Recommended treatment of cracked teeth: Results from the National Dental Practice-Based Research Network

Abstract

Statement of problem. Despite the high prevalence of posterior cracked teeth, questions remain regarding the best course of action for managing these teeth. Purpose. The purpose of this clinical study was to identify and quantify the characteristics of visible cracks in posterior teeth and their association with treatment recommendations among patients in the National Dental Practice-Based Research Network. Material and methods. Network dentists enrolled patients with a single, vital posterior tooth with at least 1 observable external crack. Data were collected at the patient, tooth, and crack levels, including the presence and type of pain and treatment recommendations for subject teeth. Frequencies according to treatment recommendation were obtained, and odds ratios (ORs) comparing recommendations for the tooth to be restored versus monitored were calculated. Stepwise regressions were performed using generalized models to adjust for clustering; characteristics with P<.05 were retained. Results. A total of 209 dentists enrolled 2858 patients with a posterior tooth with at least 1 crack. Mean ±standard deviation patient age was 54 ±12 years; 1813 (63%) were female, 2394 (85%) were non-Hispanic white, 2213 (77%) had some dental insurance, and 2432 (86%) had some college education. Overall, 1297 (46%) teeth caused 1 or more of the following types of pain: 1055 sensitivity to cold, 459 biting, and 367 spontaneous. A total of 1040 teeth were recommended for 1 or more treatments: restoration (n=1018; 98%), endodontics (n=29; 3%), endodontic treatment and restoration (n=20; 2%), extraction (n=2; 0.2%), and noninvasive treatment, for example, occlusal device, desensitizing (n=11; 1%). The presence of caries (OR=67.3), biting pain (OR=7.3), and evidence of a crack on radiographs (OR=5.0) were associated with over 5-fold odds of recommending restoration. Spontaneous pain was associated with nearly 3-fold odds; pain to cold, having dental insurance, a crack that was detectable with an explorer or blocked transilluminated light, or connected with a restoration were each weakly associated with increased odds of recommending a restoration (OR<2.0). Conclusions. Approximately one-third of cracked teeth were recommended for restoration. The presence of caries, biting pain, and evidence of a crack on a radiograph were strong predictors of recommending a restoration, although the evidence of a crack on a radiograph only accounted for a 3% absolute difference (4% recommended treatment versus 1% recommended monitoring).

Effect of Root Canal Therapy Combined with Full Crown Restoration on the Level of Inflammatory Factors and Chewing Function in Patients with Cracked Teeth and Chronic Pulpitis

“…Cracked teeth is a common dental disease in clinic, and its onset is hidden. The main symptoms of the patient are occlusal discomfort, severe pain, dull pain, and chewing pain, which bring great pain to the patient [ 2 ]. With the continuous development of cracked teeth, most of the cracks gradually deepen to the pulp, and because of various bacteria, such as actinomycete, into the pulp, the pulp is infected and then leads to chronic pulpitis [ 3 ].…”

Symptom changes and crack progression in untreated cracked teeth: One-year findings from the National Dental Practice-Based Research Network

“…It is only possible to assess the natural progress of cracks in teeth that are not treated. While some study teeth had been extracted and therefore were not available for observation, and some others received endodontic treatment, the vast majority of treatment of cracked teeth was restorative [28]. Restorations can potentially affect the progression of cracks, as well as make cracks impossible to visualize, particularly if the restoration is a complete-coverage crown.…”

“…However, due to the efforts of the Cracked Tooth Registry (CTR) study in the National Dental Practice-Based Research Network considerable research has gone into assessing correlations of patient-, tooth-and crack level characteristics to tooth symptoms, crack progression and tooth failure. The CTR represents the largest and most-comprehensive study of cracked teeth in history, and to date has provided significant insight into the associations between dentist-observable characteristics of teeth with cracks, and baseline symptoms and recommendations for treatment [25][26][27][28]. A significant strength of the CTR is that the patients will be followed for three years, providing much-needed longitudinal assessment of cracked teeth.…”

Cracked tooth syndrome, an update

“…Restorations should be placed after the symptoms have been managed. A conservative preparation will help to keep the tooth in the mouth longer and to prevent irreversible damage of the pulp [25,35] , as for example, a direct resin onlay restoration can have considerable advantages [36] , the resin restoration reduces significantly the occlusal stress on the underlying dentin of the preparation [37] . A survey of endodontists regarding the treatment they would perform on a cracked tooth, 92.65% would perform endodontic treatment when the crack extends through the marginal ridge without a probing depth, 80% preferred extraction if the crack extends through the distal marginal ridge and is associated with a probing depth.…”