Cranky Teeth?

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I have a "cranky" tooth--the problem is, I can't tell which one.  It doesn't send sharp pains (the kind that go all the way down my face and neck), but just sort of a low level ache now and then, not constant.  I get the pain when I bite--not always, but only it seems when I bite an unusual way (say on a seed in a raspberry).  It it much more hot, cold, and salt sensitive.

The dentist has x-rayed the area and cannot find anything wrong.  He feels from the symptoms it is a "cracked" tooth.  Apparently cracks don't show up on x-rays. He could not elicit any symptoms by rapping on the tooth with his instrument. 

The proposed solution is to put a crown on A tooth.  He has chosen to put in on the tooth in the area that "looks the worst"  (that is has the highest ratio of amagalm to tooth). (The area in question is the lower left molars, and all of them have considerable amalgam restoration in them.) He said that might not solve the problem because I might need a root canal too, but they wouldn't know that until later. 

My question is, is this really the best dental diagnotics can do today?  Is there no way to get a higher resolution x-ray, or do some other test before we start grinding down teeth and putting on crowns until we find the right one?  (I do not have dental insurance, and this could get to be a costly proposition--not to mention painful and perhaps useless). 

The alternative to doing anything apparently is to wait until it is bad enough that I can tell which tooth it is for sure.  The down side to this seems to be that it might crack the tooth beyond repair.  If the damage it not yet into the root/nerve area, I might worsen it.  It might all happen when I'm on travel somewhere where getting treatment would not be easy.

Can you offer any other suggestions? Thank you.
 

Cracked teeth very often are microscopic cracks of varying depths in a tooth that are stimulated only when the cusp tips are spread in just a certain manner, which is why they only bother you occasionally.  They are very hard to diagnose, and referred pain in areas of the mouth can make pinpointing the offending tooth difficult at best.  The crack lines propagate each time the tooth is stressed and you feel pain, ie, they get deeper as the crack spreads down in the tooth.  The tooth may fracture completely all of a sudden, and if it fractures beneath the gum line, it may have to be extracted.  If the fracture is above the gum line, a crown may work fine.  If the crack has propagated into the pulp, a root canal is often done before a crown. 

This is very common.  If the tooth is exquisitely sensitive to cold, or salty/sugary foods, the pulp may be irreversably involved and require a root canal first.  One way to diagnose it is to  take out the old amalgam and look for cracks, which can often be seen.  The dentist can shine his composite curing light in the side of the tooth and can see the crack easily.  Stains can be put in the tooth to demonstrate the crack.  A good way to diagnose it is to put a small round object such as a bee bee in a folded tape and move it around and bite until you feel similar pain to your complaint.  We always try to localize the tooth and then treat it. 

If you feel confident the right tooth has been found, a temporary crown can confirm the diagnosis if no pain persists when biting.  Again, in the lower molar region, after the age of 40, fractures are common, and more than one tooth may be fractured, especially in patients who are ice eaters, etc.  Good luck with your ``cranky" tooth!

Charles W. Wakefield, DDS
Associate Professor & Director
Advanced Education in General Dentistry
 

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