All Cracked Up

Question:  I have always been concerned with cracks in my teeth. Over many years of seeing my dentist, I’ve asked him about the cracks in my front teeth. He’s always reassured me that they were superficial and in the enamel only. He said, “In the back teeth where there are much greater forces applied in eating or grinding and clenching one’s teeth, that’s a different story.” Whenever there’s been a crack in my back teeth I’ve had crowns done so the crack wouldn’t spread.

Two weeks ago, I bit an olive pit on my back lower molar. The pain was so intense I nearly fainted. I sat my chair back and put my head down between my legs, until the pain subsided and I regained my senses. Now, if I get cold on that tooth I get an intense sharp pain, so everything that goes in my mouth is room temperature and I don’t dare chew on that side.

My dentist said it was a cracked tooth. He said cracked teeth need to be crowned but he also said this might need a root canal as well. He said the tooth wasn’t split in half, but he couldn’t tell if the crack went into the nerve or just cracked into the dentin. I’m not sure what to do. How do you really know what’s going on and what to do? He did say I have a big filling that made it more susceptible to cracking.

Answer: Cracks in teeth fall in five different categories. The first is superficial and look like craze lines in porcelain. They usually aren’t of great consequence in front teeth. Most people only see and are aware of this category.

The second is a crack into the dentin. Many can experience this type of cracking, and it may or may not give a sharp sensation to temperature change or biting force. When this kind of cracking leads to tooth breakage it happens above the gum. Usually, these teeth get crowned. In your case, the dentist will have to take the filling out and examine the tooth for a crack. If the crack appears to be centered over the nerve chamber, a root canal may have to be done. The advantage is that he’ll see if the crack ends, or if it continues into the roots. If it ends above the root, the root canal will be completed, the tooth crowned, and you should have no pain.

The third is a crack that goes below gum and bone.

The fourth is a crack into the nerve and extends to the root.

The fifth is a crack through the roots. In 2025, in these last three categories, the teeth would be extracted and an implant placed.

Hopefully your dentist can care for all these contingencies once the final diagnosis is apparent.

A Trifecta of Problems

Question: Well, here I am, an older retired senior with “gas in the tank,” a great wife, and a set of teeth so bucked out I could eat a pie out of a milk bottle. I kid you not, people see my teeth before they see me. “Must be Bob, here come his teeth.” Well, you get my drift. And it seems they’re getting worse. The colour of my teeth is getting darker and darker and my wife even says I should do something. At the outset I should say that I’ve got some gaps in every area of my mouth, behind my front eye teeth are gaps and that compounds the appearance problem. I’ve got a broken back tooth and one that’s got so much decay that it’s a goner.

I don’t know what to do. I know I don’t want dentures, so I put it to my dentist and he said I had a bad jaw relationship that is higher on one side than the other and he said it’s hard to make me an even bite. When I smile my lower teeth jut way up on the left side and slump down on the right.

While we were talking, he said, “You really are doing some tremendous grinding. You’re wearing your gold crowns down like nothing else. We’ll have to protect against that when all is done.”

Somewhere in the conversation I told him I was going through sleep apnea diagnosis and treatment. “That’s one of the causes of excessive grinding,” my dentist said. “We’ll work with your doctors on the sleep apnea and take that into consideration if we fix up your mouth.”

He told me it would be expensive so I’m wondering what’s the best to do.

Answer: At your age with lots of decay a problem, it’s time to seriously consider not only the aesthetics but the question, after all is done am I going to lose my teeth to decay?

Seniors can get a decay syndrome known as senile caries. In this condition, decay pops up everywhere so that you are doing fillings under crowns, replacing crowns, doing more root canals, and just hating your dental visits.

It is less expensive in the long run to go with teeth supported by implants. They accomplish many things – no more decay, bone that’s harmonized so that it’s level and can receive teeth that are in the right place functionally and aesthetically.

These teeth are fixed bridges that allow great function. If grinding is a problem, bite splints can be made and should be, to make life easier on your joints, save your new teeth, and maybe even help the sleep apnea.

Look seriously at this option because it has a great track record and will solve the three serious problems you’re experiencing (decay, jaw alignment, and aesthetics).