I just got a lucky break?


Cracks in teeth don't get better. They either stay the same or get worse by propagating further into the tooth. They can be symptomatic either some or all of the time. Most do not hurt until they worsen  enough to cause a noticeable symptom. This can be evidenced by intermittent pain on chewing, sensitivity to cold and sometimes in severe cases,  hot as well.

When I examine a patients mouth during their  recall appointment, I try to note any obvious cracks e and then ask the patient if they have had any symptoms from that tooth. I may percuss a cracked tooth and the adjacent teeth as well( tap with the back end of a mirror handle) to see if the cracked tooth "feels differently" than its neighbors.

During my examination I ask the patient if any of their teeth are bothering them and if they respond that one quadrant or another is occasionally sensitive when chewing, I try to figure out which tooth is the culpret. Often the tooth with a large silver is the culpret and my hygienist makes a note. If on a subsequent recall this tooth is still a "problem" I often recommend removing the tooth's filling and looking inside to possibly visualize a crack underneath.

Sometimes a patient with a tooth, previously on my watch list, comes in with a "broken tooth". A piece of the tooth has come off and what remains is easily restorable with a crown. I tell them that this is a "lucky break"; the break didn't compromise the long term prognosis of the tooth and only a crown is needed.

What would be termed an "unlucky break"? A tooth that lost tooth structure below the level of the bone or one in which the body of the tooth cracked it  down the middle creating two separate pieces, neither of which can be saved. These teeth often need extraction or in the first instance a crown lengthening procedure. Another type of break can be a vertical crack that travels into a tooth pulp chamber. These cracks can compromise the pulp and even the long term prognosis of a tooth, even after a necessary root canal,  since the crack my actually travel to the level of the bone. These teeth may end up being crowned, but have a guarded prognosis.

To avoid the possible loss of teeth with apparent cracks I usually advise crowning the tooth in order to protect the remaining tooth structure. Many times the cracks can not be eliminated by using a drill alone, but do benefit with the protection that "full coverage" by either a crown or onlay restoration. Although not a fool proof solution, this clearly the best way to protect the remaining tooth structure from further damage.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/06/i-just-got-lucky-break.html - http://lspindelnycdds.blogspot.com/

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