Handbook of Oral Pathology and Oral Medicine. S. R. Prabhu

involve single tooth, several teeth or generalizedFigure 4.3 Hypercementosis; extracted tooth with hypercementosis at the tip of the roots(source: by kind permission of Professor Charles Dunlap, Kansas City, USA).

       Isolated hypercementosis involves mandibular molars, followed by maxillary and mandibular second premolars, and mandibular first premolars

       An extracted tooth shows blunt root tips (Figure 4.3)

      4.3.5 Radiographical features

       Detected on routine radiography

       Widening of roots

       Apical third shows a blunt root tip surrounded by radiolucent periodontal ligament space

       Occasionally, fusion of the roots of the adjacent roots caused by hypercementosis (concrescence) is seen

      4.3.6 Microscopic Features

       Deposition of excessive cementum (mostly acellular) over the original layer of primary cementum

       Concentric layers of cementum deposition are seen

       May include the entire root or limited to the root tip

      4.3.7 Differential Diagnosis

       Cemento‐osseous dysplasia

       Cementoblastoma

      4.3.8 Management

       No treatment required

       Problems with extraction

       Systemic conditions associated with hypercementosis should be treated by specialists

4.4 Cracked Tooth Syndrome

      4.4.1 Definition/Description

       An incomplete fracture of a vital posterior tooth that involves the dentine and occasionally extends into the pulp

      4.4.2 Frequency

       Common

       Incidence rate of 34–74%

      4.4.3 Aetiology/Risk factors

       Teeth grinding (bruxism/habitual clenching)

       Large restorations

       Chewing or biting hard food

       Trauma: blows to the teeth (violence or accident related)

      4.4.4 Clinical Features

       Majority of patients are 30–50 years of age

       Men and women are equally affected

       Most affected teeth are the mandibular second molars, followed by mandibular first molars, and maxillary premolars

       Deep cracks may involve pulp (Figure 4.4)

       Patient complains of pain on biting that ceases after the masticatory pressure has been withdrawn

       Pain on tooth grinding and with cold drinks or food

       Difficulty in identifying offending tooth (by the patient)

       Vitality test is usually positive

       Tenderness can be elicited when pressure is applied to an individual cusp

       Pain/tenderness increases as the occlusal force increases, and relief occurs once the pressure is withdrawnFigure 4.4 Cracked tooth syndrome; fractured premolar tooth (black arrows) viewed in the mouth (left) and after extraction (right). (Source: Coronation Dental Specialty Group Canada; Wikipediahttps://en.wikipedia.org › wiki. Creative Commons Attribution‐Share Alike 3.0 Unported license

      4.4.5 Differential Diagnosis

       Acute periodontal diseases

       Reversible pulpitis

       Dentinal hypersensitivity

       Galvanic pain associated with silver amalgam restorations

       Sensitivity following microleakage from recently placed composite resin restorations

       Areas of hyperocclusion from dental restorations

       Occlusal trauma from parafunctional habits

       Orofacial pain arising from conditions such as trigeminal neuralgia and atypical facial pain

      4.4.6 Diagnosis

       Detailed history:Recent dental restorations, occlusal adjustmentsParafunctional habits (bruxism)Pain history: character, intensity, relation to chewing, etc.

       Clinical examination:Periodontal probing

       Bite tests:Patient is asked to bite on various items such as a toothpick, cotton roll, rubber abrasive wheels, or wooden stickPain/tenderness increases as the occlusal force increases, and relief occurs once the pressure is withdrawn (diagnostic)

       Dye test:Special stains such as methylene blue or gentian violet are frequently used to highlight the cracks

       Vitality tests for individual tooth are usually positive

       Radiographs are not reliable (since cracks usually occur in a mesiodistal direction)

       Transillumination is an important aid in diagnosing the cracks

      4.4.7 Management

       Depends on the site, direction, size, or the degree of the crack

       Minor cracks: restored with a filling or a crown

       Deep cracks with pulp involvement: root canal treatment and a crown

       Pain management by analgesics

       Crack extending into the root of the tooth beneath the bone: extraction of the tooth

      4.4.8 Prognosis

       Prognosis is good for most cases with endodontic treatment and crown

       Where vertical cracks occur or where the crack extends through the pulpal floor or below the level of the alveolar bone, the prognosis is not favourable, and extraction is the treatment of choice.

Recommended Reading

      1 Odell, E.W. (2017). Tooth wear, tooth resorption, hypercementosis and osseointegration. In: Cawson's Essentials of Oral Pathology and Oral Medicine, 9e, 85–91. Edinburgh: Elsevier.

      2 Imfeld, T. (1996). Dental erosion: definition, classification, and links. European Journal of Oral Sciences 104: 151–154.

      3 Neville, B.W., Damm, D.D., Allen,