To its credit, the practice of dentistry has become more and more focused on conservative and preventative treatments. The ease with which small cavities are diagnosed and treated has come leaps and bounds thanks to dental materials (tooth colored fillings), tools (laser and air abrasion), techniques (preventive resin restorations), and early detection (Diagnodent and digital x-rays).
Unfortunately there are still many old, large silver fillings that were placed in teeth from days gone by. Our ever ageing population, that is consistently pushing the bounds of life expectancy, has seen dentistry change for the better, but still exhibit dental procedures and materials from days gone by. Even when a cavity was small these old materials (amalgam, silver fillings, black fillings, etc.) had necessity to be a certain depth and certain width. Not to mention the practice of “extension for prevention” that resulted in removal of healthy tooth structure to prevent the recurrence of decay and promote natural cleansing.
Out of these practices came filled and overfilled teeth. These teeth coupled with the stresses and strains of time (grinding, clenching, ice chewing, missing teeth, teeth extraction for orthodontics, etc.) could cause cracks in the surrounding healthy tooth structure. Eventually these cracks can result in the fracture of a portion of a tooth or, woefully, the whole tooth through and through. So often the breakage of a tooth occurs on something as soft as sandwich bread, not so much the only culprit, but the “straw that broke the camel’s back”.
During your new patient evaluation at Suwanee Dental Care, we carefully evaluate your teeth. We inspect each tooth under magnification for visible signs of cracking. Cracking most often, except in extreme cases, isn’t visible on x-rays. There may not be symptoms present, but a cracked tooth can range from pain to biting and chewing which can be mild or intense. Pain may last for a brief or long time. The tooth could also be painful when eating certain foods or biting in a specific way. Usually there won’t be a constant ache. The tooth may also be more sensitive to cold.
I like to tell patients that we can treat these teeth proactively or reactively. With proactivity we address the tooth with visible cracks or mild symptoms prior to the fracture. This allows you, the patient, to dictate a more predictable outcome (in all likelihood just a crown or onlay) and treatment time (i.e. not on vacation or over a holiday weekend). With reactive treatment we let the crack run its course to the eventuality of a broken piece of tooth. With reactivity the treatment options become more murky. If the tooth simply breaks it may still need just a crown and now a re-build of the broken portion, making it more expensive. Sometimes the break is so bad that it will require a root canal, tooth re-build, crown lengthening and a crown, very expensive. Unfortunately common enough is the break that is so severe that it warrants removal of the tooth, leaving a dental implant or bridge as means of replacement, even more expensive. Along with being more expensive waiting for the tooth to actually break can tend to happen at the most inopportune times (family vacations, holidays, long weekends).
If you’re having symptoms already with a cracked tooth, such as a sharp pain to bite or release of the bite, then there is a logical, step-wise way to proceed. Crown preparation to help bind the tooth together is the best way to begin. During the time the tooth spends in a temporary crown is a very good barometer to see how the tooth will behave. If symptoms relieve then upon cementing the permanent crown the tooth will usually lead a happy and healthy life. Sometimes during the temporary crown phase symptoms will not resolve or will worsen. This tells us that a root canal will also be necessary to help relieve the biting pain. Rarely, but none the less unfortunate, even after root canal symptoms may still persist or be worse. These type of teeth are cracked so badly that removal is the only option.
So the recommendation from this dental professional is proactivity, but they are your teeth and you ultimately get to decide how best to proceed.
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