CRACKED TOOTH

Question 1

A middle aged gentleman complaining pain arose from 36, difficulty with chewing for 10 days, bleeding on brushing recently, an irregular dental attender, had some restorations before, smokes 1 pack of cigarettes per day Panoramic radiograph: 36 crown fractured, with apical radiolucency, multiple missing teeth and tooth wear, generalized horizontal bone loss a. List five pathological findings from the radiograph provided. (5)

Answer 1

 36 crown fractured, with apical radiolucency  Multiple missing teeth  Tooth wear  Generalized horizontal bone loss

Question 2

A middle aged gentleman complaining pain arose from 36, difficulty with chewing for 10 days, bleeding on brushing recently, an irregular dental attender, had some restorations before, smokes 1 pack of cigarettes per day Panoramic radiograph: 36 crown fractured, with apical radiolucency, multiple missing teeth and tooth wear, generalized horizontal bone loss b. What is your diagnosis for the tooth 36? What further investigations do you need to confirm your diagnosis?

Answer 2

Diagnosis

 Crown fracture 36 involving pulp

Further investigation

 EPT

 TTP

 Transillumination

 Periapical radiograph

 Probing depth

 Palpation

 Mobility

Question 3

A middle aged gentleman complaining pain arose from 36, difficulty with chewing for 10 days, bleeding on brushing recently, an irregular dental attender, had some restorations before, smokes 1 pack of cigarettes per day Panoramic radiograph: 36 crown fractured, with apical radiolucency, multiple missing teeth and tooth wear, generalized horizontal bone loss

c. What are the possible causes of this condition? Describe the pathway leading to this condition. (5)

Answer 3

 Pulpal exposure allow external stimulation to pulp including bacterial ingression, thermal damage

 Exposure of dentine allow pathway for bacterial penetration

 Bacterial toxin and invasion stimulate pulpal inflammation. Initially inflammation may be confined at coronal pulp and is reversible

 Continuous bacterial irritants together with inflammatory mediators cause the pulp severely inflamed and fail to heal and eventually become non vital

 Inflammation cease an d infection no longer be confined and spread apically eventually

 Toxin and irritants from necrotic pulp cause periradicular tissue inflammation

 Bone destruction occur due to osteoclastic activity initiated by bacterial toxin and host mediators

 Pressure created within apical tissue stimulate pain

 Presence of proprioceptors make the pain well localized

Question 4

A middle aged gentleman complaining pain arose from 36, difficulty with chewing for 10 days, bleeding on brushing recently, an irregular dental attender, had some restorations before, smokes 1 pack of cigarettes per day Panoramic radiograph: 36 crown fractured, with apical radiolucency, multiple missing teeth and tooth wear, generalized horizontal bone loss

d. List out your treatment strategies for this patient in the appropriate sequence. (6)

Answer 4

Question 5

Information given:
70-year-old woman with DM Pain on lower left molar region.

PAN: Edentulous span (upper PM to PM, lower multiple span) + Root treated 37 with likely fracture on 37MO + Horizontally impacted 48 + Large radiolucency in Q4 posterior region, connected to the crown of the 48.
Clinical findings: Vertical fracture of 37 extending to root

a. Briefly describe your radiographic findings. (5)

Answer 5

PAN: Edentulous span (upper PM to PM, lower multiple span) + Root treated 37 with likely fracture on 37MO + Horizontally impacted 48 + Large radiolucency in Q4 posterior region, connected to the crown of the 48.

Question 6

Information given:
70-year-old woman with DM Pain on lower left molar region.

PAN: Edentulous span (upper PM to PM, lower multiple span) + Root treated 37 with likely fracture on 37MO + Horizontally impacted 48 + Large radiolucency in Q4 posterior region, connected to the crown of the 48.
Clinical findings: Vertical fracture of 37 extending to root

b. What further investigation will you do on 37? Give your differential diagnosis. (5)

Answer 6

 Bite test by tooth slooth, rubber dam, cotton roll

 Sharp probe to run through the tooth to detect crack

 Probing to detect any deep, narrow, localized pocket

 Transillumination

 Staining

 Removal of current restoration to localize presence and extent of cracked line

 Radiograph

 Open flap to detect presence and extent of root fracture

 Differential diagnosis

1. Vertical root fracture
2. Acute apical periodontitis / abscess
3. Perio-endo lesion
4. Acute periodontal abscess
5. Gingival abscess / pericoronal abscess