Cracked Teeth - Preventing Catastrophe
We live in an age where we no longer use our teeth as tools; we have generous amounts of nutritious foods, an understanding of how to maintain our teeth, and access to modern dental care. Yet, in the face of all these positives, there is a looming challenge around the loss of teeth.
Cracked Teeth – Yes, this is something that I do see historically, on occasion. However, I cannot remember a time when I have seen the high number of hopelessly fractured teeth that I have seen in the last year. I’m pretty sure that my readers have a fair idea of why I suspect this is happening. Grinding and clenching of teeth.
Stress. And who wouldn’t be? So, apart from mentioning the obvious, omnipresent stress input we’ve been living with over the past 18 months – my focus for this article is better aimed at some of the management around cracked teeth.
If we discount stress from the cracked tooth equation (and we really cannot – because adverse loading is one of the major inputs to cracked teeth) – the next most fundamental cause is small, innocuous silver amalgam fillings. On numerous occasions, I’ve seen these small fillings – noticed the shadowing and what appears to be minor cracking around these teeth – and advised the patient that they should have the restoration replaced. The usual response from many of these patients is, “it’s only a small filling – and I’ve had it for years, and it’s never given me any problems.” True.
The problem with these small amalgam fillings is they exhibit a property called creep. With repeated loading, the filling gets flatter and wider, and as it’s getting wider, it is cracking the tooth. Counter-intuitively, this cracking is most dangerous when the filling is small – it’s kind of like the thin edge of the wedge. Frequently, this ‘wedge’ is driving down through the middle of the tooth, creating cracking right in the body of the tooth. This is the anatomy of catastrophic outcomes from cracking.
What is the solution? Ideally – catch it early and simply replace the amalgam filling. Another solution is a composite resin crown – where the biting surface of the tooth is rebuilt in a solid wafer of resin. This can often shore up the tooth and provide adequate strength as well as greater distribution of loads. But not always.
Sometimes when the cracking runs below the filling close to the nerve of the tooth, the nerve in the tooth will die, and there will be a necessity for root canal therapy if the tooth is to be kept.
Sometimes, due to the lack of space in the bite, even one of our composite resin crowns won’t be strong enough. The patient will still get symptoms from the tooth (usually the last tooth on the lower jaw), and we may need to transition to a crown.
Unfortunately, this is an area that I’m struggling to provide effective, tooth conserving solutions. In cases of extreme loading, I’m still resorting to crowns – usually metal crowns for ultimate strength.
Nightguards can help. These are like a mouthguard that has been adjusted to your bite. Wearing at night can create a ‘cushion’ between the top and bottom teeth – providing some protection from adverse loading.
The most conservative solution, of course, is meditation and the development of higher consciousness with less stress. Yes: this is ideal, it is cheap, and it will benefit all areas of your life. But it does take time, it takes discipline, and it may even require courage… to believe it can help.
DR ALEX HUSZTI BelleDental
Alex has had a career focused on low-biologic cost reconstructive cosmetic dental care – common sense teeth for life.
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