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February 6th, 2013

Do you have a tooth that only hurts occasionally, usually with biting on something hard or chewy?  The pain may often be hard to localize and doesn’t last long.  In fact, it may be more of an annoyance than a real problem and you may choose not to visit your dentist right away.  This might be a mistake.
What might be the cause here is a small, even microscopic, fracture in the tooth.  When you put pressure on just the right spot and in just the right direction, the fracture moves and allows fluids in the dentin tubules that contain the nerve endings, to exert  hydrostatic pressure and cause that flashing pain.  Each time it happens, the fracture can extend slightly further.  Over time, the pain can get worse and eventually may lead to fracture of the tooth.  Interestingly, if the fracture remains near the crown of the tooth, when the piece falls out, the pain may disappear completely.  Unfortunately, it is impossible to predict what direction the fracture may take.
What causes these fractures?  Clenching or grinding is often contributory.  Large fillings may weaken teeth and harmful habits like chewing ice or hard candies may put forces on teeth beyond their breaking point.  Trauma from accidents or sports injuries may also be implicated.
What to do?  You need to talk to your dentist.  The treatment really depends on your particular circumstance.  It may range from a simple bonded filling to replace a fractured piece, to a full crown to cover and protect the whole tooth.  Other considerations may include root canal treatment if the fracture has reached the nerve of the tooth, or in extreme cases, extraction of a tooth where the fracture has proceeded down the root, leaving it non-restorable.
It is critical to have potentially fractured teeth evaluated early, and to have treatment provided.  This may prevent the more severe consequences from occurring.
The diagnosis of fractured tooth syndrome can be one of the most challenging.  The pain is often of such a short duration that it can be quite hard to localize.  In fact, sometimes it’s hard to tell whether it is the upper or lower arch causing the problem.  But don’t wait thinking you need to localize it.  Your dentist has various tools and tests that will often find the problem at an earlier, more easily treatable stage.
In addition, these fractures may cause the nerve of the tooth to degenerate and lead to the need for root canal treatment.  Earlier treatment may head off the more serious damage.

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