Cracked Tooth Syndrome — ORE Part 1 MCQ

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ModerateEndodonticsCracked Tooth SyndromeORE Part 1

A 45-year-old patient reports sharp pain when biting on a posterior tooth, particularly on releasing the bite. The tooth is tender to percussion, responds normally to cold and electric pulp testing, and has normal probing depths. What is the most likely diagnosis?

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Correct answer: C — Cracked tooth syndrome

Cracked tooth syndrome is most likely. Characteristic pain on biting, especially on release, reflects separation and rebound of a cracked cusp; percussion tenderness may also occur. A normal response to cold and electric pulp testing supports retained pulpal sensibility, which is compatible with an early crack. The British Endodontic Society advises assessment for cracked cusps with magnification, transillumination and biting devices. Symptomatic irreversible pulpitis would usually give a prolonged or abnormal thermal response and spontaneous pain. Reversible pulpitis may produce a brief cold response but does not typically cause pain on bite release or percussion tenderness. An acute apical abscess usually has pulpal necrosis with swelling and/or purulence. A lateral periodontal cyst is generally an incidental radiographic finding rather than a biting-pain presentation.

Reference: British Endodontic Society. The British Endodontic Society Guide to Good Endodontic Practice, 2022 (clinical examination section: cracked cusps, sensibility testing). https://www.rcseng.ac.uk/-/media/FDS/The-British-Endodontic-Society-guide-to-Good-Endodontic-Practice.pdf