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It’s Not All It’s Cracked Up to Be!

It’s Not All It’s Cracked Up to Be!

It’s Not All It’s Cracked Up to Be!

by Bill Kuttler, DDS

“You crack me up” is an old saying meant as a term of appreciation for someone else’s sense of humor or ability to tell a good and funny story.  It’s a positive statement.  But when it is applied to teeth, it isn’t funny any more.  Teeth often develop cracks and those cracks sometimes result in the tooth breaking or splitting—not a good thing.  That can lead to the loss of a tooth or, at the very least, an extensive filling or a crown (cap).  Unfortunately, unlike bones, when a tooth cracks it stays cracked.  By that I mean that it does not repair itself.  The crack may remain the way it is or it may progress, but it never heals.

“Why does this happen?” is one of the more frequent questions I’m asked.  And while there isn’t any simple answer, there are several possibilities that probably make up the large percentage of causes.  One of the leading causes is people chewing on hard objects such as pens or ice cubes.  If you don’t chew on ice, you probably can’t imagine anyone doing it.  But for many people, it is “normal”.  And essentially what those people are chewing on is equivalent to chewing on rocks.  No wonder, over time, their teeth give up and crack or break.

Another common cause of cracks is people who either clench their teeth together or grind them.  Some people do that while they sleep but others may do it while they are doing things they find stressful or when they are physically exerting themselves.  Examples of that might be lifting weights, driving in heavy traffic, or concentrating intently.  Again, the relatively constant stress applied to their teeth ultimately causes cracking and breaking.

Perhaps a more subtle cause, but one I suspect happens more than we might suspect, comes from eating or drinking alternating hot and cold foods.  I learned at an early age not to take a dish from the refrigerator and place it in a hot oven.  It broke—the temperature shift was too great for it.  Yet I have been known to eat ice cream while drinking hot coffee and haven’t thought much about it.  That places a huge amount of stress on our teeth over and over again…and over time, can lead to cracks or breaks.

Ironically, if your tooth breaks, the solution is fairly simple.  If it is repairable, your dentist will restore it as best she or he can.  That may involve a filling or restoring the tooth with a complete crown if the damage is extensive.  And, unfortunately, if the damage is too extensive, the tooth will need to be removed and then you and your dentist can decide the best way to replace it.

The greater challenge for your dentist, if your tooth is cracked but not broken, is to decide what treatment, if any, to recommend.  If it is bothering you, you will want some type of treatment to make it feel comfortable.  But if it isn’t, there are choices ranging from doing nothing to crowning the tooth.  And there are a lot of variables that make that choice a complicated one.

I am currently involved with a four year study that involves dentists around the country evaluating cracked teeth, deciding what is the best way to treat them, and then monitoring those same teeth over the four years to attempt to determine which alternative worked the best.  The study is done under the guidance of the National Dental Practice Based Research Network whose mission is to research topics that will be immediately relevant to dental practitioners and the people they serve—you.  As a practitioner, the decision I make is sometimes easy—the crack is severe enough or has decay around it that it must be repaired.  But other times it is very uncertain.  In those situations there probably aren’t any “wrong” answers, but it is often not clear what the “right” or “best” answer is.  I hope this study will help us all learn what that is so I can assist my patients and other dentists in making the best decision possible to deal with what is occurring and the best way to treat it.

When the results of the study start coming in a few years, I’ll share what we have learned!  Until then, try to prevent cracking them up.  If you chew ice or other hard objects, STOP!  If you clench or grind, talk to your dentist about mouth guards to help protect your teeth.  And give your teeth a break (the good kind!) by not biting into super hard foods and not alternating hot and cold foods and beverages in close proximity to one another.  Prevention IS still the best approach!