29 YO healthy male presents with a chief complaint

29 YO healthy male presents with a chief complaint of not being able to chew or drink hot/cold liquid on his right side. As with all cases, history is our most important tool in coming up with an accurate diagnosis. If we just sit back, listen and ask competent and focused questions, we will many times come up with a differential diagnosis that matches the actual diagnosis. 2 of the most important questions that were asked are as follows:

1) Q: When did you first start having discomfort similar to what you are describing today? A: I have been having sensitivity on and off for the better part of a year

2) Q: Do you remember anything specific that you were doing when you first started having sensitivity? A: I was eating the hard crust of French bread and it was since then I started having issues. I have gone to my dentist several times and each time I was told there wasn’t anything they could find.

Upon radiographic survey, one would not think that a shallow restoration could cause a tooth to need a root canal. Upon closer inspection, however, we were able to determine that the distal marginal ridge was fractured (red arrow) AND was communicating with the pulp chamber; this was confirmed after endodontic access. In preparation for full coronal restoration, we had mechanically removed the crown fracture and repaired with the core composite and reduced occlusion. This patient was highly encouraged to get a full coronal restoration from his restorative dentist ASAP.