Any way to be sure a tooth is cracked - or that it's not?

[Chancery]

Hi, I wonder if any dentist could give me any insight as to what might be going on here.

In December 2019 I went to an emergency dentist because I was having problems with a molar that was causing pain sometimes when I bit on it and was particularly sensitive to heat. When she drilled into it a bit of the tooth - the cusp, I think - fell off and she said "You were right, the tooth was cracked. A bit just fell out." She gave the remaining tooth a temporary filling and sent me off over the Xmas period.

I gave the tooth some weeks but it never seemed to settle. It felt inflamed and remained 'hot' like it was irritated. However, I hoped it was just that the pulp had got a bit irritated with it being cracked and so after a couple of months I had it filled. The dentist who filled it could see no reason for it to hurt and was okay with filling it.

Now, many months down the line the tooth still isn't right. Specifically, it doesn't like heat, but it doesn't cause me to wince. Instead it will register like normal sensitivity then anything up to five or ten minutes later it will feel irritated and 'hot'. It also feels tender in general, as if it is fragile. I don't, per se, have trouble chewing on it, except it doesn't really like it and occasionally it will be a little wincey if I hit it just so (on the remaining cusp). It gets very 'hot' if I persist in eating on it and I eventually get a hot ache in my cheekbone, where my sinuses are, which can last for weeks if I don't stop eating on it. It pulses sometimes (especially when I'm climbing or exerting myself) and it often feels itchy. I frequently scratch my cheek bone when it is annoyed.

The dentist has looked at it 2 or 3 times and X-rayed it a couple of times but she says she can't see anything wrong with it, or in either of the teeth that flank it. I recently went to the dental hospital and the professor there, who didn't really examine it other than a cursory glance, said it was TMD. He gave me details to have a hard splint made. I use a soft splint currently (which he said was no good) but I have had hard splints in the past. My dentist is having this made for me.

I've stopped eating on this side of my mouth, but I have Trigeminal Neuralgia on the other side so it's not comfortable to eat there either, so I'm dealing with a lot of pain & discomfort. I am very VERY anxious about this and I have literally had a year of constant dental anxiety and it's just not worth it, but I don't know what to do to fix it. I have a fear that the tooth was cracked further than the dentist realised when it was first 'repaired'. When I mentioned this possibility to the prof at the dental hospital he said it would probably have to come out, if so. He mentioned that "some people root canal them" but it didn't have a good prognosis. That didn't help. I clench and grind my teeth and, as I have quite severe dental phobia, having toothache all the time and worrying about it means I can add a layer of psychosomatic pain into the mix, which only makes the tooth grinding worse and round and round it goes.

Does it sound like it might be cracked? Is there a way to be sure it isn't cracked? Is there ANY way I can tell, or anything my dentist can do to check (she checked it with the live current thing and it hurt like hell so the root is still alive). If it is cracked, would tooth bonding help, or will it have to be root canalled? Can I get tooth bonding on the NHS? (I don't even know what it is or how it's done!)

Any help or advice anyone can offer I'd be most grateful. I am worn down with worry and frankly feeling suicidal too often, which is ridiculous, but still true. Thanks!

P.S. Is the fact that I've had this for a year now, pretty much unchanged, significant? If it was cracked would it/should it have worsened by now?

 

[Gordon]

No is the short answer.

Cracked teeth are horrible things to diagnose and almost as bad to treat. There are no simple tests to perform, sometimes you can see the crack if you open into the tooth and use some dye, magnification can help. But not always.
Bonding the tooth basically means taking out the old filling and putting in a composite filling which can be chemically bonded into the tooth, which reinforces it and may stop the crack moving, which is what causes the pain. However, (you've guessed!) it doesn't always work. The NHS should provide it.

Root canal treatment doesn't always work. (surprise!).

Crowning the tooth can help hold the crack together but... go on, guess...

 

[Chancery]

No is the short answer.

Cracked teeth are horrible things to diagnose and almost as bad to treat. There are no simple tests to perform, sometimes you can see the crack if you open into the tooth and use some dye, magnification can help. But not always.
Bonding the tooth basically means taking out the old filling and putting in a composite filling which can be chemically bonded into the tooth, which reinforces it and may stop the crack moving, which is what causes the pain. However, (you've guessed!) it doesn't always work. The NHS should provide it.

Root canal treatment doesn't always work. (surprise!).

Crowning the tooth can help hold the crack together but... go on, guess...

Thanks, Gordon. Can I ask, is it possible the prof is right and it is a TMD issue? Would TMD produce my symptoms: sensitivity to heat, face ache in sinus area, a feeling of heat & inflammation, itching and irritation, a tenderness when eaten on? If it would - could it do this consistently for a year? Wouldn't it come and go? Wouldn't I have jaw pain too? I don't, to speak of. The flanking teeth are both root canalled so it seems feasible they wouldn't feel pain, so is it possible the only 'nerved' tooth there would be feeling this pain because of TMD?

 

[Gordon]

Well the prof has the advantage of having actually examined you over some random bloke on the internet... so yeah, it's extremely possible

TMD would certainly produce some of the symptoms you describe and it could do it for a year. You don't necessarily get jaw pain with it. It's a very poorly understood condition, we kind of know a bit of what helps it, but not why it happens and even why what we do helps it. It also spontaneously comes and goes, so it's hard to say if treatment has helped or if it's just a coincidence.
Sometimes I'm glad I've retired

 

[Chancery]

Well the prof has the advantage of having actually examined you over some random bloke on the internet... so yeah, it's extremely possible

TMD would certainly produce some of the symptoms you describe and it could do it for a year. You don't necessarily get jaw pain with it. It's a very poorly understood condition, we kind of know a bit of what helps it, but not why it happens and even why what we do helps it. It also spontaneously comes and goes, so it's hard to say if treatment has helped or if it's just a coincidence.
Sometimes I'm glad I've retired

Thanks, Gordon, I appreciate that. One of the troubles with having quite severe dental anxiety is your mind collates a thousand and one permutations for possibilities of what's wrong. You're always looking for definitive answers so you can make The Definitive Decision - the end goal, of course, being so you don't get it wrong. However, some things in life just ain't that simple. Sometimes although it is depressing, or terrifying, or both, it's good to know there is no right answer - to know that your options are limited. In its way it allows you to not beat yourself up for getting it wrong. If you do the wrong thing you at least know you did your due diligence and there just wasn't a simple answer. Still can't help wishing that God could have made a better job of human teeth though. Why couldn't we have ones like sharks that just renew and push out a new set? In fact, why couldn't I just have been a shark....

 

[Gordon]

Being a shark wouldn't suit me, I hate the taste of fish