Editing Toothache (section)

=====Dental trauma and cracked tooth syndrome=====
[[File:Cracked tooth.png|thumb|right|Crown-root fracture with pulp involvement (left). Extracted (right).]]
[[Cracked tooth syndrome]] refers to a highly variable<ref name=Mathew2012>{{cite journal|vauthors=Mathew S, Thangavel B, Mathew CA, Kailasam S, Kumaravadivel K, Das A |title=Diagnosis of cracked tooth syndrome.|journal=Journal of Pharmacy & Bioallied Sciences|date=August 2012|volume=4|issue=Suppl 2|pages=S242–4|pmid=23066261|doi=10.4103/0975-7406.100219|pmc=3467890 |doi-access=free }}</ref> set of pain-sensitivity symptoms that may accompany a tooth fracture, usually sporadic, sharp pain that occurs during biting or with release of biting pressure,<ref name=Banerji2010>{{cite journal|vauthors=Banerji S, Mehta SB, Millar BJ |title=Cracked tooth syndrome. Part 1: aetiology and diagnosis.|journal=British Dental Journal|date=May 22, 2010|volume=208|issue=10|pages=459–63|pmid=20489766|doi=10.1038/sj.bdj.2010.449|doi-access=free}}</ref> or relieved by releasing pressure on the tooth.<ref name=Hargreaves2011 />{{rp|24}} The term is falling into disfavor and has given way to the more generalized description of fractures and cracks of the tooth, which allows for the wide variations in signs, symptoms, and prognosis for traumatized teeth. A fracture of a tooth can involve the enamel, dentin, and/or pulp, and can be orientated horizontally or vertically.<ref name=Hargreaves2011 />{{rp|24–25}} Fractured or cracked teeth can cause pain via several mechanisms, including dentin hypersensitivity, pulpitis (reversible or irreversible), or periodontal pain. Accordingly, there is no single test or combination of symptoms that accurately diagnose a fracture or crack, although when pain can be stimulated by causing separation of the cusps of the tooth, it's highly suggestive of the disorder.<ref name=Hargreaves2011 />{{rp|27–31}} Vertical fractures can be very difficult to identify because the crack can rarely be probed<ref name=Hargreaves2011 />{{rp|27}} or seen on radiographs, as the fracture runs in the plane of conventional films (similar to how the split between two adjacent panes of glass is invisible when facing them).<ref name=Hargreaves2011 />{{rp|28–9}}

When toothache results from [[dental trauma]] (regardless of the exact pulpal or periodontal diagnosis), the treatment and prognosis is dependent on the extent of damage to the tooth, the stage of development of the tooth, the degree of displacement or, when the tooth is avulsed, the time out of the socket and the starting health of the tooth and bone.  Because of the high variation in treatment and prognosis, dentists often use trauma guides to help determine prognosis and direct treatment decisions.<ref name="AAETrauma">{{cite web | url=http://www.nxtbook.com/nxtbooks/aae/traumaguidelines/ | title=The recommended guidelines of the American Association of Endodontists for the treatment of traumatic dental injuries | publisher=American Association of Endodontists | date=September 2013 | access-date=January 17, 2014 | pages=1–15 | archive-date=January 8, 2014 | archive-url=https://web.archive.org/web/20140108050117/http://www.nxtbook.com/nxtbooks/aae/traumaguidelines/ | url-status=dead }}</ref><ref name="traumaguide">{{cite web | url=http://dentaltraumaguide.org | title=Dental Trauma Guide | publisher=Rigshospitalet Region Hospital, Denmark, University of Copenhagen and the International Association of Dental Traumatology | access-date=January 15, 2014}}</ref>

The prognosis for a cracked tooth varies with the extent of the fracture. Those cracks that are irritating the pulp but do not extend through the pulp chamber can be amenable to stabilizing dental restorations such as a crown or [[Dental composite|composite resin]].  Should the fracture extend though the pulp chamber and into the root, the prognosis of the tooth is hopeless.<ref name=Hargreaves2011/>{{rp|25}}