Patient history is the most important tool for making a diagnosis
The patient will likely complain about:
Pain when chewing
potentially to the extent of not being able to chew on the side on which the crack occurred
Patient will also often state the the condition existed for a relatively long period of time and that his or her dentist could not find the source or visualize any radiographic findings to suggest a cusp fracture
Other important tips
-Are filling fracutring or dislodging
Are there breif episodes of cold sensitivty
Pain characteristics
P/ts will report a sharp pain that makes them immediately sotp chewing on that side
General Diagnostics
General Diagnostics
Bite Test / Frac Finder / Tooth Sleuth
Postive result = sharp pain
Magnification with loupes or an operating microscope
only if the tooth does not have an extensive intracoronal restoration
Transillumination
assists in revealing the crack line
Tooth investigation
If the tooth has a large restoration than removal of it may faciliate use of diagnostic tools
Tooth mobility
Extra
Soft tissue exam for localized swelling or sinus tracts
percussion
palpation
biting tests (each cusp should be tested)
vitality tests (Electric pulp testing and cold testing )
Periodontal probing (flexible plastic probes)
restoration removal if necessary for complete visualization
Types of cracks and Fractures
Cracked Cusps
Manifestations
Early
sharp pain upon chewing but the affected tooth will not be sensitive or only selectively sensitive to percussion
Tooth is vital and its response to a cold stimulus may be normal, but with time, this response may resemble a reversible pulpitis
==Cracked cusps are often associated with extensive occlusal restorations