May 4, 2000
Dear Dr. Mady: I have a tooth that has been hurting me when I chew for about six months. It hurts the most upon the opening portion of my chewing and my dentist feels that it is cracked. He wants to place a crown on it to correct the problem. What do you think of all this? - T.S.Y.Dear T.S.Y.: Evidently your dentist is on the right track with respect to both diagnosis and treatment of your uncomfortable situation. Fortunately people today are living longer lives and maintaining their natural teeth for longer periods of time. Unfortunately this means that their teeth will be used and restored considerably more and therefore make them incredibly more susceptible to trauma, including cracks.
Additionally, the more stress that one has in their day to day life, the better the chances are that they will clench and grind their teeth during their sleep, and this does not help the situation. The condition I am speaking of is most commonly known as "cracked tooth syndrome".
Believe it or not, the problem you are experiencing is a very common one. Teeth crack when they are subjected to the stress of chewing hard foods, unexpected objects in foods, or items such as ice cubes. The teeth that crack most often are the posterior teeth (back teeth) with amalgam or silver-alloy type fillings. Frequently teeth with no restorations at all crack and in reality, any tooth is at risk.
If you develop a cracked tooth, it may cause you to experience several different symptoms. Most frequently you will have pain on chewing, especially between bites when you release pressure from the cracked tooth. This sounds like what you are presently experiencing.
You also may have temperature sensitivity, especially for cold drinks or cold air and sweet foods may produce mild to severe sensitivity. If the crack has extended all the way to the center of the tooth where the pulp or nerve tissue is, the pain may be constant and unbearable.
The biggest problem with cracked teeth is diagnosing them. Cracks usually will not show up on x-rays and are extremely difficult to detect with the naked eye. Most endodontists (root canal specialists) have microscopes that can assist diagnosis with success. Individuals with cracked teeth will often complain of a lengthy history of pain which has been difficult to diagnose and of treatment which has not helped the situation.
Most cracked teeth can be treated with placement of a crown or cap over the tooth in question. This will transfer the bite load to the crown instead of the cracked area of the tooth. If the crack is complex as described above and if the nerve is involved, then a root canal will have to be performed to remove the nerve prior to crown placement. This can even be diagnosed by your dentist after your tooth is prepared for the crown. If the crack is simple, all of the symptoms will disappear with even the temporary crown that is used while the permanent is being made by the dental lab.
Although not always possible, do whatever you can do to prevent cracked teeth. This should include wearing a night-guard if you grind your teeth while sleeping, mouth-guards being worn during sports and complete avoidance of chewing hard objects such as popcorn kernels, hard candy, pens and ice cubes.
Anyone who is experiencing any of the above symptoms should see their dentist immediately. Proper treatment can often save time, money and further damage. Even though cracked teeth can be successfully treated, sometimes a crack will continue to grow despite treatment and cause problems even years later.
If your dentist treats your tooth and you still are unable to obtain relief, ask him for a referral to an endodontist who specializes in root canal therapy and who is specially trained in diagnosing dental pain. Remember that if the crack keeps going, it could even lead to a non-restorable tooth and tooth loss.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5
