Cracked Tooth Classic Presentation — ORE Part 1 MCQ

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EasyRestorative DentistryCracked Tooth Classic PresentationORE Part 1

A patient presents with sharp, shooting pain in the lower right jaw that occurs exclusively when biting down on hard food with the lower right first molar. The pain is momentary and stops immediately when the bite pressure is released. The tooth has a large MOD amalgam restoration. Cold testing produces a normal brief response. What is the most likely diagnosis?

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Correct answer: A — Cracked tooth (incomplete fracture)

The diagnosis is cracked tooth (incomplete fracture). The pathognomonic clinical features are: (1) sharp, momentary pain exclusively on biting hard food with immediate cessation on pressure release—this is the hallmark symptom and results from cuspal flexion compressing the crack; (2) large MOD amalgam restoration, a major risk factor due to loss of cuspal support and weakened tooth structure; (3) mandibular first molar, the most commonly affected tooth; (4) normal brief cold response, ruling out irreversible pulpitis (which would show exaggerated/prolonged response) and periapical pathoses (which would show absent/delayed response). Irreversible pulpitis would present with prolonged pain to cold and spontaneous pain. Periapical lesions would show absent cold response, radiographic findings, and no pain on selective biting. Occlusal trauma without fracture does not produce the distinctive momentary pain on biting with immediate release and occurs in the absence of structural defect.

Reference: Cracked Tooth Syndrome: Assessment, Prognosis and Predictable Management Strategies. British Dental Journal (via PubMed PMID 33770422), 2021. https://pubmed.ncbi.nlm.nih.gov/33770422/