Dr. Alan Friedler of Guilford’s Friedler Dental Group shares advice and latest techniques
THE SNEAKY, CREEPY CRACKED TOOTH: WHAT HAPPENED?!
In all my years practicing dentistry, I’ve noticed a greater number of cracked teeth during the Holidays. Why? We tend to be more distracted, stressed and eat foods that can bring about the final blow to a compromised tooth.
Most people are not “dentally-woke” – only paying attention to their teeth when they brush (usually for less than the recommended time) or smiling for a selfie or a family photograph, or when they have difficulty chewing something they love to eat or if they want their teeth looking good for social or business reasons. Add that often dental problems don’t hurt until it’s too late, and you start getting the picture.
Cracked teeth are not always obvious nor show symptoms but there are some hints that something could be awry such as on-and-off pain, swelling of the gum around the affected tooth, pain when chewing or biting, temperature sensitivity, “sweetness-shock” to name a few.
So, the question I get asked often is … why did this tooth cracked now? The answer is seldom straightforward. Aside from an obvious blow to the mouth from playing sports, a fist-fight, or an accident other factors that cause cracked teeth are more insidious: grinding your teeth when you sleep, large fillings- which compromise the integrity of the tooth, eating popcorn, chewing nuts and hard candy are all common, every day causes for broken teeth. And of course, the natural aging process.
While not every person presents a typical symptom, dentists can sometimes foretell during a routine examination and review of dental history if large fillings need replacement. Hygienists may alert the doctor if the gums are unusually swollen or if a certain tooth has a “catch” or even if there is an actual crack noticeable. Although X-rays may or may not show a small crack, magnification of the area under surgical loops or intra-oral camera may reveal if there is something going on. It is always best to address dental issues before there is an emergency.
If preventive treatment is not done or if you present with an emergency, the course of action is to first evaluate the type of crack:
• How extensive is the crack?
• Where is it located?
• Is it impacting the gums, bone and or other teeth?
There are five types of tooth cracks. Identifying and understanding them will determine the treatment options and prognosis.
• Craze lines – very common. They are asymptomatic, micro-fractures contained to the enamel and treatment -if any- would be for esthetic reasons. Good prognosis.
• Fractured cusp – complete or incomplete crack that extends below the gum-line. Root canal treatment and restorative work will commonly be needed depending on the severity and extent of the crack and in general terms it could have a good prognosis.
• Cracked tooth – treatment varies depending on multiple factors and prognosis is often questionable.
• Split tooth – complete fracture with tooth segments entirely separated. Treatment options must be discussed.
• Vertical root fracture – often times seen on x-rays, this type of fracture is mostly associated with a history of root canal treatment. The prognosis is virtually hopeless.
The biggest complication of a cracked tooth is an infection that can spread to the gums and bone. This complication is very serious for your overall health, and you should seek dental care to evaluate the condition and start antibiotic treatment.
Prevention is always the wisest choice.
• Visit your dentist for regular cleanings and check-ups.
• Keep a good in-home oral hygiene regiment
• Make sure kids have mouthguards if they play sports
• Seek treatment for grinding teeth (bruxism)
• Avoid chewing hard foods
• If you crack a tooth, keep the area clean, rinse with warm water, eat soft foods, take anti-inflammatory pain medication and put a cold compress on the outside of your cheek … and call your dentist.
• Do not delay treatment.
A PATIENT’S JOURNEY:
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