Incompletely fractured teeth associated with diffuse longstanding orofacial pain: diagnosis and treatment outcome

To evaluate the diagnostic value of different clinical findings, and analyse the symptoms experienced from teeth with incomplete dentinal fractures in patients with diffuse orofacial pain. Secondly, to present the outcome of different treatment modalities in these patients.

Thirty-two patients, referred to the teaching clinic at the Faculty of Dentistry, University of Bergen, with poorly localized orofacial pain, were finally diagnosed with 46 incompletely fractured teeth. The distribution and pattern of pain was thoroughly recorded for each patient. The final diagnosis, incompletely fractured tooth, was obtained after removal of fillings and direct inspection of possible fracture lines.

Many of the patients had suffered diffuse orofacial pain for more than 1 year, and had earlier consulted dental and medical expertise. Direct inspection of fracture lines, combined with staining solution and transillumination proved to be the best diagnostic tools. The longer the duration of pain before the diagnosis of an incompletely fractured tooth was established, the more diffuse was the distribution of pain. Endodontic or restorative treatment relieved the symptoms in 90% of the patients, whilst persisting symptoms in 10% were considered part of an orofacial pain complex of obscure aetiology.

This study shows that the diagnosis of the incompletely fractured teeth in patients with longstanding diffuse orofacial pain symptoms are time consuming and represent a diagnostic problem. With appropriate endodontic and/or restorative treatment, symptoms were relieved in the majority of cases.