Suspect a Crack?…. What Does it Take to Reach a Definitive Diagnosis? – by Samer S. Alassaad, DDS
Tooth cracks can be evaluated by transillumination (Fig 1), staining with dyes such as methylene blue dye (Fig 2), tactile examination with a sharp explorer (Fig 3) and magnification.
However, the diagnosis of cracked teeth, even when symptomatic, could be very challenging.
The key is to be aware of all forms of tooth cracks, with or without symptoms, their pathological consequences and their diagnostic methods, so our approaches can be adjusted accordingly.
A 78 year-old female presented with moderate gum soreness at the lingual area between teeth #s 14 & 15 (Fig 4). Periodontal examination revealed a 5 mm pocket with bleeding on probing and rough subgingival root surface at the disto-lingual of tooth # 14. Upon gentle probing and as the periodontal probe reached the base of the pocket, the patient felt severe pain. Once the patient’s symptoms were duplicated, the source of pain was confirmed.
Radiographic examination showed horizontal bone loss, but no periapical pathology (Fig 5). Although the distal margin of the restoration of tooth # 14 is clinically compromised, it is not contributing to periodontal symptoms since the restoration margin is supragingival (Fig 6).
A preliminary diagnosis of localized acute periodontitis was made and emergency limited subgingival scaling and root planning (SRP) under local anesthesia was initiated. After SRP, while carefully evaluating the smoothness of the root surface with slow explorer strokes, the tip of the explorer fell into a possible crack at the level of the gingival margin. Transillumination revealed a distal crack extending subgingivally (Fig7).
However, the pattern of bone loss was not typical of that associated with cracked roots. An isolated narrow periodontal pocket – due to bone loss along the fracture line as a response to microbial invasion – is more indicative of root fractures with periodontal involvement. Access to the distal crack was gained by creating a disto-occlusal cavity preparation through the gold restoration to explore the apical extension of the crack (Fig 8). Transillumination along with methylene blue dye was utilized as the symptomatic crack was chased subgingivally (Fig 9).
Once the subgingival extension of the crack to the root was confirmed, a definitive diagnosis of incomplete vertical root fracture contributing to symptomatic periodontal disease was made. The treatment plan was extraction of tooth # 14 and implant placement at the sites of teeth #s 13 & 14. The photographs facilitated the presentation of findings, diagnosis and treatment recommendation to the patient.
Dr. Alassaad is in private practice in Davis, California. You can reach him at: sameraldds@yahoo.com.
Editor’s Message:The GP NewsFlash is now accepting clinical briefs for publication. Click here to check the guidelines to clinical briefs and submit your clinical brief or any question you may have to: GPNF@cagd.com
Overcome Procrastination – Your Staff Models You by Olivia and Kerry Straine
When faced with an unfamiliar, unpleasant, or difficult task, what do you usually do? Think about it for a moment and answer truthfully. You might be interested to learn that executives who were asked that same question in a recent poll answered it this way:
- 49% — Do the task immediately
- 37% — Procrastinate
- 9% — Delegate
- 5% — No answer
These unfortunate findings show that more than half of the respondents don’t execute the tasks required of them immediately which, in our opinion, is the single most important reason most businesses fail to meet their objectives. You do know, don’t you, that employees follow the example of leaders who procrastinate and delegate? Nearly 90% of how people learn is visual. Employees need to see what implementation and execution looks like more than hearing about it in a seminar. Have you ever heard that a poor policy executed consistently is more effective than an excellent policy implemented haphazardly? We tell our clients over and over that the most effective leadership is by example, not edict. Actions really do speak louder than words.
If you find yourself in the more-than-50% category of executives who procrastinate and delegate, then you must change this behavior immediately. Until you learn to manage your own behavior, you’re powerless to influence anyone in your organization. So here are some tips for you to get moving:
Prioritize your work. Separate your tasks into four categories:
- High importance; high urgency. Tackle this first. Don’t procrastinate and never delegate.
- High importance; low urgency. Set deadlines. Work into your daily routine.
- Low importance; high urgency. Save your strength. Delegate to an assistant now.
- Low importance; low urgency. Determine real value. Get these off your list fast!
Stop procrastinating and follow these six steps to get things moving:
- Understand the significance of the task. Determine value and therefore priority.
- Identify how to motivate yourself – respect, reward, or recognition – and focus on the benefits you’ll receive for a job well done.
Break the task into components so that each part becomes more manageable. - Acknowledge that most projects require a lot of time. Schedule blocks of time – such as 10-minute increments – into your daily schedule for each project.
- Recognize how important your work is to the team. Remember that others are counting on you!
- Set deadlines for yourself and meet them. Reward yourself often!
We have found that many business owners focus their energies on changing employees, consultants, and objectives, and never think of changing themselves. Have you ever considered that the one constant in your life is yourself? Asking your employees to attend all the seminars in the world will never compensate for your procrastination and lack of execution. Begin today. “Everyone who got where he is had to begin where he was.”
Olivia and Kerry Straine are certified professional and behavioral value analysts. They have written hundreds of articles in relation to practice performance, emotional intelligence and leadership and teamwork principles. Straine Consulting has been a leader in the dental practice performance management field for almost three decades and during this time has consulted with thousands of dental practices across the United States and Canada. To learn more about Straine Consulting you may call 800.568.7200 or visit its website www.straine.com.
CDA Cares – Free Dental Clinic in San Jose, May 18-19th – Tim Verceles, DDS, MAGD
CDA Cares – Free Dental Clinic in San Jose, May 18-19th
Tim Verceles, DDS, MAGD
CAGD President-Elect
I encourage all CAGD members to join me in volunteering for the next CDA Cares event to be held in San Jose, CA, on May 18th and 19th.
The past two events in Modesto and Sacramento provided $2.8 million in dental services to more than 3,600 patients and dentists performed 17,288 procedures including cleanings, fillings, extractions and dentures, all free of charge.
It is a powerfully moving experience and an example of the best of dentistry in action.
Learn more and register at:
http://www.cdafoundation.org/give/volunteer/cda-cares-free-dental-clinics
Congrats to CAGD!
Congratulations to the CAGD for receiving the AGD 2013 Constituent Mini-Grant for supporting FellowTrack programs offered at numerous dental schools. These programs are organized at U.O.P. by Dr. Sun Costigan, at U.C.S.F. by Dr. Ralph Hoffman, and at U.C.L.A. and U.S.C. by Dr. Cheryl Goldasich.