Correlation between symptoms and external characteristics of cracked teeth

Abstract

Background Cracked teeth are ubiquitous in the adult dentition. The objective of this study was to determine which patient traits/behaviors and external tooth/crack characteristics correlate with cracked teeth being symptomatic. Methods Dentists in the National Dental Practice-Based Research enrolled a convenience sample of subjects each with a single, vital posterior tooth with at least one observable external crack in this observational study; 2,975 cracked teeth, from 209 practitioners, were enrolled. Data were collected at the patient-, tooth-, and crack-level. Generalized estimating equations were used to obtain significant (p<0.05) independent odds ratios (OR) associated with teeth presenting as symptomatic. Results Characteristics positively associated with cracked tooth symptoms, after adjusting for demographics, included individuals who clenched, ground or pressed their teeth together (OR=1.30; 95%CI: 1.12–1.50), molar teeth (OR=1.58; 95%CI: 1,30–1.92), teeth with a wear facet through enamel (OR=1.22; 95%CI: 1.01–1.40), caries lesions (OR=1.31; 95%CI: 1.07–1.60), cracks that were on the distal surface of the tooth (OR=1.31; 95%CI: 1.13–1.52) and cracks that blocked transilluminated light (OR=1.31; 95%CI: 1.09–1.57). Teeth with stained cracks were negatively associated with having cracked tooth symptoms (OR=0.68; 95%CI:0.55–0.84). Conclusions and Practical Implications The greatest likelihood of a cracked tooth being symptomatic was found when patients reported clenching and/or grinding their teeth and had a molar tooth with a distal crack that blocked transilluminated light. This information can help inform dentists in the decision-making process regarding the prognosis for a cracked tooth.

Associations of types of pain with crack-level, tooth-level and patient-level characteristics in posterior teeth with visible cracks: Findings from the National Dental Practice-Based Research Network

“…There are several differences between this current paper and our previous publication regarding the correlation of various patient-, tooth- and crack-level characteristics to pain in cracked teeth [10]. In that manuscript, analyses were on the global definition of “symptomatic,” i.e.…”

“…Cracks located on the distal surface of teeth were significantly correlated with increased symptoms: presence of pain on biting, pain on biting alone, spontaneous pain alone, when both pain on biting and spontaneous pain were present, and when all three types of pain were present. As noted in our previous publication, it is not clear why a tooth with a crack on the distal surface would be more likely to be symptomatic compared to a tooth with cracks on other surfaces [10]. However, other studies have found correlations to cracks in the distal surface of teeth and adverse outcomes.…”

“…A detailed description of the enrollment and data collection processes is provided in a previous publication [10]. Briefly, a convenience sample of subjects between 19 and 85 years old having a single, vital posterior tooth with at least one observable external crack (referred to in this paper as cracked teeth) was enrolled by dentists in the National Dental Practice-based Research Network [11].…”

“…Enrollment proceeded in two phases: a pilot phase from April-July 2014, in which 183 patients were enrolled by 12 practices, and a main launch phase that occurred from October 2014-April 2015. In a previous report [10] we described 2,975 patients/cracked teeth enrolled by 209 practitioners. This current report excludes 96 cracked teeth that were partially or completely fractured (violation of eligibility criteria), and 21 patients we identified as duplicates, leaving 2,858 patients/cracks.…”

Quantitative percussion diagnostics as an indicator of the level of the structural pathology of teeth: Retrospective follow-up investigation of high-risk sites that remained pathological after restorative treatment

“…Current visual dental diagnostics give a static, unloaded image of a defect in visually accessible areas. The results are qualitative, subject to different interpretations, 3–5 and can be unreliable because of artifacts from radio-opaque restorative materials. 6 The most definitive method for diagnosing a root fracture is a flap reflection toreveal a bony defect, but this procedure is invasive and limited to advanced lesions.…”