The treatment of Cracked Tooth Syndrome is fairly complex and you may not remember all the details mentioned to you at the time of your visit.
Cracked tooth syndrome is a very common problem, usually affecting teeth that are heavily filled. The decay and subsequent filling causes a weakening of the remaining tooth structure. Like all materials, teeth are subiect to stress fatigue.
After many bites on the tooth, (stress cycles), a hairline fracture can develop, usually at the bottom corner of the cavity. If you are under a lot of psychological stress, you may grind your teeth (usually at night).
Yes, and grinding is a very common habit. Almost every person will at some time in their life grind their teeth- usually due to stress.
Clenching/grinding at night causes a massive increase (200%-300%) in the stress and strain on your premolars and molars, especially if you have worn down your canines and lost the protective “lift-off” effect they can give in sideways grinding jaw movements. You may benefit from either a night guard, or a permanent addition to your canines to protect the back teeth from cracking. You may also have susceptible tooth anatomy (genetic) or worn down fillings, where the “valleys” on top of the teeth are deep, not shallow. This puts a lot more sideways spliting forces on the tips of the tooth during chewing, which leads to cracking. Even unfilled teeth can get cracks.
As the tooth flexes microscopically, the nerve is stimulated. There are tiny fluid filled tubes (‘tubules’) which are situated in the dentine (the inner core of the tooth, below the enamel).
These tubules run down to the nerve and as the tooth flexes microscopically, the crack opens and closes, sucking and pumping on these tubules, causing fluid to push and pull on the sensitive nerve.
The nerve is aggravated by the crack and by the bacteria being pumped into it via the tubules. It becomes inflamed because of the toxins in the bacteria. A classic symptom of nerve inflammation is excessive sensitivity to hod and cold.
The crack continues to slowly propagate (spread) and the fragment of tooth breaks off. The crack can also go deep into the root and at times right into the nerve.
Teeth can often go for months in a stable, yet inflamed condition. Sometimes they seem to get better, only to suddenly get worse. It is hard to predict the course of the untreated tooth, but usually it is a slow downhill slide as the crack deepens. It is not a good idea to leave it, because a small crack can be treated effectively, but a bigger one can lead to root canal treatment or extraction if you are unlucky.
The nerve can be attacked by the bacteria, leading to extreme sensitivity to hot and/or cold and a persistent ache in the tooth as it dies, usually of moderate to severe intensity. The infection in the nerve can then spread into the bone underneath, causing an abscess. This pain is usually severe and not always effectively controlled by pain killers or antibiotics.
Unless the crack is immobilized the tooth is very likely to deteriorate. Although various methods have been employed in an attempt to stick the crack together, chewing forces are extremely powerful, and these ‘patch up’ solutions are fairly un predictable and ineffective. The only real solution is to bind the whole toothtogether with a ‘cap’ or’crown’ (same thing), so that any chewing force moves the tooth as a whole, rather than splitting it apart.
Most people prefer a natural appearance; therefore porcelain fused to metal crown is made in most cases. Because most cracked teeth have large black amalgam filligs, an improvement in appearance results, which is some compensation for the time and expense involved.
The crown is bonded over the entire tooth-this seals all the microcracks and the variety of sources of bacterial leakage coming from the joints in the patchwork of fillings typically in these teeth.
No! Despite the best treatment about 10% of cracked teeth have nerves that go on to die. The looth can still move slightly within the bone and this slight movement can flex the crack from underneath despite the crown on top.
Sometimes the existing bacterial damage is so substantial, that the nerve goes on to die regardless of what we do. Early treatment is therefore recommended to minimize the size of the crack and the extent of the bacterial invasion.
The nerve will die and an abscess will probably develop. Therefore the dead nerve remnants should be removed and the inside of the tooth cleaned and sealed. This process is called Root Canal Therapy (RCT) or Endodontic Therapy.
Yes. Cracks in teeth can develop slowly and this can allow a slow ingress of bacteria into the nerve. As a result the nerve can die in a manner that is less noticeable than usual. Nerves can become mildly sensitive to hot and cold, and then die, or they can die without any noticeable symptoms or pain.
Many patients have teeth which, unknown to them, have dead nerves. Sometimes there are even dormant abscesses on these teeth and the patient still does not know.
Sometimes you can get away with it for a while, but unfortunately these teeth are like ticking time bombs.
The low grade infection that is usually in them can suddenly flare up and cause pain, swelling and pus. This usually happens when your immune system is down – often because of stress from an important life event.
A dental crisis is the last thing you need at this time. It is best to treat it as soon as possible to minimize the size of the bone destruction that occurs at the end of the root, where the infection comes out of the tooth and into the jaw.
Yes, and even more so. You need a crown now to stop the existing crack (which was severe enough to kill the nerve), spreading down the brittle root.
This is called a ‘vertical root fracture’. These nasty accurrences results in an untreatable problem, and extraction of the whole toothe is required.
Crowns are needed on ‘dead’ teeth even more so than teeth with living nerves, because they become surprisingly brittle and very prone to these unfortunate types of cracks.
Regardless of how a nerve dies, crack or no crack, it is standard practice to put a crown on a tooth that has had root canal treatment because of the risk of this crack developing.
If there is already a crack, then it would be unwise not to put a crown on it. Therefore, if you have cracked tooth syndrome, be it in a tooth with a living nerve or a dead one, you need the protective wraparound effect of a crown, regardless.
The actual root treatment is about 95% successful. However, where there is a crack in the tooth which is not completely immobilized a further 10% of those root canal treated teeth will get continuing pain when the tooth is bitten on, or sometimes pushed from the side.
This is due to the movement irritating the tissues around the tooth known as the periodontal ligament. There is no treatment other than extraction for these rare cases.
For the healthiest gums use these formulas for brushing, flossing, massaging gums, mouth-rinses, proxa-brushes, sulca-brushes, rubber-tip stimulators to overcome sensitive teeth, to ease the recovery of oral surgery, and for general overall cavity prevention.
A beautiful smile can give patients a lifetime of happiness!