One-year Cracked Tooth Symptom Status Change: National-Dental-PBRN Study

Objectives: To describe changes in cracked tooth symptom status from baseline to one-year follow-up.
Methods: Dentists in the National Dental Practice-Based Research Network (PBRN; www.NationalDentalPBRN.org) enrolled subjects each with a single, vital posterior tooth with at least one observable external crack. Data were collected at the patient-, tooth- and crack- level at baseline and one-year later. Teeth were determined to be symptomatic if they were spontaneously painful, or painful to cold and/or bite testing. Change in symptoms was determined by an increase/decrease in the number of types of pain experienced.
Results: 209 network dentists enrolled 2,986 subjects/cracked teeth (one per patient) at baseline with an asymptomatic or symptomatic cracked posterior tooth; data collected on 2,494 subjects with one-year follow-up. 1,570 (63%) were recommended for monitoring (no treatment) of which 1,477 (94%) were vital. Changes in symptoms were assessed in this latter group. Overall, 408 (27.6%) had a change in symptoms. The following table presents frequencies and percentages of symptom changes by type of pain:

The most common change, n=312, involved pain to cold, and twice as many had a reduction in symptoms as had an increase. Changes in pain to biting and spontaneous pain were considerably less common than to cold. As with pain to cold, decreases in biting pain and spontaneous pain were more common than increases. Regardless of the direction of symptom change, most changes involved only one type; for increases 122/137 = 89%; for decreases 244/289 = 84%.
Conclusions: Considerable changes in symptom status of untreated cracked teeth occurred in one year. Interestingly, more cracked teeth showed a decrease in symptoms than an increase, potentially suggesting that certain characteristics of cracked teeth may be indicative of factors that make monitoring an acceptable strategy when they are present. Support: U19-DE-22516