Cracked Teeth

Amy Beth Dukoff, D.M.D.
Cracked Teeth

Amy Dukoff	RACKED TEETH are usually difficult to diagnose, but they are commonly seen in practice. Naturally, we see them in older patients, since their teeth have been in use for a long time, subjected to years of the stresses and strains of mastication. However, in practice, I have seen them in patients of all ages, since a crack may be caused by a single incident as well as cumulative stresses. Often, the patient who has a cracked tooth reports eating hard foods, such as hard candies, ice, popcorn, hard breads, nuts, or dried peas. Continued mastication of hard objects very often causes fatigue of the tooth structure, which could lead to cracks. Also, occlusal aberrations can weaken the tooth structure and eventually create a crack, as can such habits as clenching and grinding. Many times a “crack” sound is heard immediately, but the crack may actually have been present but undetected for a while. When a crack occurs in a tooth with a restoration, or in a tooth near one that has a restoration, the patient may jump to the conclusion that the pain he or she feels is the fault of the dentist. Diagnosis can be a frustrating experience for the practitioner, who may be unable to see anything “wrong” with the patient’s tooth restoration. The patient and the dentist have to come to a mutual understanding about the condition of the tooth and the nature of the crack. When a cracked tooth requires treatment, the nature, location, and severity of the crack may suggest a variety of treatment options with a variety of prognoses. The anatomy of certain teeth makes them more susceptible to cracks. The cuspal height and shape may increase the force on the tooth’s structure, leading to cracks. Keeping a tooth “healthy” is important in preventing cracks; therefore, care should be taken as to all aspects of the tooth. In diagnosing a crack, transillumination, microscopic evaluation, x-rays, staining techniques, and a bite stick are important. Transillumination helps the dentist to visualize the crack by the difference of the transmitted light through the tooth since the crack blocks light, causing a dark appearance. Microscopic evaluation helps to clinically detect the extent of the crack when it is near or in the root. Radiographs can show the bone breakdown around the tooth, which can help determine the size of the crack. Various stains, such as methylene blue, may also help visualize the crack. Lastly, a bite stick could help reproduce the patient’s symptoms and thereby help in locating the crack. These are just a few aids used to identify cracks. Cracked teeth can be a diagnostic challenge. However, resolution of the patient’s problem is satisfying. Proper techniques in diagnosing and analyzing the clinical condition are likely to lead to a good result. Summer 2004
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