Sometimes a patient will come into the office with a history of a tooth that has been painful to biting. They can usually tell the general area of the discomfort, but if it’s only been a short time that they’ve noticed it they may not be able to tell exactly which tooth is the culprit. Sometimes, the tooth makes it very easy to tell. Every time the involved tooth is touched they feel the discomfort. Sometimes, there is a part of the tooth that has broken off or we can see a moveable piece of tooth. Regardless of the situation, we start looking for the answers to where is the pain coming from, what is causing it, and what do we need to do to restore the tooth to it is healthy state and make the pain stop.

1. Tooth Mobility – is the tooth (or part of the tooth) moveable with pressure? When we do this we are looking for a possible bite issue or an issue with how the teeth are lining up and possibly causing the discomfort. In these situations, it may only require a slight polishing of the tooth that is hitting too hard.

2. Pain with biting pressure – does the tooth hurt during normal biting pressure? We use a small plastic or wooden stick that is placed on different areas of the possible teeth and see if we can repeatably reproduce the symptoms. Then we can run other tests to see if the tooth is either cracked and how healthy is the nerve.

3. Is there a crack visible – when we can see a crack in the tooth through visual inspection and it corresponds to the sensitive tooth, we can then move forward with appropriate treatment. How do we see a crack in a tooth? When a crack is present, the light transmits differently through the enamel (or outer surface of the tooth). We also use an intra oral camera with fluorescent lights that make the cracked area show up differently than normal or healthy enamel.

4. X-ray – is there evidence of an abscess or infection at the tip of the root on an x-ray? If there is we then determine what the best treatment for the infection would be and any treatment needed following healing from the infection.

Usually, when there is a crack in a back tooth (premolar or molar), at the minimum, a crown would be needed to keep the tooth from breaking further and to make it so you can chew with it. If the crack goes into the nerve or the nerve is no longer healthy, a root canal will need to be done before the crown is made. Sometimes, a crack can go all the way through the base of the tooth. If this happens, the tooth will likely need to be removed and replaced with either a bridge or a dental implant. We will talk about those two options at a different time.

If you would like to discuss the topic in greater detail as it relates to your dental health, please feel free to call and schedule an appointment so we can discuss. We are always happy to give you the information you need to make a decision about your dental care that is right for you.

Yours in Dental Health,
Jason Schermer, DDS
Noor Almudallal, MS, DMD
(440) 483-1003