Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-03-06, 08:52:14 | version 1.38.0
A dental nurse in a specialist setting complained of toothache all of a sudden with no prior warning or pream- ble. The pain was excruciating; it was visible on her face. Her expression was tethered on the side of this incredibly painful upper first molar. She would hold the suction with one hand and her cheek with the other. She could not bite or chew and the dentists she worked with all sym- pathised. She saw one endodontist in the unit and, de- spite all the signs being inconclusive at the time, he sug- gested a crack (Fig. 1). Of course, it was at the back of everyone’s mind that this tooth was unrestored and she had a pristine mouth. She saw a second endodontist in the practice owing to the escalation of her symptoms. By this time, she wanted the tooth extracted, but the roman- tic amongst us all felt the tooth could be saved, so it was extirpated! The pulp positively nuked and the tooth dead. That should have sorted it right? Unfortunately, her symp- toms continued. Could it have been something atypical? She had been stressed and grinding. More deliber- ation, still no further was the diagnosis. The tooth was dressed once again, with a change in the medicament. Still no joy. A restorative dentist then proceeded to drill the crack out and restore with composite. Still no joy. The tooth was taken out of occlusion when one dentist noticed the development of periodontal ligament widening on one of the long-cone periapical radiographs. The root canal treatment was completed jointly by two excellent endo- dontists and the second mesiobuccal canal was located. Under any other circumstances, it was a fantastic clinical outcome. Unfortunately, the pain was unabating (Fig. 2). Let us see as much as we can. A CBCT scan was taken that was also inconclusive (Fig. 3). Was it something to do with the sinus? The radiographic report was suggestive, but again nothing conclusive. Towards the end of the two weeks, the patient marched herself into the office of the ex- odontist to have the tooth extracted. Misery. We had failed. With the tooth in hand and a wry smile, the nurse dipped the tooth in disclosing solution, which identified one large crack in the furcation area of the palatal root with several accessory ones (Fig. 4). The relief was pal- pable on her face. Despite losing a tooth, the culprit had finally been identified. It seems as though the mechanical failure of teeth, unlike our old adversary, bacteria, has the ability to trump us, from diagnosis through to treatment, despite our best intentions, knowledge and experience. The question that crosses my mind as I see the slow but steady increase in “crackitis” is how are we going to man- age this contemporary problem? Will we see the emer- gence of crackologists? The first step is raising awareness among patients and the profession. Patients need to stop themselves from grinding their teeth needlessly during the day and have to instigate strategies to reduce the likelihood of parafunction in the night. One emerging issue is psycho- logical health. Patients are increasingly stressed and de- patient communication | pressed, which is a recognised risk factor. One fairly para- doxical issue is that medication may actually increase the likelihood of bruxism, so the pharmaceutical industry may be perpetuating the problem in that stressed people who already grind are medicated and grind even more. Cracking the code of fractured teeth is going to be dif- ficult and will be a contemporary challenge for us all. One of my trainers from yesteryear, who had more wisdom than Yoda, once said, “From these words never depart, lips together and teeth apart”. contact Aws Alani is a Consultant in Re- storative Dentistry at King’s College Hospital in London, UK. He can be contacted at awsalani@ hotmail.com. www.restorativedentistry.org AD S E E U S AT R O O T S S U M M I T (cid:353) B E R L I N (cid:3) (cid:3) (cid:3) (cid:3) (cid:3) (cid:3) (cid:3) (cid:3) (cid:3) (cid:3) (cid:3) (cid:3) (cid:3) N E W GUTTAPERCH A REMOVAL INSTRUMENT WITH PEEK-H ANDLE according to Dr. Yoshi Terauchi Bodenseeallee 14-16 78333 Stockach, Germany Tel. +49 7771 64999-0 Fax +49 7771 64999-50 info@kohler-medizintechnik.de www.kohler-medizintechnik.de roots 1 2018 37