title: Incompletely fractured teeth associated with diffuse longstanding orofacial pain: diagnosis and treatment outcome.
abstract: OBJECTIVE
  To evaluate the diagnostic value of different clinical findings, and analyse the symptoms experienced from teeth with incomplete dentinal fractures in patients with diffuse orofacial pain. Secondly, to present the outcome of different treatment modalities in these patients.
  
  
  METHODS
  Thirty-two patients, referred to the teaching clinic at the Faculty of Dentistry, University of Bergen, with poorly localized orofacial pain, were finally diagnosed with 46 incompletely fractured teeth. The distribution and pattern of pain was thoroughly recorded for each patient. The final diagnosis, incompletely fractured tooth, was obtained after removal of fillings and direct inspection of possible fracture lines.
  
  
  RESULTS
  Many of the patients had suffered diffuse orofacial pain for more than 1 year, and had earlier consulted dental and medical expertise. Direct inspection of fracture lines, combined with staining solution and transillumination proved to be the best diagnostic tools. The longer the duration of pain before the diagnosis of an incompletely fractured tooth was established, the more diffuse was the distribution of pain. Endodontic or restorative treatment relieved the symptoms in 90% of the patients, whilst persisting symptoms in 10% were considered part of an orofacial pain complex of obscure aetiology.
  
  
  CONCLUSIONS
  This study shows that the diagnosis of the incompletely fractured teeth in patients with longstanding diffuse orofacial pain symptoms are time consuming and represent a diagnostic problem. With appropriate endodontic and/or restorative treatment, symptoms were relieved in the majority of cases.
authors.affiliation: Department of Odontology - Endodontics, School of Dentistry, University of Bergen, Bergen, Norway. atle@softscenario.no
authors.forename: A
authors.initials: A
authors.lastname: Brynjulfsen
authors.forename: I
authors.initials: I
authors.lastname: Fristad
authors.forename: T
authors.initials: T
authors.lastname: Grevstad
authors.forename: I
authors.initials: I
authors.lastname: Hals-Kvinnsland
mesh_terms: D001732:Bite Force; D004396:Coloring Agents; D003793:Dental Restoration, Permanent; D003804:Dentin / Q000293:injuries*; D003937:Diagnosis, Differential; D005157:Facial Pain / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008751:Methylene Blue; D010474:Percussion; D010808:Physical Examination; D011671:Pulpitis / Q000175:diagnosis / Q000628:therapy; D012017:Referral and Consultation; D012390:Root Canal Therapy; D014082:Tooth Fractures / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014172:Transillumination; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue