re: prognosis for this molar?
    ... >The dentist said it just needed an onlay, ... >two-thirds of the tooth down, leaving a third above the gumline. ... >continuation of the cuspal crack that I'd originally spotted. ...
    (sci.med.dentistry)