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Vague Pain (Cracked tooth) Section 2 - Coggle Diagram
Vague Pain (Cracked tooth) Section 2
Cracked tooth
:<3:
can be
reversible/irreversible pulpitis
If pain on biting - may be there could be a c
rack in the filling that u had
- on bottom teeth.
particularly 36 - tht we suggested to
place a cap
year ago.
Reversible pulpitis
- :red_flag: if pt says pain on biting + sensitive to cold.
Irreversible pulpitis
- :red_flag: lingering pain, sensitive to cold
wake them from sleep (does not always mean irreversible)
Investigations
:question:
Clinical examination
Extraoral
Palpate the cheek muscles (check fr muscles)
Swelling beyond jaws
Check fr fever
Intraoral
look inside the mouth
check the filling (for cracks, weakened cusps)
cold test
(v gonna pt s/t cold quickly - jst to make sure frm which tooth it is coming frm)
palpate the gums
signs of tooth wear
tap and see
(careful if pain)
:red_flag:
(may be give u a cotton wool)
X rays
(bitewing)
to rule out signs of decay
(not helpful in crack) (may b v need to organise some x rays)
Bite test
if too painful - cotton wool to bite on
Frac finder/tooth slooth test
toothbrush like instrument - does'nt have bristles.
selective test
helps to find crack is present on which cusp? what part of tooth is cracked?
Transillumination
aftr finding the tooth which is culprit?
then once we hv narrowed down the teeth,
remove the filling
shine the light on there
see extent of crack - help us to decide with our management
frm wht u mentioned - it looks like reversible pulptitis - so we gonna put temp band and filling and review.
(merge everything together - then talk abt second possibility)
Address signs & symptoms
If u remembr - i told u last time tht there ws a large silver filling n v recommended a cap fr it.
usually when there is large filling - we cut a lot of tooth structure to retain it + there cud be added factors such as - back teeth, pressure from grinding, normal wear n tear.
looks like - u hv a small crack i.e. passing through in one of ur bottom teeth - reason for ur pain & sensitivity.
c/o
cracked tooth with reversible/irreversible pulpitis
(can we tell the exact tooth?) or aftr investigations.
it could be a
simple crack
(corner of the tooth is broken)
or
complex crack
(involving the nerve)
Causes
Large filling on 36
- might hv weakened teeth as we hv to cut a lot of tooth structure to retain the silver filling --> makes it fragile + back teeth absorb the most biting forces - which puts a lot of stress, causing it to crack.
Pressure from
grinding ur teeth or clenching.
Normal wear & tear
- as u knw this filling been there from many years.
Extreme chngs in temp of mouth
- eating something extremely hot n then trying to cool with ice water.
Food impaction on 26 :fire:
Second possibilty - the pain cud be coming frm ur uppr jaw as well. as u mentioned there's a small gap there - food getting stuck there - cud be gums in there be inflamed --> which we call it as gingivitis. or there could be decay as well underneathin the upper & lower jaw.
Somehow the grains cn get stuck in there as well, n u mentioned tht u are nt flossing + hanging resto. So, these provide safe places fr bacteria to grow. So, to b certain. im gonna
paplate the gums
in there n do some
gum charting.
If that's the case ,v gonna do cleaning arnd ur gums. May b later on we will hv to replace it with a new filling.
Filling is too bulky
where it meets the tooth - Ideally transition should be smooth.
Health of our gums depend on the fit of the filling
these fillings cn cause a lot of damage in a short amt of time by trapping food n bacteria cn grow --> gum disease
Food particles can get trapped into these small spaces (such as fibres of meat, fruit seeds) in ur case -- grainy sandwich +
make it difficult to clean and floss --> gum disease + tooth decay.)
As u can seein the X ray -
overhang of filling + small gap
in uppr teeth
Risk factors
:warning:
Grainy sandwich (grains can get trapped inside gums)
Stress
Old fillings - silver fillings
Not flossing in uppr jaw
Grinding
Smoking - triggers for stress.
Ty Lucy fr answring all my questions.
Now, I cn see tht one of ur tooth on the L) side is troubling u.
there could b many possible reasons, n v cn go through it together.
So, first possibility u mentioned tht u hv pain on biting which started yestrday aftr u hd tht grainy sandwich, so probably there might be a crack developed on any of these fillings tht u hhv got on tht side, particularly theres
one of the tooth tht we recommended placing a cap year ago
(as it has got a very large filling). So, it could be this one or any other one we are nt certain. So, grains cn trigger tht + silvr filling in itself is a risk factor ---> ovr the time it absorbs moisture -- expands and put a lot of pressure on tht tooth
mentioned tht u get a headache when u wake up --> so, may be u are undergoing a lot of stress coz of which u might b grinding ur teeth.
So, these cud be some of the R/F tht led --> crack developing in the tooth.
u mentioned coz of tht u hv got senstitvity to cold tht lasts for few seconds --> so, probably tht crack has gone upto the 1st and 2nd layr of tooth. (if reversible)
in ordr to be certain abt that - i will hv to do few investigations.
Grainy sandwich - will nt cause crack bt make it worse + gum condition as well --> trigger :warning: