Fracture Necrosis: when a Virgin, Solid Tooth Goes Bad

Q: I have had a tooth ache for months and my dentist cannot find anything wrong with the tooth on the X-ray. The tooth has no fillings or any dental work what so ever which puzzles her and me. It is a dull ache that comes and goes and sometimes hurts when chewing. Any ideas?

A: Today at lunch the outside thermometer reading on my Jeep showed 104. I thought it was my oil pressure. I dreamed of my days in school at McGill University in Montreal and how nice the spring and summers were.

Last night I got an instant message from a classmate’s little brother, now in is early 50’s, telling me how miserably hot it’s been in Montreal lately. I recall the summer in Montreal lasts what feels like about ten days. I remember that the first sign of spring in late May was when the snow melted and layers of entombed dog feces began to melt and stink up my street. (I prefer the chirping of birds to introduce me to” le printemp” rather than “le merde”.)

Fracture Necrosis: The usually cause of a tooth ache on a tooth with little or no dental work; no fillings, no crowns; nothing. A microscopic fracture begins in the part of the tooth you see when you open your mouth, above the gum line; what we call the “clinical crown.” (Not the dental work called a “crown”.) The fracture propagates through the root of the tooth like cracks on thin ice on a pond. (More winter analogies to keep cool while you read this and to keep you awake.)

Along this crack, two things die and become infected: the pulp (nerve inside your root canal system) and the periodontal ligaments that hold your tooth into your jaw bone, forming a deep bone-eating pocket of infection. Most likely the tooth needs to be extracted and replaced by an implant.

Special tests need to be done to make the diagnosis: a blue die test, intra-oral fiber optic camera images, sometimes 3D CT scans, and pulp tests checking the reaction to hot and cold. (“Cold”; there I go again.)