I think we’re cracking up

I’ve been seeing a LOT of cracked teeth lately.  They’ll present all sorts of different ways.  The mildest form, craze lines, are usually benign and just linger in the outer enamel shell of the tooth without causing trouble.  I’ll leave those alone.  I can find those in most patients.  It’s unusual to see deeper cracks in teeth that have never had a previous filling or cavity, but it happens if the patient loads their teeth with too much force.  Every material on the planet has a breaking point, even steel.  Teeth are no exception.  The jaw muscles are STRONG.  It’s been studied that teeth are supposed to touch each other 6 minutes a day, each chew about 1/2 second totaling about 6 minutes per day.  People who clench or grind their teeth, as a function of habit or stress, make their teeth touch way more than that.  Sometimes hours.  That’ll make the teeth have a workload 20-30x or more their intended amount.  That can cause cracks, and also TMJ disorder.

So how do you know your tooth is cracked?  Sometimes you don’t.  Sometimes you just get a pain on chewing or releasing the bite.  Sometimes you can look in your mouth and see the crack.  Sometimes a chunk of tooth comes flying off into your dinner plate.  Don’t feel like you have to apologize to the people you’re sitting at the table with, chunks of their teeth will probably come flying out one day too.  Sometimes the diagnosis is TOUGH.  Cracks can be invisible.  They can lurk underneath fillings and evade detection on X-Rays.  Sometimes a crack that has been present for a while will begin to amass stain and will highlight the crack for us.  Sometimes a crack will develop underneath a cavity that has weakened the tooth. In those cases we’ll usually catch the cavity and fix it, then incidentally find a crack at the base of it.

The treatment of cracks run the whole spectrum.  Sometimes they can be fixed with a filling if they are not too severe.  More commonly, the tooth should be crowned.  The crown will favor holding the tooth together more than a filling, which can act as a mechanical wedge to help drive the tooth further apart.  The dentist’s experience and judgement is needed to select the best treatment for each scenario.  There are times where a crack has reached the nerve in the center of the tooth and the tooth will require a root canal to save it.  The endodontist (root canal specialist) will access the tooth and determine if the root canal will resolve the problem, or if the crack has progressed into the root at which point, sadly, the tooth will need to be extracted.  A bridge or implant can be used to replace the tooth at that point.

The best way to prevent cracks, like almost everything else, is to come to the dentist for your cleaning and checkup every 6 months.  That tends to catch problems when they’re small.  Small problems are usually fixed with small treatments.  Teeth with tiny problems or no problems tend to crack way less frequently.

That’s about all.  Use a handheld device instead of your teeth when opening pistachios and walnuts.