Fracture in a tooth: a case study


A patient in her 40s showed up in my office last summer. One of her complaints is that she could not chew on her lower right molar (#30), and the discomfort was persistent. I recommended that she see a root canal specialist, which she finally did almost a year later. The fracture was visible on a photo of the biting surface, and this extended to the back of the tooth between the teeth. The endodontist’s recommendation was to place a crown on the tooth, and he felt that there was a pretty good chance that that would take care of the problem.

A crown procedure was performed on that tooth shortly thereafter, and the appointment went well with no surprises.

Last week the patient showed up to have her crown cemented, and she reported that the tooth still hurt to chew, and in addition, the tooth was giving her some pain when she went to sleep. This is an indication that the fracture went deeper into the tooth than hoped for and will need root canal therapy.

She will be going to the endodontist soon and he will perform root canal treatment prior to the crown cementation. This should clear up the problem for her.

In my experience, symptomatic fractures can be treated successfully with a crown. The symptoms are pain on chewing, but no pain when not chewing. If the tooth starts to throb, become temperature sensitive that lasts for several minutes, or throbbing for no apparent reason at all, then a root canal is indicated to save the tooth. This procedure has a very high success rate.