Crack Tooth Syndrome

Yes , and grinding is very common habit. Almost every person will at some time in their life grind their teeth – usually due to stress. Unknown to you, grinding at night causes massive increase ( 200-300% ) in the stress  and strain on your premolars and molars . especially if you have worn down your canines and lost the protective “lift -off “effect they can give in sideways grinding jaw movements. You may benefit from either a night guard, or a permanent  addition to your canine to protect the back teeth from cracking . you may also have  susceptible toothanatomy (  genetic  )  like deep cuspal oinclines  or worned out fillings , where the “valleys “ on top of the tooth  are deep , not shallow. This put a lot more sideways splitting forces on the tips of the tooth during chewing, which leads to cracking. Even unfilled teeth can get cracks .

As the tooth flexes microscopically, the nerve stimulated. There are tiny fluid filled tubes ( tubules ) which are situated in the dentine ( inner core of tooth below enamel ).The tubules rundownto thenerve and as the tooth flexes microscopically, the crack open and closes, sucking and pumpingon these tubule, causing  fluid to push and pull on the sensitive nerve.

The nerve is aggravated by the crack and by the bacteria being pumped into via tubules. It becomes inflamed because of the toxins in the bacteria. A classic symptom of nerve inflammation is  excessive sensitivity to hot and cold .

The crack continuesto slowly propagate ( spread ) like a crack in glass. Some times crackgoes off to the side andfragment of tooth breakoff. Crack can also go deep into the rootand at times right in to the nerve. Teeth can oftenfor months in a stable yet inflamed condition. Some times they semto get better, only to suddenly get worse. It is hard to predictthe course of the untreated tooth, but usuallyit is slowdownhil slideas the crack deepns. Its not a good idea to leave it , because a small crack can be treated effectively, but bigger one can lead to root canal tretemnt or extraction if you are unlucky.The nerve can be attackedby the bacteria,leading to extremesensitivity to hot and cold / persistant ache in the tooth as it dies,usually of moderate to severe intensity. The infection in the nerve can then spread in to bone  underneath, causing an abscess  . The pain is usually severe and not always effectively controlled by pain killers or antibiotics.

Unless the crack is immobilized the tooth is very likely to deteriorate. Although various methods have been employed in an attempt to stick the crack together , chewing forces are extremely powerful, and these "patch up"  solutions are fairly unpredictable and ineffective . The only real solution is to bind the whole tooth together with a 'cap' or  'Crown'   ( same thing ), so that any chewing force moves the tooth as whole , rather than splitting it apart.

Most people prefer a natural appearance, therefore porcelain / porcelain fused to metal are made in most cases, You can have gold/ metal crowns if you prefer .Because most cracked teeth have large black amalgam fillings, an improvement in appearance results, which is some compensationfor the time and expense involved.

The crown is bonded over the entire tooth- this seals all the micro cracks and the variety of sources of bacterial leakage coming from the joints in the patchwork of fillings typically in these teeth. The nerve is now given its best chance at recovery because it has been hermetically sealed and the crack has been immobilized- but not necessarily a complete immobilization.

No, despite the best treatment about 10% of crack teeth have nerves that go on to die. The tooth can still move slightly within the jawbone and this slight  movement can flex the crack from underneath despite the crown on top. Some times the existing bacterial damage is  so substantial, that the nerve goes on to die regardless of what we do. Early treatment  is therefore recommended to minimize the size of the crack  and the extent of bacterial invasion.

The nerve will  die  and an abscess will probably develop. Therefore, the dead nerve remnants should be removed and the inside of the tooth cleaned and sealed.  This process is called Root Canal Therapy  ( RCT ). A small hole is made on the top of the crown  ( the crown cannot be removed with out  the risk of breaking  of tooth  or crown )  and access  obtained to the nerve for cleaning. Later on,the space inside tooth  is filled in with root filling material and  permanent seal on top . It is pity to have a hole in the crown , because it may  weaken the crown  slightly, but it is quick and uncomplicated solution  to the problem, with few longterm roblems.,If the hole really worries you, a new crown can be made if you don’t mid the additional expense. There is another option, and that is to cement the crown  with temporary cement, so that in the event of nerve dying, the crown can be removed  and reconnected later when the RCT is completed.This saves having a hole drilled in it, but comes with its own set of problems- and you must decide if you are prepared to accept these. Firstly, if the crown is put on with temporary cement it will eventually come off. Depending on type of cement and the retentive ability of the crown  this could be 3 months to 5 years. Usually 99% of the time,the crown will come off and you will notice it and retrive it, so that all ends well. However, you may bite on it, break it or the opposing tooth or swallow it accidentally- so you  need to consider these possibilities before you make  your decision, because you may need  to pay for the cost  repairs or a new crown. After the crown falls out  you  can elect to have it recemented again with temporary cement  or have it cemented permanently. If enough times has passed to decide with fair degree of certainty that the nervehas survived, you may want to go permanet cementation. Discuss with your dentist . because the time needed  to reach a reasonable safety zone varies from 3 months to 3 years. Clinical judgement  and many complex individual case factors need to be taken in to account, and even despite the best efforts, some nerves go on to die after permanent cementing  ( some times years later ). You should also note that the cost of making  your crown  includes cementing it once only. If you elect to cement it temporary cement extra expense will be involved.

Yes. Cracks in teeth can develop slowly and this can allow  a slow ingress of bacteria in to the nerve. Asa result, the nerve can die in a manner that is less noticeable than usual..Nerves can become mildly sensitive to hot and cold, and then die, or they can die with out  any noticeable symptoms or pain. Many patients have teeth which, unknown to them, have dead nerves. Sometimes there are even dormant abscess on these teeth and patient still does not know.

Sometimes you can get away with it for a while, but unfortunately these teeth are like ticking time bombs. The low-grade infection that is usually in them can suddenly flare up and cause pain, swelling and pus. This usually happens when your immune system is down-often because of stress from an important life event. A dental crisis is the last thing you need at this time. It is best to treat it as soon as possible to minimize the size of bone destruction that occurs at the end of root, where the infection comes out of the tooth and into the jaw.

Yes, and even more so. You need a crown now to stop the existing crack

( which was severe enough to kill the nerve ) , spreading down the brittle root   causing root fracture . these nasty occurrences result in an untreatable problem, and extraction of hole tooth is required.

Crowns are needed on ‘dead ‘ teeth even more so than teeth with living nerves, because they become  surprisingly brittle and very prone to these unfortunate types of crack, it is standard practice to put a crown on a tooth  that has had root canal treatment because of the risk  of this crack developing. If there is already a crack, then it would be unwise not to put a crown on it. There fore if you have crack tooth syndrome , be it in a tooth with living nerve or dead one , you need the protective wraparound effect of a crown, regardless

The actual root treatment is about 95%  successful. However, where there is a crack in the tooth which is completely not immobilized a further 10% of those root treated teeth will get continuing pain when  the tooth is bitten on, or sometimes pushed from the side. This is due to crack movement irritating the tissues around the tooth known as periodontal ligament. There is no treatment other than extraction for these rare cases. If you end up losing the tooth there are options for replacement – an implant in to the bone which supports a new tooth, a conventional bridge ( caps on the teeth on either side of the gap, fused to a false tooth resting  just above gum ), a Maryland bridge ( with special wings instead of caps – but not universally applicable ) or a partial denture .