To all of those who read this newsletter, thank you. I hope you find this monthly newsletter educational and interesting; perhaps it may even answer some questions about oral health that you may have been pondering. If you have any dental questions or topics you would like me to write about, please let me know! This month I want to discuss a topic that Dr. Krist and I see every day: cracked teeth and cracked tooth syndrome.
It is important to have a basic understanding of fillings in order to understand cracked teeth and cracked tooth syndrome. When a tooth develops a cavity and is restored with a filling, it will never be as strong as it was initially. When the extent of the decay on a tooth has been excavated, the filling often extends on to multiple surfaces of the tooth. There are five surfaces on every tooth: the occlusal surface (“biting side”), mesial surface (“front side”), distal surface (“back side”), facial surface (“cheek side”), and lingual surface (“tongue side”). Smaller fillings that only cover one of two surfaces have a much higher chance of long-term success compared to large fillings. Some fillings may include four or five surfaces of a tooth, and these fillings tend to break down quicker and are less reliable than small, predictable fillings.
Teeth with large fillings have the highest likelihood of cracking and breaking. Furthermore, teeth with metal amalgam fillings are more likely to crack because undercuts must be added to the tooth to mechanically retain the metal filling. Over time, a metal amalgam filling acts like a wedge and risks splitting the tooth while chewing. The difficulty with cracks is that we typically cannot see the extent of them from x-rays. We can see cavities, abscesses, bone, and existing dental work, but cracks are usually so small that they do not appear. This makes diagnosing the severity and the extent of the crack difficult and it puts dentists in a tricky situation.
Everyday Dr. Krist and I see teeth that have cracks in them. Some of these cracked teeth are completely asymptomatic and the patient has been living with them for years without any issues and they may never have issues. Some of these teeth fracture to the point where they are unrestorable and need to be extracted. Some of these teeth do not fracture but they develop symptoms known as “cracked tooth syndrome”. Cracked tooth syndrome typically consists of intermittent or constant pain to chewing on a tooth with a visible crack. Every time the patient chews on a tooth with cracked tooth syndrome, the crack flexes and causes pain. Teeth exhibiting cracked tooth syndrome must be covered with a crown, also known as cap. Crowns are made of either gold or porcelain and cover the whole tooth and shield it from further breakdown and propagation of the crack.
Dr. Krist and I approach cracked teeth in a systematic way. First, we inform the patient that we see a crack on their tooth and take photographs. This allows the patient to see what we are seeing and understand the condition of their tooth. Then, we explain that the tooth should be covered with a crown to protect it and we give the patient the choice of being either preventative or reactive regarding the crack. Preventative patients choose to get ahead of the problem and cover the tooth with a crown before any symptoms or fractures arise. Reactive patients choose to “wait and see” and allow us to monitor the tooth for any further breakdown or decay.
It is important for reactive patients to understand that if cracked teeth develop symptoms, more expensive and extensive treatment is often needed. If the tooth is symptomatic to chewing and has hot and cold sensitivity, the crack has likely extended into the nerve of the tooth and a root canal also needs to be performed. In rare cases, the tooth can be fractured down the root and needs to be extracted and replaced with either an implant, a bridge, or a partial denture. When patients come to Dr. Krist and I with symptomatic cracked tooth, we will cover the tooth with a temporary crown and monitor the symptoms. If the symptoms persist once the tooth has been covered with a temporary crown, we will refer the patient out to have a root canal before the final crown is delivered.
Dr. Krist and I understand that crowns are expensive and that nobody truly wants to have their teeth worked on. However, it is our moral obligation to inform patients of our findings and give them autonomy to make decisions about their teeth. Thank you for reading and please call me or Dr. Krist if you have any questions or concerns!
Dr. John Obeck