10 Facts on the Cracked Tooth: How Stress May Be Impacting Your Smile
Joseph Stern, D.D.S., Clinical Assistant Professor of Dental Medicine
Here’s to one of my favorite topics...‘THE CRACKED TOOTH’
A recent article in the New York Times explores the some of the reasons for the huge uptick in cracked teeth. All that can be said is this article is NOT EXAGGERATING, as we’ve seen more cracked teeth recently than ever before. The question is why? This article explores some of the reasons for that. It is quite an interesting read.
As an addition to this article I’ve provided some food for thought...
10 Facts about the Cracked Tooth:
1. Mandibular first and second molars are the most common teeth to fracture. Then comes the maxillary premolars. The crack is most often found on the mesial or distal marginal ridge.
2. Classic symptoms of cracked tooth includes sharp pain on biting (or release) and unexplained temperature sensitivity. One of the best ways to diagnose a cracked tooth is by testing each cusp of a suspected cracked tooth with a ‘tooth sleuth’.
3. Early diagnosis and detection is paramount in the management of the cracked tooth. With early detection many teeth can be saved.
4. There is a wide range of treatment for the cracked tooth. Treatment will usually fall in to one of three categories:
B. Root canal and crown.
The treatment depends on the diagnosis of the pulp and depth of the crack. A surgical operating microscope is essential in determining the extent of the crack and the treatment prognosis.
If a cracked tooth is diagnosed with reversible pulpitis (pulpal diagnosis in which there is no lingering or spontaneous pain) then a temporary crown is advised for 6-8 weeks. If symptoms resolve, then proceed with a permanent crown. If symptoms don’t resolve, root canal therapy is indicated prior to permanent crown placement.
If the cracked tooth has a pulpal diagnoses of irreversible pulpitis (spontaneous or lingering pain) or necrosis (infection) then root canal therapy is indicted prior to crown placement.
If clinical or radiographic exam reveals that the crack extends into the root, then extraction may be indicated.
Alternatively, if root canal treatment is initiated and it is discovered that the crack extends into the root then extraction might be indicated as well.
5. A cracked tooth shouldn’t be confused with vertical root fracture. VRF’s are found in previously endodontically treated teeth. These fractures are initiated in the root. Cracked teeth on the other hand are found in teeth have not had root canal treatment. These cracks are initiated in the crown portion of the tooth and spreads apically towards the root.
6. Some common causes of cracked teeth are grinding, clenching, or bad chewing habits (biting on ice, chicken bones, hard nuts etc.).
7. Many teeth have crazed lines. This is not to be confused with a crack line. A craze line is confined to enamel while a crack line extends into the dentin. A patient with a crack will usually have symptoms to temperature and bite. A craze like would not cause these symptoms.
8. Older patients have a more brittle dentin structure and as such their teeth are more prone to fracture. Rarely do we see classic cracked tooth symptoms in children or adolescents. The dentin is 50% weaker in those above 55 years old in comparison to those younger than 35.
9. If a tooth is minimally restored and has no caries but yet presents with symptoms of pulpitis or necrosis then suspect a cracked tooth. These teeth can often be retained if diagnosed and treated in a timely manner.
10. One of the best ways to prevent cracking a tooth is to wear a night guard if clenching or grinding is a habit.
Full coverage restorations on susceptible teeth are also a good option to help safeguard vulnerable teeth. A patient with a history of a cracked tooth should be evaluated for full coverage restorations on those teeth vulnerable to fractures in the future. It is very common to see a patient have a tooth removed due to a crack only to return a short time later with another fracture because the edentulous space was never restored.
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