Cracked Teeth Don’t Always Hurt…
Cracked teeth with silver mercury fillings usually don’t hurt, but need attention before they split!
This finding is fairly common when I examine patients, especially those who brux or grind their teeth at night. When I perform a dental examination I look closely at the biting surfaces of my patient’s teeth. Not only am I on the lookout for cavities and broken fillings, but I am also looking for white or black lines that may be evidence of a vertical crack. Although it is tempting to leave teeth alone when there are cracks that are not painful, this probably is not the best approach.
Cracks in teeth do not heal themselves and cracks tend to spread as time goes by. Waiting until a cracked tooth hurts is probably not an optimal approach. I find that the best way to deal with most teeth that have a visible crack like in the above photo (taken of a new patient to our practice yesterday) is to clean out the tooth. This involves taking out any existing filling in the tooth and also making a channel at the site of the visible crack. This channel is usually approximately 2 mm deep for back teeth (premolars and molars) and shallower for front teeth. Once the channel is completed and any fillings removed, I shine a bright bonding light on the tooth in order to help find any more cracks in the tooth, and I also take a close-up photograph to look at on our computer monitor. If there are not remaining cracks in the tooth then the tooth can be either filled with composite (tooth-colored plastic filling) or if the amount of missing tooth warrants it, a dental implant can be planned, or even completed the same day. Not all front teeth with cracks need crowns, this all depends on the patient’s bite and how the front teeth meet or if there are missing back teeth. Occasionally some front teeth with cracks can be bonded as a repair.
Most back teeth with cracks that are still visible after cleaning out should be crowned. This treatment will help distribute the biting forces to the tooth and help prevent cracks from getting larger. If the crack is significant, the patient is advised that if the tooth becomes symptomatic after crowning it may require root canal therapy.
Dr. Andrea Stevens is a cosmetic and family dentist in practice in Kanata, Ontario. If you have dental questions, you can call her at 613.271.7091.