Chicago Dentist for Life

When your Dentist tells you that you need some form of dental treatment…

…check this blog first and educate yourself so you know what to expect.

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Question 1: What are some signs and symptoms of a cracked tooth?

Answer 1: The most common symptom of a cracked tooth is a quick, sharp pain when chewing something such as a bagel, bread, crust or similar food.   The pain lasts only a second, but can be very startling at the beginning. The most commonly cracked tooth is the lower second molar, but can be on many other teeth.  It is one of the most difficult dental problems to diagnose and, in fact, is very often diagnosed by a process of elimination.  Clinically, the tooth may show a tiny surface crack, but not always.  The x-ray usually is normal in appearance and the tooth may have a large filling or even no filling at all.

Question 2: What is the treatment for a cracked tooth?

Answer 2: The treatment, like the diagnosis, can vary. If your symptoms are minimal, nothing may be done. If pain occurs with hard chewing only, the tooth can be prepared for an onlay or crown to see if binding the structure together eliminates your discomfort. If the tooth is sensitive to heat or cold, or you feel a dull ache or pain with even light chewing, nerve tissue may be involved and endodontic treatment is recommended. If infection has developed or the crack is extreme, extraction of the tooth may be the only option.

Question 3: Does a crack ever heal itself?

Answer 3: Unlike bone, the cracked tooth never heals. That is why we recommend beginning restorative work immediately. Delaying treatment can allow a minor crack to worsen and require more extensive treatment.

Question 4: How does root canal treatment eliminate pain in a cracked tooth?

Answer 4: It eliminates the pain coming from the pulpal (nerve) tissues inside the tooth. The fibers around the tooth (the ligaments and bone) can still create some discomfort, but not the intense pain caused by the nerve tissues. While creating a completely normal-feeling and pain-free tooth can’t be guaranteed, eliminating those pulp tissues, along with restorative work, can bring very satisfactory results.

Question 5: What is an endodontist and how would they treat a cracked tooth?

Answer 5: An endodontist is a dentist who specializes in treating diseases of the pulp (the nerve and connective tissues inside the tooth) and the periapical tissues (the tissues around the root end such as bone and periodontal ligament). The endodontist frequently sees dental patients in emergency situations, as the most severe dental pain occurs from the root canal system. For a cracked tooth, an endodontist would perform root canal treatment to eliminate the affected pulp tissues, easing discomfort and pain.

Question 6: If a patient has cracked tooth syndrome and root canal treatment is indicated, what can be expected?

1. is it painful?
2. how many visits will it take
3. how long is each visit
4. how effective is root canal therapy in treating cracked tooth syndrome?

Answer 6: We understand that patients are frequently in pain by the time they visit the endodontist and should not have to endure any additional discomfort during treatment. We use local, injectable anesthetics that are incredibly effective in ensuring there is no pain associated with a root canal treatment. Treatments can take one or two appointments of 45 minutes to one hour each, with the anesthetics lasting about four hours to ensure a pain-free treatment. Root canal therapy is very predictable, with some of the highest success rates for medical/dental procedures. However, the long term success in treating cracked tooth syndrome is more unpredictable because we don’t always know the extent of the cracks in each individual case. While there are many excellent techniques available today for replacing teeth, none are as good as your own natural tooth. That’s why our number one priority is always to help you keep your teeth for a lifetime.

Question 7: So a combination of restorative dentistry and root canal therapy is the best long-term treatment for most cases of cracked teeth?

Answer 7: Absolutely, the prognosis for these cases is very good. The key is early diagnosis and prompt treatment.  Our ability to diagnose gets better every year due to more advanced techniques for visualization (cone beam and CT scans), while treatment discomfort has been virtually eliminated.

Question 8: Is it possible to prevent cracked tooth syndrome? What precautions can you take if you’re at greater risk–a history of a cracked tooth, a weak-looking tooth or are a heavy teeth clencher or grinder?

Answer 8: Prevention is not always possible, but it makes good sense to take precautions in higher-risk situations.  Patients with deep anatomical pits and fissures, who may have previously had cracked or fractured teeth, should be watched more closely for crack detection.  In addition, consider doing restorations such as onlays or crowns to protect the cusps on those teeth—and do it early.  Older restorations should be examined thoroughly for early signs of cracks or fractures. If your teeth show excessive wear patterns, protect them with bite guards or proper bite adjustments as needed.   Other teeth to watch: those with fractured cusps, cracked teeth, split teeth (the pieces have separated) and vertically root fractured teeth (fractures that start below the gumline, such as when a posted tooth has split from the root end toward the crown). Don’t be concerned if your teeth have “craze” lines—these are tiny cracks that affect only the outer enamel of the teeth and do not need to be treated.

Information courtesy of:

Lester B. Chernick, DDS

Loyola Univ. School of Dentistry

Northwestern University Endodontic Resident and Specialty Certificate
Clinical Associate Professor of Endodontics for 11 years

Partner: Water Tower Endodontics

www.Watertowerendo.com

info@watertowerendo.com