Cracked teeth: How Do We Treat Them?
Patients frequently notice craze (a network of fine cracks on (a surface). lines on their front teeth but they are asymptomatic. These are usually craze lines in the enamel and do not go through into the dentin. So, no treatment is required. They are quite commonplace.
But cracks on the molars where you can see a crack, usually at the back biting surface of the molar, is quite a different story. So, we break these down into symptomatic and asymptomatic.
Treating Cracked Teeth in the Past
With the asymptomatic in the past, I could ignore them, and addressed them only when they became symptomatic. This group usually did fine. Then there were some cases where I placed a small filling with the hopes of giving some support to keep the crack from getting larger. As long as there were no changes or pain, I could go with that. There is a school of thought that these should all be crowned, and that is a reasonable choice.
If the patient had some chewing pain with these cracks but the tooth did not hurt all the time and there was no pathology on the x-ray, I would recommend a crown. This worked most of the time, but if mild pain occurred I would have the patient wait. If the pain didn’t resolve or if the patient was experiencing moderate to severe pain, I would refer the patient to an endodontist for root canal therapy. Yes, there was some guesswork, but starting from conservative treatments seems like the best route.
Using a CT Scan to Evaluate Cracked Teeth
Now I can take much of the guesswork out of the equation. I refer the patient to my root canal specialist for an evaluation. He has a CT scan that can give more data to the state of the crack. The endodontist will recommend either a) no treatment, or b) place a small filling in the area where the crack is, or c) place a crown on the tooth and do a root canal if the tooth becomes symptomatic, or d) perform root canal therapy then place a crown on the tooth, or e)extract the tooth.
If the endodontist can see a crack going down the side of the tooth, treatment is futile because the tooth will not respond favorably to any treatment. In this case I have spared the patient of the inconvenience of unnecessary treatment and cost…but I could not diagnose this without the instrumentation that gives me this data. So now I can go into this problem knowing that I have made the best guess for the patient with the help of my endodontist.
As dental technology evolves, so does our ability to help our patients at Lohmann Dental.