Irreversible pulpitis/crack below surface or slow healing?

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Apr 11, 2023
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My back molar had a hairline fracture which caused lots of pain, sensitivity etc. My dentist did a new filling and sealed the crack. He said usually that would work, but could be irreversible pulpitis.
Although the pain and sensitivity have gone, there is still a little line of redness at gum ( which isn't usually there) and a slightly sensitive spot when brushing. I'm wondering if the pain has disappeared as the nerve has died completely or the bite is not quite right or it needs more time ( now around 3 and a half weeks).
I'm cautiously eating on it, but very worried it'll have to be removed. I'd welcome any help.
Nothing showed on the xray eg absess or pulpitis and crack only showed on photo, not the xray.
I've no fever, lymph nodes, obvious problems with it.
 

MattKW

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Depends on the type of crack. If it's merely superficial craze line, then not a problem. If it's a cracking cusp, then the cusp has to be "capped" with either a direct filling material (composite, amalgam) or with a crown or onlay. For large cracks that go through the pulp chamber ("nerve"), then the tooth has to be extracted - see attached.
 

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Joined
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Depends on the type of crack. If it's merely superficial craze line, then not a problem. If it's a cracking cusp, then the cusp has to be "capped" with either a direct filling material (composite, amalgam) or with a crown or onlay. For large cracks that go through the pulp chamber ("nerve"), then the tooth has to be extracted - see attached.
Thanks very much for taking the time to answer, Matt. The hairline crack, not just craze lines was across the middle of the tooth from gumside to lingual side. My dentist did a new filling, but how do I know if it's gone through to the pulp chamber as my dentist said it was impossible to tell? He said if it hadn't settled in 8 weeks we'd have to extract it. It's been around 4 weeks, thus far
 

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MattKW

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Did you already have a filling in the biting surface of the tooth?
Did the dentist replace all the old filling?
Cracks either run across a corner, or front-to-back. They don't go across cheek-to-tongue. It's all to do with the structure of teeth and how we chew (side-to-side). All you can do is wait. Attached is a nice summary ( I had to break it up).
 

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Thank you for taking the time to post all of this which is incredibly helpful.
In answer to your questions, yes it was previously filled with an amalgam filling which was removed and replaced with a composite filling.
I don't understand what you mean by it not being possible to fracture in that way as my tooth is very like the third molar in in page 3 of 6 where there is a crack line through the shorter dimension to the tongue. I grind my teeth and had, foolishly stopped wearing a mouth guard following an earlier procedure a few years ago.

I got quite excited when it said that there was only a third chance of it going into the pulp, until I read that this excluded the third molar!

I feel very disappointed as I have good oral hygiene, regular hygienist visits and really try to work hard at caring for my teeth.

The tooth is feeling tender at the back where it joins the wisdom tooth and I feel that's tending towards irreversible pulpitis, isn't it? I just wondered if it could be a wrongly adjusted bite, but feel that I'm clutching at straws. Also the bit that's tender isn't where the original crack was!

Thanks again. I'll let you know what happens, but fear the worst which has been very sudden.
 

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Hi Matt, just to give you a follow up. I went to an endodentist yesterday who carried out a root canal. He did the ball-bearing test and also checked the x ray for dark ligament shaping the initial consultation and said it didn't seem to be cracked below the gum line, but you couldn't be sure?
When doing the root canal with 30x magnification he said it wasn't cracked.
I'm just a teeny bit concerned as whilst I have no pain whatsoever, the cusp area where there was percussion previously still has slight percussion which I thought would gave disappeared after the procedure. Am I just bein impatient? Hopefully, this is normal and it will just take time to settle?
Many thanks for reading!
 

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