What are the physical exam findings for a cracked fifth upper right tooth?

From the Guidelines

Physical examination of the 5th upper tooth on the right side reveals an infraction, which is a crack or craze line in the surface of the enamel, as described in the study by 1. The tooth appears intact, but crack lines may be visualized by shining a focused source of light onto the crown of the tooth in an axial direction.

• The clinical examination should include a thorough evaluation of the face, lips, and oral musculature for soft tissue lesions, as outlined in the study by 1.
• The facial skeleton should be palpated for signs of fractures, and the dental trauma region should be inspected for fractures, abnormal tooth position, and tooth mobility.
• Identifying whether the injured tooth is a primary versus a permanent tooth is important in the management of certain types of dental injuries, as noted in the study by 1.
• Radiographic examination would be necessary to determine the full extent of the fracture and to assess for any periapical pathology, as recommended in the study by 1.
• The patient should be referred to a dentist promptly for definitive evaluation and treatment, which may include restoration with a crown or onlay if the fracture is limited, or root canal therapy followed by crown placement if pulpal involvement is confirmed. The study by 1 provides a systematic approach to assessing dental trauma, including a thorough medical and dental history, neurologic assessment, and examination of the teeth and surrounding tissues.
• The study emphasizes the importance of familiarity with tooth anatomy in determining the extent of injury present, and notes that disturbances in the occlusion (bite) should be assessed because this may reveal a displaced tooth or an alveolar or jaw fracture.
• The study also highlights the need for radiographic assessment of an injured tooth, which is best accomplished with conventional intraoral dental radiographs, as stated in the study by 1.

From the Research

Physical Exam Findings for a Cracked 5th Upper Tooth on the Right Side

The physical exam findings for a cracked 5th upper tooth on the right side may include:

• Visual inspection for any visible cracks or fractures on the tooth surface 2, 3
• Sensitivity testing to assess the tooth's response to temperature changes, sweet or sour tastes, or pressure 2
• Percussion testing to check for any tenderness or pain when the tooth is tapped 2
• Palpation of the surrounding gums and tissues to check for any signs of inflammation or tenderness 2
• Radiographic examination, such as X-rays or CBCT scans, to assess the extent of the crack and its location within the tooth 3, 4
• Use of high magnification loupes or a surgical operating microscope to observe the tooth for microscopic crack lines or enamel craze lines 3

Possible Classification of the Crack

The crack may be classified as:

• A craze line: a small, superficial crack in the enamel 4
• A cuspal fracture: a fracture that involves the cusp of the tooth 4
• A cracked tooth: a fracture that extends from the occlusal surface of the tooth down towards the root, but does not extend through the entire tooth 4
• A split tooth: a fracture that extends through the entire tooth, resulting in two or more separate pieces 4
• A vertical root fracture: a fracture that extends from the root of the tooth down towards the apex 4, 5

Importance of Early Diagnosis

Early diagnosis of a cracked tooth is important to relieve pain, restore function, and improve the prognosis for the tooth 2. A delayed diagnosis can lead to further propagation of the fracture, making treatment more complex and potentially resulting in tooth loss 3, 5, 6.