Complications of an ageing dentition part 3: overview and case report

In the author's experience, clinicians usually find the area of cracked teeth confusing. Therefore, to help with this, a summary of the previous information discussed in the previous two papers has been provided in Figure 1. This flow chart aims to provide a logical, sequential approach when confronted with a cracked tooth. It is worth noting that the occlusal assessment takes place during the initial stages along with the normal clinical examination and pulp testing methods. It is important to consider occlusal trauma, endodontic pathology, chronic orofacial pain (eg atypical facial pain) and other dental pathologies (eg periodontal disease), as with the alternative aetiologies, without immediately assuming that there is a fracture within the tooth structure.

Under specific circumstances, it may not be possible to diagnose each and every patient case at the first appointment. If the situation arises where there are doubts regarding the diagnoses, then the astute clinician will collect all the relevant clinical information at the initial visit and treat as he/she feels is most appropriate at the time of presentation, whilst being as conservative as possible. The following review appointment may confirm the provisional suspicion, or it will provide a new insight into the underlying cause. However, if there are any uncertainties with regards to the diagnosis, then the clinician should seek a second opinion from a suitably qualified colleague.