Cracked Teeth?

I make my living from the advent of people’s misfortune – as do auto mechanics, veterinarians, clergymen, and plumbers. I wish it was not this way, but that’s just how it is.

A common question, then, is when do I suggest a fix, lobby for intervening, urge treatment, or do nothing?

This week’s discussion focused on cracked teeth, a very common observation that is often insignificant and occasionally a complete loss. I believe it would be safe to say that cracks in teeth exist in every adult’s mouth. Most of these are superficial in nature, restricted to the outer enamel layer, have no symptoms, and require no treatment.

The difficulty comes in figuring out how deep a crack is or how likely it is to propagate. A crack can extend horizontally and break off a piece of the tooth. If the patient is lucky, this requires a crown. If the crack runs into the nerve, a root canal is needed. If the crack runs down to the root, the tooth is hopeless.

This week’s picture is one of hopeless teeth. The patient has a broken-down filling we were going to replace. In addition to this, she mentioned that the tooth had recently developed a “zinging” soreness to biting that didn’t linger.

This suggests a crack in the tooth that went past the enamel, into the soft living dentin layer, but not into the nerve, as these typically have more severe unsolicited pain. But no crack was visible to start.

There was a big SURPRISE waiting when I removed the old filling. A crown over this tooth some time ago would have prevented the crack from propagating, but without symptoms or obvious visible findings, who would have known?

Replacing this lost tooth is a subject for another time.

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