Cracked Tooth Syndrome Feb 16


Cracks in teeth can happen, and have the potential to cause the same amount of pain as a tooth ache. But the question is how do you get a crack in a tooth? Is it only trauma that causes a crack? How does a crack cause a tooth ache? Below is answers and more on of dental cracks. 
 
Definition
  • Crack - Break without complete separation of parts.
  • Infraction - A fracture without displacement.
Longitudinal Fracture:
  • Vertically 
  • Size and extension changes overtime (usually)
Horizontal Fractures:
  • Generally traumatic 
 
Classifications
 
Craze lines - Often times people will note very faint lines in their front teeth. These generally only stay in the outer layer of the tooth or the enamel. Most often seen in anterior teeth and in patients over 40 years of age. They are fairly innocuous and usually do not produce pain or symptoms. They may be an aesthetic issue in which case restorative camouflage can be discussed if necessary. 
 
Quick Bits:
  • Outer layer / only in enamel (external layer of the tooth)
  • Most often seen in anterior teeth
  • Generally all patients over 40 / have craze lines 
  • Fairly innoculous 
  • No pain
  • May be an aesthetic issue
Fractured cusps - Are often seen in restored teeth. If a tooth has been heavily restored and has quite a large filling, there is a chance that the tooth over time may get a crack or fracture. These types of fractures can often be repaired with restorative material; however, in some cases if a tooth is substantially weakened full coverage or a crown may be necessary to prevent any further cracks or fractures. In some cases they types of fractures will not produce any major symptoms; however, if it is very deep and close to the pulp it may produce pain. In some cases root canal therapy or extraction may be necessary if the tooth will not settle.
 
Quick Bits:
  • Through enamel into dentine
  • Extends through the outer surface of the tooth
  • Transillumination -> I very bright light can be flashed on the side of the tooth to look for evidence of a crack.  
Cracked tooth - This a fracture that is getting deeper than the cusps on the teeth. These fractures generally occur in a front to back direction. This type of fracture is still within the top of the tooth only, or the crown of the tooth. It is often more centrally located than a fractured cusp and unfortunately more likely to cause pulpal or nerve troubles leading to a tooth ache. 
 
Quick Bits:
  • Usually in the front to back 
  • Fracture is in the crown only 
  • More centrally located than fractured cusp 
  • Far more likely to cause tooth complications 
Symptoms:
  • Often hard to pin point or hard to find the offending tooth
  • Pain on chewing (most common)
  • Cold hypersensitivity 
  • Sweet sensitivity (least common) 
Treatment:
If the tooth settles 
  • The tooth is stabilised
  • Symptoms are re-assessed in 2 weeks 
  • If symptoms settle considerations for full coverage or a crown long term
  • A root canal may be necessary long term 

If the tooth does not settle

  • Consideration of either saving the tooth or extraction
  • If keen to save the tooth is stabilised
  • Root canal therapy is started the inside of the tooth is examined for cracks 
Split tooth - This is an extension of a cracked tooth, in this case the tooth is truely split into two pieces. Often times the only course of action is extraction or removal; however, in some the tooth many still be saved but extensive treatment may be needed. Treatment of the gums and inside the tooth may be necessary. 
Quick Bits: 
  • Extension of a cracked tooth
  • Front to back
  • Split tooth is the evolutionary end-pt of a cracked tooth
  • Prognosis dependent on apical extent of fracture
  • The tooth may or may not be restorable 
Vertical root fracture - Is a fracture that originates in the root of the tooth. In most cases vertical root fractures are the result of root treated teeth. In which case the tooth has had root canal therapy and subsequently fractured. In cases of vertical root fractures the gums often become inflamed and sore beside the tooth with a very deep pocket. 
Quick Bits: Originates in the root 
  • Can involve one side or both
  • Fractures run in a buccal/palatal direction
  • Initiates within the root 
  • Usually minimal signs and symptoms
  • May be diffuse bone loss
  • Can be very difficult to diagnosis
  • Can mimic periodontal disease or failed RCT
Treatment:
  • Extraction or removal 
 

If you wish for more information on Cracked Teeth or have any concerns please do not hesitate to contact Skygate Dental today on (07) 3114 1199 or 0406 579 197.