Protect your teeth from pressure and cracks

As we age, we get more wear and tear on our teeth. Teeth can chip, crack or split. We may hit a piece of bone in our food when we are 20. This creates a microfracture. Over the years, we drink hot and cold liquids, which exacerbate the crack. We grind and clench our teeth due to the stresses of jobs, children and life. Then inevitably, many years later, as we are eating a soft piece of bread, the tooth fractures and we have pain. A patient may think he/she broke the tooth on something soft, but the damage really happened long ago.

People may grind their teeth at night and not realize it. Their only clue may be occasional tension or soreness in the morning directly in front of their ear opening. Inside the mouth, the dentist will notice clear indications: holes, flat spots or pits in their enamel. Grinding can rapidly change a minor crack into a major crack. Because we have so many hard impacts on our teeth over the years, we need to minimize the nighttime pressures.

Dentists often recommend a hard plastic splint that fits between the upper and lower teeth. The splints distribute the force evenly and dramatically soften the pressure on the teeth. Once patients are comfortable with this appliance (usually in about a week), they are far less likely to turn minor cracks into major fractures. Chewing ice, popcorn kernels and hard candy can quickly turn beautiful, healthy teeth into a mouth full of fractures as well. Once this happens, it is only a matter of time before the dentist and patient get better acquainted.

Antidepressant medications such as Prozac can increase the force and duration of nighttime teeth-clenching as well. Patients may notice mouth soreness or tooth pain a few months after changing antidepressant medications. Always let your dentist know when you begin these medications so he/she can monitor the teeth for any evidence of grinding. A change of antidepressant may be a simple way to fix the problem.

Cracked teeth may not always be painful. Dentists have a saying: "Only people who are lucky have cracked teeth associated with pain." Why? Because the tooth pain forces them to visit the dentist before a root canal is required or the tooth splits. When a tooth crack first starts, the pain is usually fleeting, maybe only a couple of seconds. The pain often happens not when we bite down, but when we release the pressure and open our mouths. Early or shallow cracks are usually treated by crowning the tooth. Treating cracks quickly usually solves the problem and the patient avoids further treatment. The earlier the patient gets a crown, the less likely he/she is to need a root canal.

Avoiding a crack only makes it get worse. There is no way the tooth will heal itself. Continued pressure spreads the crack until the nerve is angry and inflamed. The duration and intensity of the pain now increase substantially. The nerve will never heal itself and must be removed in a root canal. The procedure is quite successful and usually solves the problem.

Cracks that continue to spread will eventually fracture and can cause considerable pain. Depending on the location of the fracture, treatment can be difficult. If the tooth splits in two, it is lost, and an extraction with a bridge or an implant is recommended.

Most dentists have high-powered magnifying glasses or microscopes to inspect teeth. They can easily show you detailed pictures of the cracks. Once most patients see the damage to their teeth, they understand what is going on in their mouths and have better long-term outcomes.

It is easy to avoid cracked teeth and we have to be careful to avoid creating high pressures in the mouth. Keep current on your dental visits so that any cracks can be treated early and go to the dentist immediately if you have pain.