My lower left molar (2nd from last) has a hairline crack. Because of this, every once in a while if I bite down on something small & hard (e.g., a seed) in just the right way, I get this sharp pain. The dentist theorized that the crack temporarily separates but because it's a hairline crack, it stays shut & doesn't cause pain all the time.
Problem is, the only fix they could suggest is a crown or pulling the tooth. Are there not any alternatives like bonding that can "glue" the tooth together?
a hairline crack constrained within superficial enamel would not be symptomatic like this ... while being hairline on the surface appearance, the pain is classic fractured tooth behavior. your dentist is suggesting a very conservative method of treatment, in the absence of any other symptoms, and given the type of forces this tooth sustains. the idea of banding the tooth is like putting one of those two hoops on a barrel (and visualize the planks of woods as hairline cracks). it holds the tooth together in spite of forces being applied in all directions. applying resin to the planks is helpful, and in fact, it *might* be sufficient to hold the tooth together for a while in the absence of any type of banding (like a crown). but given you are having pain (that is, movement like tectonic plates within the tooth along a fault line that is causing pain along the fault line) resin alone will probably not be sufficient, at least not for long. but there is no harm in trying that first, so long as you don't fracture the tooth by accidentally chomping on a popcorn kernal or a walnut shell hiding out in a salad! good luck!
The Following User Says Thank You to Elizabetho For This Useful Post: NickAC (08-12-2011)
Elizabetho, thanks for the very informative reply! Yes, by "hairline" I meant in appearance only. i.e., there isn't a piece of tooth that is missing. Your "tectonic plate" analogy is a good one - kind of what happens if I bite down wrong.
The banding is an interesting idea. Now that you mention it, I do remember a dentist suggesting something like that a while back but we didn't follow up on it. And the latest dentist (the one who suggested that has left the office) didn't mention anything about that. Would that require grinding away tooth material to make room? My biggest concern about a crown is the idea of grinding away some of the tooth - I'd hate to do that if there was an alternative.
About the resin - I'm okay with trying it as long as there is a chance that it will work. So far the dentist I spoke to only gave me the crown as a solution. Believe me, I'd still be careful when chewing! But if this was a possible solution, then I can spend some time calling around to see if there is a dentist that supports this.
you are very welcome! unfortunately, the tooth would have to be inspected in order to render an opinion that will be useful to you. the thing is, once a tooth is compromised in any fashion, it never improves on its own. the best outcome is that the state of damage it is in (whether it is the external part of the tooth, or the internal pulp part) might be able to be arrested. there is one exception to this, which is that very early stages of decay can actually be reversed with remineralization with a fair amount of diligence on the patient's part. but i don't want you to get your hopes up too much with this crack already in existence.
we do know there is a through and through crack somewhere, but don't know where it is or the extent that it spans. the pain you are feeling is the ligament that attaches the tooth to the bone. you can imagine how a wedge-like action applied on the tooth's surface is going to pull those ligaments when the tooth gets manipulated just so (like with that dreaded painful bite). if it can be found and sealed, there is the possibility the resin can be applied and a band (like an ortho band) could be put on and you could maybe be lucky. but eventually, it will deepen from just normal use. even if you were to be as careful as humanly possible, there are forces that will be applied to the crack beyond your control -- when you are asleep, for example. and even regular chewing on neighboring teeth still transfers some force to the compromised tooth, although not as greatly as biting down directly on the crack. it all adds up over time, even if you try your darndest to baby it.
for children, this method of banding sometimes works nicely, as their jaw is growing and so slipping a band on might temporarily misalign the teeth but the bone grows and quickly makes room for the band without any enamel needing to come off and the teeth can basically realign. the deciduous teeth are shed anyway so the tooth can often win this contest with father time! with a permanent tooth, there is no luxury of another tooth coming in later, so the best you can do is to restore the tooth artificially. unfortunately, the direct solution is a crown. and even then, if the crack extends below the gum line, there is the chance for bacteria seeping into the area where resin cannot be applied. in this case, with time, you may need a root canal if bacteria seeps in to the pulp along the crack and the pulp becomes infected. generally speaking, if a crack extends too far below the gum line, the prognosis worsens as it cannot be sealed directly. if the dentist can positively determine the crack is indeed confined to the area above the gum line you will have the best prognosis, and maybe even an excellent prognosis. if this were a front tooth, you might be able to solve the problem with a less invasive removal of enamel such as with a veneer. but for a molar, the entire crown needs to be encompassed in some way. the forces on a back molar are enormous. a band is not impossible depending on how closely your teeth touch. for example, a band could be slipped over it if the 3rd molar was missing. or if the tooth is bulbous, a thick wire could be theoretically slipped in along the gumline and essentially twist-tied closed. deciduous teeth happen to be bulbous and so this is feasible in some cases. however, remember, depending on how wide the band is, you would have two circumferences of vulnerability to decay -- around the top of the loop, and along the bottom of the band. a crown, on the other hand, has only one margin to keep clean. even though it is a shame to sacrifice perfectly good enamel, the great goal is to not lose that tooth from the crack worsening. that particular tooth is very important and its loss starts a whole series of biological chain events that adversely affect both arches. i hope the crown is do-able so you can get back to not having to think about every bite!
You make some VERY good points! I think what was bugging me is that they didn't even consider any alternatives. Had they told me that these resins exist and the bands exist but those are not applicable to me because of the nature of the crack, I would have felt more comfortable with the crown option.
I don't know if it makes a difference but they can see the crack and believe it doesn't extend below the gumline. But what's scary is that they said if during the grinding process the crack starts growing, and grows long enough, they'll have to stop the procedure and remove the tooth as the only option! :O
But this is great information for me to explore if the alternatives are even possible. Since the crack is visible, I can ask them to rethink other options or visit other dentists. Then if a crown is the only solution, at least I know I tried everything else & feel better about the decision.
only a pedodontist or an orthodontist would be likely to bring up banding, so please don't feel shortchanged about not being given treatment options in that particular department. it's not a treatment modality any other specialty utilizes on a regular basis (if at all). actually, a crown is probably more conservative than it sounds, given that waiting will guarantee the crack will certainly grow and may end up rendering the tooth nonrestorable. (meaning it would have to extracted then you would then have to choose among a bridge, partial, or implant.)
you really cannot determine the extent of the crack until you get in there and start doing the crown prep. (cracks very rarely are visible on xrays, which is why you have to go in and " follow it" with the handpiece, magnification, good light, and dye. actually, let me be more specific ... in a sense it doesn't matter what is going on with the crack in the top part of the tooth (above the gum line) unless the pulp is exposed. if a crack reaches the pulp an endo would be advisable because in adults, generally, an exposed pulp is an infected pulp. (and a crack that reaches from the external world to the pulp is an exposure, even though it is a tiny spec of real estate that the pulp is in contact with. to bacteria, this is the grand canyon.) there may not be symptoms right away, or even for years, but an infection will develop with time. in this case, the prudent thing to do would be do the endo first, and then crown it as soon as possible.
now the tricky part is determining what it going on at and under the gum line. if, during the prep phase, the dds can see that the crack fizzles out and definately ends within the dentin, you can have a good prognosis with a crown. again, if the crack goes in to the pulp, an endo is wise. but if the crack extends below the depth of the bone level, there are two possibilities:
first, let's say it ends at the bone level. in this case you could have a crown lengthening done and then have the crown put on and this could have a decent prognosis. the crown lengthening involves removing a little bone in order to give the gum a little neccessary elbow room in order to heal properly where the nearby crown margin will be sitting.
now let's say the crack looks like it's still going strong by this level and is obviously going down deep below the bone level. in this unfortunate case, the tooth would be nonrestorable.
well i hope this helps- and that you can get on this pretty quickly. time is not your friend with substantial cracks. good luck with this!
The Following 2 Users Say Thank You to Elizabetho For This Useful Post: asdecorazones (04-14-2012), NickAC (08-15-2011)
More good points! As of now, it's only been observed by the dentist. i.e., no dyes or anything else, but they did have good light and their magnifying glasses. They did take an X-ray, but as you pointed out, these aren't often visible. But they felt pretty confident that the crack did not extend into the gumline.
I understand what you're saying about even the tiniest of cracks being a huge opening for bacteria. So I will ask them again about banding or options but it sure seems like putting a crown might be the best alternative.
As I said from the beginning, my main goal was to make sure that I have explored other alternatives before going this route. And you have helped me do that! Even if it is fairly a conservative route, I will feel more comfortable knowing that I tried my best before having them grind away the tooth.
i think you have completely done your due diligence! that's very good news abt the crack being confined to the crown -- that's about as good an outcome as possible, actually! good luck on the treatment!
Wanted to post back what happened. Early in Aug, the dentist recommended getting a crown, but I was traveling so he suggested I wait til I get back.
During the waiting, 2 things happened:
1. The pain subsided
2. I realized I don't feel comfortable with this dentist.
I called the office and asked to get reassigned to the dentist I had briefly last year - the one who had suggested banding as a possibility. I just felt more comfortable with this dentist. Yesterday I had the follow up appointment and he used a special light to see how deep the crack went.
Interestingly, he said the crack is very superficial and there is no need for a crown! I relayed the issue to him again since I had only told him once before: that every so often I get a sharp pain while eating and it usually subsides after a few hours or sometimes a couple of days.
He theorized that since there was no deep crack, it was a sprain in the ligaments that hold the tooth in the gums. Like a sprained ankle, once it gets hurt you need to give it attention or it can easily sprain again. He also said the nerves around these ligaments join the main nerve - that's why the pain feels like it's coming from the middle of the tooth.
He also commented that if it really were a crack that was separating while chewing, there is no way the pain would subside. That a crack big enough to cause pain would cause pain all the time since the crack would keep opening just through normal activity - not just chewing something hard.
What is scary is - assuming he's right - I could have made a HUGE mistake replacing with a crown when it was not needed! For now, we're just going to watch it until my next regular cleaning appointment.
This thread is interesting. I've had the same kind of pain in a second bicuspid for a while. It usually only hurts when I bite down a certain way on something hard, and sometimes for a while afterwards from the resulting irritation. An x-ray taken a few months ago didn't show anything abnormal. I am reluctant to get a crown but I also wouldn't want to risk losing the tooth. This isn't necessarily an easy call, especially since I've seen one dentist who seems eager to put in a crown and another who seems pretty sure he can fix the problem by slightly filing down other teeth. I just want to run and hide from both of these guys. NickAC, if you see this, is your tooth pain-free now?
Your situation sure sounds a lot like mine - as best as I can tell not being a dentist and not seeing you personally! Hard to say whether you really need the crown. But my feeling is anything irreversible you should make sure you really need it before getting it down. If I hadn't listened to my instincts and followed the one dentist's advice, I'd have possibly ruined a tooth that was okay.
The steady pain I had for which I visited the dentist last summer has gone away. But the overall issue is still there. That is, the tooth is still sensitive, and I do still get flashes of pain if I bite down wrongly. This may be an injury I just have to live with, but at least I'm not getting a crown unnecessarily. I had a regular cleaning/checkup a few weeks ago. The dentist made sure to give this tooth a close look and said there doesn't seem to be any changes from the last visit (i.e., still no crown - yay!!)
What is scary from reading your post is what you said about both dentists being "eager" to either put in a crown or file down teeth. Like I said above, my feeling is that any irreversible thing like this should be done only as a last resort. Get an additional opinion if you can. Plus make sure you feel comfortable with the dentists. Like I said in my earlier post, one of the hesitations I had was how uncomfortable I felt with the one dentist who wanted to put in a crown (not just because he wanted to put in the crown - but rather a lack of comfort instinctively).
Last edited by NickAC; 04-15-2012 at 05:04 PM.
The Following User Says Thank You to NickAC For This Useful Post: asdecorazones (04-15-2012)
Thanks for these comments. My tooth has been sensitive for about two years now and if anything it's gotten slightly worse, so I'm starting to think that I'll probably need a crown. Also, I wonder if by having waited so long I may now end up with a worse outcome than a crown, i.e. root canal. I probably shouldn't have used the word "eager" as the dentists certainly haven't pressured me to do anything and the one who did some filing assured me that it was minimal. He said I might have to go back for more, but I haven't followed up with him. I feel comfortable with both dentists but I can't help feeling that there's inevitably some guesswork in what they do, and after a few bad experiences with other dentists (including a crown that broke after a year) I can't help second-guessing them. I've also been partly procrastinating and partly reluctant to do anything for fear of getting a crown that I don't really need. The only thing I know for sure is that I need to have it looked at again soon and ask for a clear explanation of my options and the risks involved with not taking care of this problem for once and for all. Also, I'm getting really sick of having to chew so carefully, favoring one side of my mouth, and I wonder if this could adversely affect my bite and cause other problems.
The way my (good) dentist explained it, if it's just sensitive, then that may not need a crown. His comment was that if the tooth was indeed cracked, I'd have pain *all* the time. You're right though - having to be careful chewing all the time is not fun. I've tried to be positive about it - saying that at least this helps me eat more slowly and hopefully lose weight. But it does get old.
Problem is, if this dentist is right and the pain is caused by the sideways motion of the tooth spraining the ligaments, then my concern was that even if I got the crown just to avoid having to chew carefully, will the crown really help since it may not do much to reduce sideways tooth motion.
In any case, don't feel bad second guessing your dentists. These are your teeth and your body after all. YOU have to pay the price for a mistaken procedure - especially an irreversible one. And any doctor/dentist should be able to handle questions professionally.
You have classic symptoms of cracked tooth syndrome. True, you may have initially had sprained ligaments as well, but now you simply have symptoms of a cracked tooth. It's not true that you would have had constant pain if it were really cracked.
By not seeking treatment now, you are at increased risk for further injury--one mis-bite and a piece could actually break off, or decay/abscess. If any of those things happen, the likelihood of being able to do something conservatively to treat the tooth are likely out the window.
You've been lucky so far, but sadly, I think your luck will run out eventually.
The Following User Says Thank You to Brocallie For This Useful Post: asdecorazones (04-16-2012)