Thomas J Hilton1, Ellen Funkhouser2, Jack L Ferracane3, Valeria V Gordan4, Kevin D Huff5, Julie Barna6, Rahma Mungia7, Timothy Marker8, Gregg H Gilbert9. 1. Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042, United States. Electronic address: hiltont@ohsu.edu. 2. School of Medicine, University of Alabama, 1720 2nd Avenue South, Birmingham, AL 35294-0007, United States. 3. Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042, United States. 4. Dept of Restorative Dental Sciences, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, United States. 5. Private Practice, 217 W 4th St, Dover, OH 44622, United States. 6. Private Practice, 222 JPM Rd, Lewisburg, PA 17837, United States. 7. Department of Periodontics, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 8258, San Antonio, TX, 78229-3900, United States. 8. Private Practice, 2210 Kulshan View Rd., Mount Vernon, WA 98273, United States. 9. Department of Clinical and Community Sciences, School of Dentistry, University of Alabama, Birmingham, AL, United States.
Abstract
OBJECTIVES: The objective of this study was to determine which patient traits, behaviors, external tooth and/or crack characteristics correlate with the types of symptoms that teeth with visible cracks exhibit, namely pain on biting, pain due to cold stimuli, or spontaneous pain. METHODS: Dentists in the National Dental Practice-Based Research Network enrolled a convenience sample of subjects each of whom had a single, vital posterior tooth with at least one observable external crack (cracked teeth); 2858 cracked teeth from 209 practitioners were enrolled. Data were collected at the patient-, tooth-, and crack-level. Generalized estimating equations were used to obtain significant (p < .05) independent odds ratios (OR) associated with teeth that were painful for 10 outcomes based on types of pain and combinations thereof. RESULTS: Overall, 45% of cracked teeth had one or more symptoms. Pain to cold was the most common symptom, which occurred in 37% of cracked teeth. Pain on biting (16%) and spontaneous pain (11%) were less common. Sixty-five percent of symptomatic cracked teeth had only one type of symptom, of these 78% were painful only to cold. No patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Positive associations for various combinations of pain symptoms were present with cracks that: (1) were on molars; (2) were in occlusion; (3) had a wear facet through enamel; (4) had caries; (5) were evident on a radiograph; (6) ran in more than one direction; (7) blocked transilluminated light; (8) connected with another crack; (9) extended onto the root; (10) extended in more than one direction; or (11) were on the distal surface. Persons who were <65 yo or who clench, grind, or press their teeth together also were more likely to have pain symptoms. Pain was less likely in teeth with stained cracks or exposed roots, or in non-Hispanic whites. CONCLUSIONS: Although pain to cold was the most commonly noted pain associated with symptomatic cracked teeth, no patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Characteristics were only associated with pain on biting and/or spontaneous pain with or without pain to cold. CLINICAL SIGNIFICANCE: Although often considered the most reliable diagnosis for a cracked tooth, pain on biting is not the most common symptom of a tooth with a visible crack, but rather pain to cold.
OBJECTIVES: The objective of this study was to determine which patient traits, behaviors, external tooth and/or crack characteristics correlate with the types of symptoms that teeth with visible cracks exhibit, namely pain on biting, pain due to cold stimuli, or spontaneous pain. METHODS: Dentists in the National Dental Practice-Based Research Network enrolled a convenience sample of subjects each of whom had a single, vital posterior tooth with at least one observable external crack (cracked teeth); 2858 cracked teeth from 209 practitioners were enrolled. Data were collected at the patient-, tooth-, and crack-level. Generalized estimating equations were used to obtain significant (p < .05) independent odds ratios (OR) associated with teeth that were painful for 10 outcomes based on types of pain and combinations thereof. RESULTS: Overall, 45% of cracked teeth had one or more symptoms. Pain to cold was the most common symptom, which occurred in 37% of cracked teeth. Pain on biting (16%) and spontaneous pain (11%) were less common. Sixty-five percent of symptomatic cracked teeth had only one type of symptom, of these 78% were painful only to cold. No patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Positive associations for various combinations of pain symptoms were present with cracks that: (1) were on molars; (2) were in occlusion; (3) had a wear facet through enamel; (4) had caries; (5) were evident on a radiograph; (6) ran in more than one direction; (7) blocked transilluminated light; (8) connected with another crack; (9) extended onto the root; (10) extended in more than one direction; or (11) were on the distal surface. Persons who were <65 yo or who clench, grind, or press their teeth together also were more likely to have pain symptoms. Pain was less likely in teeth with stained cracks or exposed roots, or in non-Hispanic whites. CONCLUSIONS: Although pain to cold was the most commonly noted pain associated with symptomatic cracked teeth, no patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Characteristics were only associated with pain on biting and/or spontaneous pain with or without pain to cold. CLINICAL SIGNIFICANCE: Although often considered the most reliable diagnosis for a cracked tooth, pain on biting is not the most common symptom of a tooth with a visible crack, but rather pain to cold.
Authors: Willem M M Fennis; Ruud H Kuijs; Cees M Kreulen; F Joost M Roeters; Nico H J Creugers; Rob C W Burgersdijk Journal: Int J Prosthodont Date: 2002 Nov-Dec Impact factor: 1.681
Authors: Thomas J Hilton; Ellen Funkhouser; Jack L Ferracane; Gregg H Gilbert; Camille Baltuck; Paul Benjamin; David Louis; Rahma Mungia; Cyril Meyerowitz Journal: J Am Dent Assoc Date: 2017-02-02 Impact factor: 3.634
Authors: Thomas J Hilton; Ellen Funkhouser; Jack L Ferracane; Michele Schultz-Robins; Valeria V Gordan; Bobby J Bramblett; R Mack Snead; Walter Manning; Jeffrey R Remakel Journal: J Prosthet Dent Date: 2019-06-12 Impact factor: 3.426
Authors: Ellen Funkhouser; Jack L Ferracane; Thomas J Hilton; Valeria V Gordan; Gregg H Gilbert; Rahma Mungia; Vanessa Burton; Cyril Meyerowitz; Dorota T Kopycka-Kedzierawski Journal: J Dent Date: 2022-02-25 Impact factor: 4.379
Authors: Thomas J Hilton; Ellen Funkhouser; Jack L Ferracane; Gregg H Gilbert; Valeria V Gordan; Sandra Bennett; Jennifer Bone; Peggy A Richardson; Hans Malmstrom Journal: J Dent Date: 2019-12-30 Impact factor: 4.379
Authors: Thomas J Hilton; Ellen Funkhouser; Jack L Ferracane; Gregg H Gilbert; Valeria V Gordan; Dorota T Kopycka-Kedzierawski; Cyril Meyerowitz; Rahma Mungia; Vanessa Burton Journal: J Am Dent Assoc Date: 2020-12-24 Impact factor: 3.634