Incompletely fractured teeth associated with diffuse longstanding orofacial pain: diagnosis and treatment outcome

By Brynjulfsen A, Fristad I, Grevstad T, Hals-Kvinnsland I

Date: 01/2001
Journal: IEJ

Purpose:

To look at the diagnostic value of different clinical findings, to analyze the symptoms experienced from teeth with incomplete dentinal fractures associated with diffuse orofacial pain, and to present the outcome of different treatment modalities

Materials/Methods:

  • N= 32 pts to Faculty Practice UBergen with poorly localized pain–finally diagnosed with 46 incompletely fractured teeth
  • Diagnosis made using standardized questions, radiographs, and clinical tests: percussion, bite test, staining, and transillumination (none of the patients experienced the traditional pain patterns normally associated with incompletely fractured teeth– sudden onset and short duration brought on by cold and chewing). Anesthesia was helpful to localize pain to MX or MD jaw. Serial removal of fillings, starting with the most posterior, to allow direct visualization of fracture lines done until crack detected. Staining used. If symptoms didn’t resolve after a crack was visualized and restored, then more fillings removed.

Results:

Pain:

  • All patients had been complaining of pain for at least 3 months (greatest was 11 years)
  • The longer the duration of pain prior to diagnosis the more diffuse the orofacial pain.
  • 50 % Endodontic and 50 % restorative (included cuspal coverage) treatment relieved symptoms in 90% patients; 10% still had persistent orofacial pain- considered to be of unknown etiology

Referral pattern:

  • 81 % had consulted GP more that twice
  • 63 % referred from GP
  • 22 % medical referral (5 from ENT, 2 from neurologist
  • 9 % from OS
  • 6 % from perio

Distribution:

  • 72 % only one tooth; 28 % more than one tooth (range 2- 6 involved teeth)
  • 89 % in heavily restored teeth, 7 % with Class I restoration, 4 % without restorations
  • Majority were in maxilla: evenly distributed between premolars and molars. Mostly molars in Mandible. all fractures M-D direction
  • 10 % of cases exhibited a centrally running crack; 70 % on the side of balancing cusp, 20 % on the side of the supporting cusp
  • Buccal cusp max and lingual cusp mandible (matches occlusal cusp fossa relationship)

Clinical Significance:

Oral facial pain of long duration may be related to cracked teeth; The sooner it is diagnosed, the less diffuse the pain will be (potentially easier to localize). Once a proper diagnosis is reached, high success is seen with treatment.