Sometimes difficult to see, sometimes difficult to diagnose.
When a tooth breaks or has a visible crack then it is easier to see. However more often than not teeth are sensitive because of cracks in teeth that are not visible either to the eye or by taking an X-ray.
The pain may come and go and be difficult to localise.
Symptoms
- Sensitivity to cold or heat
- Tenderness on chewing food
- Sensitivity to sweet foods
- Tooth has broken
Why does this occur?
- A history of clenching or grinding of teeth
- Trauma to the teeth e.g. a blow to the front of the mouth
- Mercury amalgam fillings - as amalgam ages it expands and cracks teeth. It is not uncommon for people to say "I was only biting into a sandwich (or something soft) and the tooth broke"
What are the treatment options?
95% of teeth with cracks require a restoration, which covers the tooth and prevents further fractures
50% of teeth may require nerve treatment or extraction
- The use of bonded filling materials (composite resins)..
- The placement or bonded porcelain restorations CEREC
- The use of crowns- porcelain or porcelain fused to gold.
Highlighting the difference between a cavity prepared with a bonded composite (above left) where the filling physically bonds to teeth and therefore requires much less tooth to be removed.
Compared to an amalgam filling (below left), which does not bond to teeth and must be undercut to lock the filling in requiring more tooth removal.
An amalgam filling is far more likely to crack a tooth because:
- Of the undercut tooth structure
- As amalgam ages it expands and cracks the tooth at the weakest point (in red)
Even teeth with smaller amalgam fillings show signs of a crack
Here the entire cusp of a lower molar has fractured off.
A sequence of 3 photos below showing the extent of cracking that can occur
Note:
The crack occurs below the gum line and very close to the nerve of the tooth.
