Pain when biting: a cracked tooth or an occlusion problem?

Pain when biting: a cracked tooth or an occlusion problem?

Direct answer in 60 characters

“Pain when biting” is not a diagnosis. A crack, occlusal forces, apical inflammation, periodontal disease, or a non-tooth source may all be involved; a dentist needs to distinguish them by examination [F3][F12]. Seek medical care immediately for expanding swelling, fever, trouble swallowing, or trouble breathing [F13][F14].

Scope: This guide provides general health education based on international literature. It does not concern the insurance or regulations of any particular country; follow the arrangements where you seek care for appointments and costs. The compliance note at the end cites Taiwan's Medical Care Act solely to define this site's publication status and is marked geo: TW in its F-Unit.

Division of work among related cards: this card triages sources behind the complaint “biting triggers pain.” The overall pattern triage for tooth pain (triggered and stops, spontaneous and persistent, with swelling, or non-odontogenic) is in KM-DENTAL-33; this card uses the same framing and only summarizes one sentence from overlapping literature before linking there [F2]. KM-DENTAL-16 covers how long resin fillings last and material choices; KM-DENTAL-46 covers what to do when a filling falls out; KM-DENTAL-37 covers the trade-offs and drawbacks of all-ceramic crowns; KM-DENTAL-05 covers triage when swelling and pain arise in the gums [F2].

First, the position: this card does not diagnose you; it helps you describe the clues accurately

People searching for “pain when my teeth meet” usually want a yes-or-no answer: is it a crack, or is something wrong with the bite? This card will not give that either-or answer, not out of excessive caution but because the literature does not support reading symptoms that way [F12].

The systematic review commissioned by the European Society of Endodontology for its S3 guideline states the problem directly. Because scientific evidence for the accuracy and reproducibility of diagnostic tests is limited, effectiveness in diagnosing pulpitis is low; the central difficulty is the lack of a reliable reference standard under clinical conditions; given the limited evidence, the more promising current approach is to combine different clinical tests and symptoms [F12]. The same logic applies to biting pain. The European Society of Endodontology's 2025 position statement on longitudinal cracks and fractures of teeth states that early cracked teeth are challenging to diagnose because symptoms are poorly localized, may be mistaken for other odontogenic or non-odontogenic conditions, and may in some cases be an incidental finding without symptoms [F3].

So this card has one job only: lay out the possible sources of “pain when biting,” so that you know what a dentist is trying to distinguish, what examinations may be used, and what facts you should report [F2]. The following five pathways are this site's communication framework assembled from F3 through F26; they are not a diagnostic flowchart [F2].

1. The cracked-tooth spectrum: a continuum from superficial craze lines to a tooth split apart

Many people treat “a cracked tooth” as a yes-or-no question, but the position statement separates several states with different definitions [F3]:

• Craze line: a superficial coronal crack line confined to enamel, with no loss of tooth integrity. It occurs naturally during chewing and becomes more evident with age; apart from staining-related appearance concerns, it needs no treatment [F3][F6].
• Cracked tooth: a crack extending into dentine, with unknown depth and size; it may extend below the alveolar crest into the root and may involve the pulp [F3].
• Fractured cusp: a complete or incomplete fracture of a molar along the buccal/lingual groove and in a mesiodistal direction; in premolars it usually involves a marginal ridge [F3].
• Split tooth: the entire tooth is completely and visibly separated into two parts [F3].
• Vertical root fracture (VRF) and fractured root: an incomplete longitudinal root fracture involving cementum, dentine, and the root-canal space; complete separation is called a fractured root [F3].

For clinical features, the position statement records an early cracked tooth as having occlusal wear, possibly thermal sensitivity, pain on chewing or on release of pressure, a positive sensibility-test response, and directly visible crack lines that block transillumination [F3]. At a more advanced stage there may be symptoms of pulpitis or apical periodontitis, such as dull pain, tenderness to percussion or palpation, or an abscess. Usually one buccal or lingual cusp is tender to percussion, and there may be an isolated, deep, narrow periodontal pocket [F3].

“It hurts when I bite down” or “it hurts only when I release” — both patterns are recorded in the literature

This deserves its own section because it is often written as an either-or rule [F2].

The same position statement contains two descriptions that do not point in exactly the same direction. In describing the purpose of a bite test, it says the aim is to reproduce symptoms, especially sudden sensitivity and sharp pain when biting hard foods or clenching, which stops when pressure is released [F4]. In its clinical-features table, however, an early cracked tooth is listed as having pain on mastication or on release of pressure [F3]. In addition, the introduction to a U.S. national practice-based research-network study describes incomplete tooth fracture as local pain during chewing or biting, unexplained cold sensitivity, and pain on release of pressure [F9].

The correct reading is therefore this: both descriptions exist in the literature. Report honestly which one you experience; do not choose one label for yourself [F2][F3][F4][F9]. A dentist may use examinations such as a bite test to reproduce symptoms. That is a clinical examination method; this card does not describe how to perform it and does not advise trying it yourself [F4].

Symptom proportions: biting pain is not the majority pattern among cracked teeth

The position statement cites a U.S. practice-based study of 2858 teeth from 209 dentists: 45% of cracked teeth were symptomatic, and the common symptoms were pain to cold (37%), biting pain (16%), and spontaneous pain (11%) [F3]. Another original report from the same research network records 2,975 cracked teeth from 209 practitioners, of which 1,364 teeth (46%) were symptomatic [F8]. The tooth counts differ between the two sources (2858 and 2,975). This card records each source's figures separately; it does not combine or recalculate them [F3][F8].

The direction of these figures matters: among cracked teeth, pain to cold was recorded more often than biting pain; biting pain was not the majority pattern [F3]. That is why a symptom is a clue, not a criterion [F2][F3].

A normal radiograph does not mean there is no crack

This may be the card's most practical point. The position statement records Hilton et al.'s report that only 2% of cracked teeth with vital pulps had evidence of a crack on a radiograph. It also says cone-beam computed tomography (CBCT) is not predictable for detecting cracks, though it may reveal subtle crestal bone loss associated with a cracked tooth [F6].

This is not a reason to distrust imaging. It is a reason to understand that a dentist judges a cracked tooth from the combination of clinical examination and symptoms, rather than from one image alone [F6][F12][F2].

Symptoms suddenly disappearing does not automatically mean the problem is over

For an advanced fractured cusp, the position statement records that symptoms may be relieved once that cusp fractures off [F3]. In other words, “it hurt when I bit before, then suddenly stopped hurting” is a change documented in the literature; it does not automatically mean the problem has ended [F3][F2].

2. Occlusal forces and occlusal arrangement: grinding, clenching, and previous restorations

The second pathway is the one commonly considered by people searching for pain when upper and lower teeth meet: is something wrong with the bite, or is one spot “too high”? [F2]

The position statement describes cracked-tooth aetiology as multifactorial, involving occlusal interferences, tooth morphology, previous operative dentistry, increased masticatory loading from hard-food diets, and/or parafunctional habits [F5]. Its table of potential factors also lists stress generated by restorative procedures and thermal expansion, contraction, and corrosion of restorative materials as contributing factors [F5]. In its general section, the statement puts it even more strongly: the impact of excessive occlusal forces in the aetiology of cracked teeth, split teeth, and vertical root fractures cannot be overemphasized [F5].

Grinding and clenching are behaviours, not automatic causes

The practice-network study quantified some associations. After adjustment for demographic variables, characteristics positively associated with symptomatic cracked teeth included people who clench, grind, or press their teeth together (odds ratio 1.30, 95% CI 1.12 to 1.50), molars (1.58, 1.30 to 1.92), teeth with wear facets through enamel (1.22, 1.01 to 1.40), carious lesions (1.31, 1.07 to 1.60), cracks on the distal surface (1.31, 1.13 to 1.52), and cracks blocking transilluminated light (1.31, 1.09 to 1.57). Stained cracks were negatively associated with symptoms (0.68, 0.55 to 0.84) [F8].

But the international consensus is careful about what “bruxism” means. Its 2018 report says that in otherwise healthy people, bruxism should not be treated as a disorder but as a behaviour that may be a risk factor, and may also be a protective factor, for certain clinical consequences. Standard cut-offs for deciding that a person does or does not have bruxism should not be used in this group [F18].

Taken together, these two sources mean this: clenching and grinding have a statistical association with cracked-tooth symptoms [F8], but that does not mean “you grind your teeth, so grinding caused your pain.” That conclusion requires a dentist's examination [F18][F2].

An “occlusal interference” does not automatically mean pain: two human experiments

This is the part most easily misunderstood, and it is worth stating as the sources do [F2].

• A double-blind randomized crossover experiment placed an artificial occlusal interference in 11 young healthy women (an active interference and a sham interference for 8 days each). The active interference significantly reduced the number of masticatory-muscle activity periods per hour and their mean amplitude. No participant developed signs or symptoms of temporomandibular disorder during the study, and most adapted fairly well to the occlusal disturbance [F19].
• Another study separated people reporting very high (10 people) or very low (10 people) frequencies of oral parafunctions and gave them an experimental occlusal interference. The interference caused more occlusal discomfort in the high-frequency group than in the low-frequency group; only in the high-frequency group was it associated with a significant increase in masticatory-muscle pain and headache [F20].

These studies had only 11 and 20 participants, respectively, and were small experimental studies. They cannot be generalized as proportions for the general population [F19][F20]. The only direction that can be stated is that the same interference can have different results in different people. Therefore, “that new filling must be too high” is not a conclusion you can make for yourself [F19][F20][F2].

“Will an occlusal adjustment make the pain stop?” What this site found, and did not find

This site did not obtain direct research on whether adjusting the occlusion of a newly placed restoration reduces biting pain: on 2026-08-06, a PubMed search for `"occlusal adjustment"[tiab] AND "postoperative pain"[tiab] AND restoration[tiab]` returned 0 results [F28].

What can be cited is a similar but different clinical setting: whether preventive occlusal reduction during root-canal treatment reduces postoperative pain.

• A 2021 systematic review included 12 studies in qualitative analysis and 9 in quantitative analysis. Its meta-analysis found no significant difference in postoperative pain after occlusal reduction at 6, 12, 24, or 48 hours after endodontic instrumentation, or at 6 or 12 hours after endodontic obturation; the certainty of this outcome was moderate under GRADE [F21].
• A 2020 systematic review and meta-analysis included 6 randomized controlled trials and 344 participants. It concluded that occlusal reduction was not supported for pain control in the first two postoperative days, but on day three (72 hours) the intervention group had significantly more pain reduction than placebo (SMD −1.07; 95% CI −1.81 to −0.32) [F22].

Please note the scope of these two reviews: they studied preventive occlusal reduction during root-canal treatment, not grinding down a newly placed restoration that seems too high. They cannot substitute for each other. This card cites them only to make one point: even at the level of randomized controlled trials, “grind it down a little and the pain will stop” is not a consistently established causal relationship [F21][F22][F2].

3. Pulpal and apical sources: pain to percussion and pain on biting down

The third pathway is inflammation inside the tooth and around the apex [F2].

A Cochrane systematic review states in its background that symptomatic apical periodontitis and acute apical abscess are common causes of dental pain, arising from an inflamed or necrotic dental pulp or infection of a pulpless root-canal system [F13]. The position statement also records that non-vital cracked teeth may have symptoms and/or signs of apical periodontitis and evidence of marginal-ridge fractures [F4], and that an advanced cracked tooth may have tenderness to percussion or palpation [F3].

This pathway overlaps clinically with the first pathway, a crack. If a crack progresses to the pulp, these are successive stages in the same tooth rather than two mutually exclusive choices [F3][F4][F2]. That is why “is it a crack or inflammation?” is often not an either-or question in the clinic [F2].

How long pain lasts after pulp removal and how many visits root-canal treatment takes are the scope of two other cards and are not repeated here [F2].

4. Periodontal supporting-tissue sources: pain around a tooth

The fourth pathway is the supporting tissue around a tooth [F2].

The 2017 World Workshop consensus report defines a periodontal abscess as an acute lesion characterized by localized accumulation of pus within the gingival wall of a periodontal pocket or sulcus, rapid tissue destruction, and a risk of systemic dissemination. The same report defines an endodontic-periodontal lesion as pathological communication between pulpal and periodontal tissues at a given tooth [F15].

For the question “can occlusal forces harm the periodontium?”, the evidence points in a fairly consistent direction:

• A narrative review from the 2018 World Workshop records that occlusal trauma can only be confirmed histologically, while clinical diagnosis relies on clinical and radiographic surrogate indicators, making clinical trials difficult. Studies generally agree that occlusal trauma and excessive occlusal forces do not initiate periodontitis or loss of connective-tissue attachment. When plaque-induced periodontitis and occlusal trauma coexist, weak evidence suggests that occlusal trauma may increase the rate of connective-tissue loss. Occlusal therapy has indications as part of periodontal treatment to reduce mobility and improve patient comfort and masticatory function [F16].
• A 2026 scoping review included 18 studies (8 clinical, 7 animal, and 3 in vitro). It concluded that occlusal trauma may be a modifying factor that aggravates periodontitis progression in susceptible individuals, but should not be regarded as the initiating cause of disease. The authors also noted that observed clinical effect sizes were modest, so selective rather than routine occlusal intervention may better optimize the benefit-to-burden ratio [F17].

The practical meaning for readers: if pain comes with swollen gums, pus drainage, or tooth mobility, those are periodontal-direction clues. Distinguishing them requires probing and imaging [F15][F3]. “Adjusting the bite” in periodontal treatment is a conditional, selective intervention, not a universal solution [F16][F17][F2].

5. The pain source may not be in the tooth: muscles, joints, and a “strange bite”

The fifth pathway corresponds to the search expression “my bite feels strange” [F1][F2].

A systematic review separates nonodontogenic toothache into eight groups according to the primary disorder: myofascial pain referred to a tooth, neuropathic toothache, idiopathic toothache, neurovascular toothache, sinus pain referred to a tooth, cardiac pain referred to a tooth, psychogenic toothache or toothache of psychosocial origin, and toothache caused by various other disorders. It concludes that unnecessary dental treatment should be avoided [F25].

The situation “my bite just feels strange, but nothing is found on examination” has a specific name in the literature and a clear management position:

• A 2020 clinical guideline, an expert consensus based on a literature review of 77 articles, says that occlusal dysesthesia exists independently of occlusion and results from maladaptive signal processing. It says the focus should be on patient education, counseling, defocusing, cognitive behavioral therapy, supportive pharmacotherapy, and certain nonspecific measures; irreversible, particularly exclusively dental, treatment approaches must be avoided [F23].
• A 2026 scoping review of 20 studies records that occlusal dysesthesia is considered to result from disordered central sensory processing or maladaptive signal processing rather than a primary occlusal abnormality. Current evidence supports conservative multidisciplinary management, while irreversible dental intervention is contraindicated. The authors also state that the existing evidence is low quality and comes mainly from case reports and case series [F24].

The purpose of this section is not to tell you that your problem is psychological [F2]. It is to explain why, when a dentist cannot find a tooth-based cause, the dentist may stop rather than continue grinding or remaking things. That is a conservative approach grounded in guidance, not dismissal [F23][F24].

Why this card does not provide a “biting-pain lookup table”

Versions circulating online often read like this: pain when biting down = a crack; pain only on release = a crack; bite feels high = an occlusion problem. This card does not use that wording for four evidence-based reasons [F3][F12][F28].

1. The diagnostic tests themselves have limited accuracy. The systematic review concludes that diagnosing pulpitis has low effectiveness, with the central problem being the absence of a reliable reference standard under clinical conditions [F12].
2. Symptoms of early cracked teeth are poorly localized. They can be misdiagnosed as other odontogenic or non-odontogenic conditions, and can also be incidental findings without symptoms [F3].
3. Symptoms themselves change. A one-year follow-up study records that 209 practice-network dentists enrolled 2858 participants, of whom 1850 teeth remained untreated at one year and formed the analytic cohort. Pain symptoms changed in 32%; decreases were twice as common as increases (23% versus 10%); 2% had increased biting pain and 2% increased spontaneous pain; only 6% had an increased number of cracks. The authors concluded that these untreated cracked teeth showed no meaningful progression at one year when measured by increased symptoms or crack number [F10].
4. This site did not find research supporting self-diagnosis. On 2026-08-06, PubMed searches for `self-diagnosis[tiab] AND cracked tooth[tiab]` and `"biting pain"[tiab] AND "diagnostic accuracy"[tiab]` each returned 0 results [F28].

There is a particularly easy way to misread this, so the card says it plainly: the one-year figures in the preceding paragraph (32%, 2%, 6%) and the practice-network's three-year figures (only a minority fractured, 3%, or had crack progression, 12%) [F11] can easily be read as “so I can ignore it.” The source does not say that. The position statement explicitly says it remains unclear how long asymptomatic, untreated cracked teeth can stay stable, because available studies have followed them for only 1 to 3 years [F7]. The three-year source says that features guiding a clinician's decision about treatment include active caries and biting pain, along with several examination findings of lesser influence [F11]. In other words, biting pain itself is one of the features the literature lists as guiding consideration of treatment. These figures support a dentist deciding after evaluation whether to monitor or treat; they do not support deciding for yourself not to seek care [F11][F7][F2].

Seek medical care immediately for these situations (this card's red-flag section)

Each item below corresponds to a condition documented in the literature. They are not a self-diagnosis checklist; they are signals to move the priority of seeking care forward [F2].

• The area of swelling is expanding. The Cochrane review lists signs of spreading infection (cellulitis, lymph-node involvement, diffuse swelling) as situations on a different level from local treatment [F13]. Cellulitis and lymph-node involvement are findings a clinician must determine. “Is the area of swelling continuing to expand?” is this site's wording that turns that criterion into something you can observe and report at home; it is not the source's wording [F13][F2]. No observation interval is deliberately given here—not “compared with yesterday” or “compared with this morning.” A spreading infection can change within hours, and any time anchor would give a reason to wait another round.
• Fever or general malaise. The same review lists systemic involvement (fever, malaise) alongside the preceding item [F13].
• Difficulty swallowing, altered voice, limited mouth opening, neck swelling, neck pain, or respiratory distress. A textbook entry on deep neck infections records that symptoms commonly arise from local pressure effects on the airway, nerves, or digestive tract and include neck swelling, dysphagia, dysphonia, and trismus; clinical presentation often also includes fever, neck pain, and respiratory distress [F14]. This group is not a situation to wait for a scheduled appointment; seek medical help immediately [F14].
• Pus emerging from the gums or rapid local swelling. The World Workshop consensus report describes periodontal abscess as an acute lesion with localized pus accumulation and rapid tissue destruction, associated with risk of systemic dissemination [F15].
• The tooth appears split into two pieces. The position statement records that a split tooth has an unfavorable prognosis and that timely extraction should be considered to minimize development of acute symptoms and limit bone loss [F7].
• A tooth is clearly mobile. This item is not in the position statement's description of cracked teeth (the statement does not list mobility as a cracked-tooth feature). This site lists it separately because marked mobility itself requires a dentist's examination and should not wait [F2]. Whether this is the situation you have must be decided by a dentist; this card gives no self-check method [F7][F2].

Be honest about the red-flag section's completeness limit: this card's red-flag list is limited to signs enumerated by the sources above. The card does not add signs that the sources did not list. This is the trade-off of “do not state what has no support,” not a statement that unlisted situations are unimportant [F28][F2]. In addition, if tooth pain occurs with chest tightness, cold sweats, or breathlessness, seek emergency care rather than dental care; the evidence basis and limitations for that item are handled in full in KM-DENTAL-33, so this card only points there and does not rewrite it [F2].

Risk factors: when biting pain is less appropriate to delay

• People who grind, clench, or press their teeth together. In practice-network data, these people were positively associated with symptomatic cracked teeth (odds ratio 1.30, 95% CI 1.12 to 1.50) [F8]. The position statement also lists parafunctional habits among causes of cracked teeth and advises management advice for those habits when indicated [F5].
• Molars, or teeth with large fillings or previous restorative treatment. Molars were positively associated with symptomatic cracked teeth (1.58, 1.30 to 1.92) [F8]. The position statement lists previous operative dentistry and stress generated by restorative procedures as causes or contributing factors. It also records that untreated high-risk cracked teeth may progress to fractured cusps or split teeth; examples include distal marginal ridges of terminal premolars or molars, extensively restored teeth, isolated or terminal teeth, and people with longstanding parafunctional habits [F7].
• A tooth that has already had root-canal treatment. The position statement records poorer prognostic factors for cracked teeth after root-canal treatment: multiple cracks, a crack extending into the root, a terminal location in the dental arch, pre-existing apical periodontitis, or placement of an intraradicular post. It also records that periodontal probing of 5 mm or more is associated with lower survival rates [F7].
• A tooth with active caries at the same time. Carious lesions were positively associated with symptomatic cracked teeth (1.31, 1.07 to 1.60) [F8], and active caries is listed as one of the features guiding a clinician's treatment decision [F11].

Risk disclosure: the different treatments for biting pain—including occlusal adjustment, an occlusal stabilization splint, cusp-covering restoration, root-canal treatment, extraction, and periodontal treatment—each have indications, limitations, and possible adverse effects [F5][F7][F16]. Documented points include the position statement's finding that no clear evidence identifies which restorative approach is most suitable, and that staged treatment can observe pulpal status but pulp vitality may be compromised by microleakage, cement breakdown, or further treatment [F7]. In occlusal dysesthesia, guidance explicitly says irreversible, exclusively dental treatment approaches must be avoided and are contraindicated [F23][F24]. In periodontal treatment, occlusal intervention is recommended selectively rather than routinely [F17]. This card does not decide whether any of those apply to you; a dentist must assess that from examination and imaging [F26].

Checklist before the visit (8 questions; consider asking all of them)

1. For this biting pain, which source pathway do you think is most likely: a crack, occlusion, pulp/apex, periodontium, or outside the tooth? [F3][F12]
2. Which examinations support that judgment? Is another examination still needed? [F3][F12]
3. My radiograph looks normal: what does that mean, and what does it not mean? [F6]
4. If you suspect a crack, is the current plan observation or treatment first? What are the differences and risks of each? [F7][F11]
5. Do I have signs of grinding or clenching, such as wear facets? If so, how do you recommend addressing them? [F8][F5][F18]
6. If you adjust the occlusion, which tooth are you adjusting, and when should I return to check it? If it does not improve, what is the next step? [F5][F17]
7. Which changes mean I should return early, and which mean I should seek care the same day? [F13][F14]
8. What has been done to this tooth before (filling, crown, root-canal treatment), and how does that affect this assessment? [F7][F26]

How to find a clinic that provides this service

This site lists no clinics and does not recommend, rate or compare any medical institution.

To find a clinic that provides this service, use the following official lookup channels yourself —

they are maintained by the competent authorities and are more current than any list:

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- The Ministry of Health and Welfare's medical-institution lookup: search by city or county,

township and specialty (dentistry) for institutions that have completed practice registration.

The results show the institution's name, address and registered specialty. This is the first place

to confirm whether a clinic is lawfully registered.

- The National Health Insurance Administration's contracted-institution lookup: check whether a

clinic is under contract with National Health Insurance. This determines which items are covered

and which are self-paid, and therefore what kind of fee explanation you will be given.

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Both systems are on the respective authorities' official websites; searching for the

medical-institution lookup or the contracted-institution lookup will find them. This site does not

reproduce the URLs, because they change; use whichever entry point the authority currently publishes.

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In an emergency, do not spend time looking up lists. If your breathing, swallowing or speech is

affected, or swelling is spreading, go to the nearest emergency department.

Chinese labels to look for on the official pages

These official systems, datasets and files are published in Chinese only. The English names above are this site's renderings; on the page itself you will see the following strings, so search for these:

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- 「醫事機構查詢」

- 「特約醫事機構查詢」

- 「特約院所查詢」

Compliance note

This is health-education information under Article 87 of Taiwan's Medical Care Act [F27], not medical advertising, and it does not recommend a particular institution. The various treatments for biting pain—including occlusal adjustment, occlusal splints, cusp-covering restorations, root-canal treatment, periodontal treatment, and extraction—have risks and contraindications. Possible situations include postoperative discomfort, impaired pulp vitality, restoration failure, and symptoms not improving as expected; actual treatment and outcomes vary by person and must be assessed by a dentist [F7][F26]. The five-way triage in this card is for communication when seeking care. It cannot replace clinical diagnosis and cannot be used as a basis to delay care yourself, adjust your occlusion yourself, or self-medicate. This card gives no medicine name, dose, or use advice. Percentages, odds ratios, and survival rates cited in this card are study-level group figures and cannot be used to estimate an individual's outcome.

Every clinical statement in this article is mapped line by line to its cited source (see the sources and evidence chain below). It has not been clinically reviewed by a licensed practitioner. This is health information, not individual advice; assessment by a clinician is required.