Baylor Dental Journal, Fall/Winter 2015
A cracked tooth may begin without warning as a tiny fissure on the chewing surface and begin its advance through the tooth undetected. It may lurk in silence even as repeated stress causes the crack to advance downward toward the nerve and blood vessels at the tooth’s center.
In other situations, a small crack can become a problem in an instant when a person bites down on something. Symptoms such as intermittent pain when chewing, sensitivity to hot and cold temperatures, and unpredictable stints of discomfort often prompt a patient to seek dental help.
In some respects, the “root” of the problem is positive: An observed uptick in cracked teeth cases is due largely to the increasing lifespan of the American population and the fact many people are keeping their teeth longer.
“Cracked teeth seem to be a result of repetitive stress injury, and so the longer teeth are in use, the more likely they will become cracked. This is a modern epidemic and something we have never before as a profession had to deal with,” says Dr. Robert Roda of Scottsdale, Arizona, immediate past president of the American Association of Endodontists.
At Texas A&M Baylor College of Dentistry, dental students and endodontic residents receive intensive education on early detection methods, says Dr. Gerald N. Glickman, professor and chair of the Department of Endodontics and director of its graduate program.
“Earlier detection and protection of teeth from the less severe cracks will keep them from propagating further, thus preventing tooth loss,” Glickman says.
When cracks in the teeth are not detected early, endodontists have their work cut out for them.
“Endodontists are the specialists in dental diagnosis, but sometimes cracked teeth will thwart even our best efforts,” Roda says. “The response of the pulp to a crack is sometimes very difficult to localize, and great care has to be exercised not to treat the wrong tooth.”
“Cracks can be hidden under fillings or other restorations, and they even occur on root surfaces under the gum line.”
The use of cone-beam computed tomography—a variation of traditional CT systems that uses a cone- shaped X-ray beam to produce 3-D patient images –has aided dentists in diagnosis, but even that tool just allows them to infer the presence of a crack.
Patients can take the offensive against this oral health concern by avoiding chewing on hard objects, being fitted for a retainer if they clench their jaw or grind their teeth, wearing a mouthguard during contact sports, and preventing dental decay.