Når tænder med revner gør ondt, hvordan takles det så af tandlægen?

Transcription

1 Årskursus i Tandlægeforeningen 2012 Når tænder med revner gør ondt, hvordan takles det så af tandlægen? Ulla Pallesen

2 Definition Symptoms Prevalence and location Etiology Diagnosis

3 Definition The cracked tooth syndrom An incomplete fracture of a vital posterior tooth involving dentin and possibly pulpal tissue Cameron, 1964

4 Symptoms discomfort or pain that occurs at the release of a chewing pressure sensitivity to thermal changes, to sweet and sour foods and alcoholic beverage Hiat, 1975 Homewood, 1998 Christensen, 1996

5 Symptoms Loading Pain upon loading is explained by dentinal tubular fluid flow, which is a result of the movement of the two fracture sites away from each other Thermal or osmotic The pulp may become inflamed because of physically irritation or microleakage of bacteria and their toxins through the crack Brannström, 1986 Abou-Rass, 1983

6 Prevalence Full-time practitioners Treating slightly more than three fractured teeth per week Treating nearly seven patients with the cracked tooth syndrome per month Bader et al, 1996 Treating one patient/week with the cracked tooth syndrome Homewood, 1998

7 Prevalence Prospective clinical study in Denmark MATERIAL Patients treated from 1998 til 2008 Teeth symptoms to pressure, cold and heat no other pathological conditions respond to bite at a Fracfinder verification of crackline in dentine Observation time 0 10 years Pallesen U, Odontologi 2011, Munksgaard

8 Prevalence RESULTS 491 patients 66 (13%) with symptoms from cracked teeth Prevalence 10% Pallesen U, Odontologi 2011, Munksgaard

9 Number per patient The cracked tooth syndrome number per patient Number of patients Pallesen U, Odontologi 2011, Munksgaard

10 Age The cracked tooth syndrome age of patient (n=66) X = 49 yr (22 79 yr) patients with cracks Number of patients X = 45 yr ( yr) all patients Pallesen U, Odontologi 2011, Munksgaard

11 Prevalence Cracked tooth syndrom related to gender Females more susceptible than males Cameron, 1976 Fitzpatrick, 1982 No difference between male and female Dewberry, 1996 Pallesen, 2011

12 The cracked tooth syndrome Pallesen U, Odontologi 2011, Munksgaard n=

13 Cracked tooth syndrome related to +/- restoration Restored Non restored n=73 Abou-Rass, 1983

14 Cracked tooth syndrome related to size of cavity, type of restoration and material Class I Class II MOD Inlay n=54 Amalgam Gold Abou-Rass, 1983

15 Expansion, corosion and creep of amalgam In vivo study of endodontically treated teeth, showed after 3 years: 33% of premolars restored with amalgam had fractured All 40 premolars restored with MOD composite restorations remained intact Hansen E, Dent Mat 1988

16 Expansion, corosion and creep of amalgam A possible cause for increased fracture frequency of root canal-treated teeth could be due to amalgam types with high copper contend (non-gamma-2 alloy) Expansion of amalgam (setting and phase changing) is the same for gamma-2 and non-gamma-2 alloys Creep is not the same for the two types of amalgam Hansen E, Dent Mat 1988

17 USA Prevalence of cusp fractures in teeth restored with amalgam and resin-based composite Material 1902 adults posterior teeth Private general dental practice Cusp fracture Amalgam (1.9%) - Composite (2.3%) Wahl MJ et al, J Am Assoc., ;

18 The Netherlands Prevalence of fracture of tooth/cracked tooth in teeth restored with amalgam and resin-based composite Material: 912 amalgams 1955 composite resins Private general dental practice Fracture of cusp/cracked tooth: Amalgam (3.4%) - Composite (1.3%) Opdam JM et al, Dent Material 2007; 23, 2-8

19 Etiology Summary Fatigue Most Stress incomplete fractures are Trauma caused by a combination of several Iatrogenic factors damage Predisposing factors

20 Diagnosis May be difficult, since the symptoms are often bizarre and varying, ranging from vague discomfort for years to severe constant pain Silvestri, 1976

21 Diagnosis Thermal sensitivity (cold) ice, chloraethyl Sensitivity on biting localisation of crack site with Fracfinder or Tooth Sloth Crack visible after removal of restoration

22 Diagnosis Transillumination Magnifying lenzes Microscope Dye iodine methylene blue gentian violet caries detector

23 Diagnosis Radiologic findings of a localiced periodontal breakdown in an otherwise periodontally healthy dentition may indicate a split tooth

24 Differential diagnosis Supra contact Dentin hypersensitivity Erosion/wear Caries Pulpitis Marginal-/apical periodontitis Otitis Artritis Sinuitis Neuralgia