Cracked teeth can be difficult to diagnose due to their vague clinical presenting symptoms. Patients may even present with shallow fillings in molar teeth with sensitivity to hot/cold and on biting. Often the pain is intermittent and change in intensity. Our patient may describe pain on releasing their biting pressure. The gum may present with a deep and narrow periodontal pocket. X-rays often do not show cracks in the teeth, but after a period of time we may see bone breakdown around the roots. J-type bone breakdown may be seen in these cases.
The complaint may occur in teeth which have or had amalgam fillings. This is because of the nature of the preparation made to hold the amalgam filling in place introduced unsupported or weakened cusps.
If the undermined cusp in question can be identified and reduced to prevent further flexing, and is then overlayed with a restoration, the tooth may settle. If the tooth does not settle a decision will need to be made whether the tooth should be root treated. Sometimes the cracks are too significant and the tooth may have to be extracted.
Below are some examples of unusual visualisation of cracks that could be identified on x-ray. See if you can spot them