Treating Cracked Teeth
One common occurrence to teeth when they mature is that they become more brittle. This combined with a changing bite could result in one or more teeth absorbing more that their normal loading forces. The result is often a cracked tooth.
Symptoms
Cracked teeth, and the often accompanying cracked-tooth syndrome, are difficult to diagnosis and treat because symptoms are often confused with other pathology. Many cracked teeth go undetected until tooth loss is inevitable. The most common symptom to occur with a cracked tooth is sporadic sensitivity to cold and biting. Generally, the intensity and frequency of these symptoms increase over time. There are a number of reasons why teeth crack.
Incidence of Cracked Teeth
• Four percent of teeth eventually crack.
• They occur most commonly (48%) in the lower second molars and in upper molars (42%)
• The most distal tooth in the lower arch.
• They occur more commonly along inside cusps.
• They usually occur in the front to back plane.
• Most are vertical (79%).
• Many extend the full length of the root (24%).
• They most commonly occur between ages 40 and 49.
Symptoms Associated with Cracked Teeth
• Sharp pain of a few seconds duration only while chewing .
• Dull pain which comes and goes on its own (29%).
• Pain on chewing which does not occur every time the patient eats but increases in frequency with time.
• Hypersensitivity to cold.
• No symptoms (35%).
Clinical Findings Associated with Cracked Teeth
Periodontal pockets are frequently associated with a cracked tooth. Overall, 66% of cracked teeth are associated with bony defects. When a deep vertical three-walled pocket is seen in an otherwise healthy mouth (with no other such pockets) and the patient has symptoms of the cracked tooth syndrome, the likelihood of that tooth being cracked is high.
Frequently by the time a patient has distinct and persistent symptoms, more than one crack is present and more than one tooth may be involved.
Radiographs (x-rays) rarely show a fracture but are useful in excluding other pathology. The routine use of radiographs during the examination of a possible cracked-tooth syndrome patient is recommended to rule out more commonly occurring pathology with similar symptoms (e.g. a pulp abscess).
Treatment for Cracked Teeth
If a cracked tooth is only slightly suspected, an occlusal adjustment may be in order. If this alleviates the symptoms no other treatment is indicated. However, if the symptoms persist, restorative procedures are the treatment of choice.
The most common treatment is to take the tooth out of occlusion. If any fillings are present they are removed and the tooth is inspected for cracks. A medication is then placed in the tooth to induce healing and a temporary restoration is then placed to seal the tooth tight.
Occlusal Adjustment
The purpose of occlusal adjustment is to obtain biomechanical stability of the jaw by selective grinding of tooth surfaces. The jaw is considered stable when the jaw joint is fully seated in the same position as when the teeth are in maximum contact. This can be an effective way to prevent future cracked teeth. Once the first cracked tooth is detected occlusal adjustment should be considered.
Healing Period
Once the tooth has been initially treated it will usually take a number of weeks for the symptoms to subside. During this period, adjustments may be necessary as the teeth settle in after treatment.
Restorative treatment will not necessarily remove the symptoms of cracked teeth. It is important to treat the teeth symptomatically with temporary restorations prior to placing permanent restorations.
When cracked teeth are temporized symptoms commonly regress for 3-4 months. At this point in time, when symptoms have subsided the tooth should be restored with a final restoration. If temporized for too long symptoms may return indicating that permanent restorative treatment may have to be postponed.
Final Treatment
Once the tooth has become asymptomatic a cusp coverage restoration should be placed. The two most common restorations are the gold onlay and the tooth-colored ceramo-metal bonded restoration (CMBR).
A gold onlay provides the best cuspal support, even better than natural teeth. The tooth colored CMBR provides cuspal support also, but at the expense of removing slightly more tooth structure. A full crown would be the last treatment of choice since it requires the most removal of tooth structure.
Complications
When restorative procedures fail on cracked teeth, tooth extraction (58%) or root resection (11%) may be indicated. This of course is a last resort. Early diagnosis and treatment improves the chances for success in treating cracked teeth.
Prevention
Sound restorations, a stable bite, and regular follow-up visits are the best way to avoid cracked teeth. When it comes to cracked teeth, an ounce of prevention is worth 100 pounds of cure and you can save your tooth in the process