ENDODONTICS: Colleagues for Excellence
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Includes Credits
CE Hours: 0.5
Description: The incidences of cracked teeth have increased significantly in the United States over the last decade! Even before the pandemic, the AAE 2015 Special Committee on the Methodology of Cracked Tooth Studies conducted a survey and found 49% of 941 endodontists had seen an increase of cracked teeth and vertical root fractures compared with the previous decades. (1) Poor occlusion, bruxism/parafunctional habits, and wedging events combined with repetitive forces are all potential etiologies for tooth cracks. As these early cracks develop, bacteria and biofilms can form, eventually progressing towards the pulp and resulting in pulpal necrosis. (2) Cracks when left untreated, can propagate into fractures resulting in catastrophic failures and tooth loss, such as in the incidence of a split tooth. (3)
Early in the COVID-19 pandemic, a Sept. 11, 2020, article in USA Today reported that endodontists were seeing twice as many cracked teeth as they did in the prior year. (4) The March 21, 2021, ADA Huddle reported that an ADA Health policy survey had found a rise in stress-related tooth damage linked to pandemic stress. (5) More recently, the JOE published an article comparing the incidence of cracked teeth in a private endodontic practice over three years (2019, 2020, and 2021), showing a significant increase in the incidence of cracked teeth in the 40-60 age group (2020) and males 40-60 and over-60 age groups in 2021. (6) Regardless of direct or indirect causes, the diagnosis of cracked teeth was already highly prevalent before the pandemic and has subsequently and substantially increased since that time. We are at a point where we must include cracked teeth and vertical root fractures in almost every differential diagnosis of tooth pain.
Let us look at the new definitions of cracked teeth and vertical root fractures.
Learning Objectives:
- Discuss the most recent definitions used for longitudinal fractures of teeth.
- Describe the clinical diagnostic features of both cracked teeth and vertical root fractures.
- Describe the radiographic features of both cracked teeth and vertical root fractures.
- Discuss current treatment options for both cracked teeth and vertical root fractures.
- Discuss prognosis for cracked teeth requiring root canal treatment using the Iowa Staging Index.
Keith V. Krell, D.D.S., M.S., M.A.
Dr. Krell received his D.D.S. and M.S. degrees from the University of Iowa in 1981 and 1983, respectively. He earned his M.A. degree in sociology-anthropology in 1975, from the United States International University in San Diego, Calif.
Dr. Krell has been an endodontist for over 43 years. He was a full-time educator for 8 years at the University of Iowa and was in private practice in West Des Moines, Iowa for 29 years until he retired December 31, 2017. He is still an adjunct clinical Professor in the Department of Endodontics at the University of Iowa College of Dentistry. He has lectured nationally and internationally about his research on cracked teeth based on his data base of over 3,000 private practice cases. His complete data base is over 50,000 cases.
Dr. Krell is a Diplomate of the American Board of Endodontics, as well as a past president and past director of the ABE. He is a past president of AAEF (now the Foundation for Endodontics) and finally is past president of the American Association of Endodontists.
Dr. Krell has been married for over 52 years to Diane and they have five grandchildren. He still has research interests in cracked teeth and vertical root fractures.
Disclosure:
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
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Includes Credits
CE Hours: 0.5
Description: When planning endodontic treatment on mandibular teeth, the location of the inferior alveolar nerve (IAN) must be taken into consideration. Failure to properly assess the potential for injury to the IAN may result in sensory disturbances such as paresthesia, anesthesia, or dysesthesia to the chin, lip, or associated anatomic structures and dermatomes. (1,2) These post-traumatic sensory neuropathies can present as a range of symptoms from merely a minor annoyance to devastating life-altering changes which can affect everyday well-being. (3) This is why it is critical for the clinician to carefully assess and manage any pending endodontic treatment in the mandible, particularly when a reasonably careful clinician should have foreseen and thus prevented any undue risk of harm to their patient.
At the conclusion, participants should be able to:
- Discuss the advantages of new imaging technologies in identifying key neurovascular structures and their proximity to the root canal systems of teeth.
- Describe the sequelae of chemical and obturation overfill into neurovascular anatomy and the potential for injury.
- Evaluate surgical versus non-surgical interventions for neurologic injury with outcome expectations.
Alan H. Gluskin, D.D.S.
Alan H. Gluskin DDS is currently Professor, Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific in San Francisco, California. He served as Chairperson of the Endodontic Department for over thirty years. He is at present a Fellow of the International College of Dentists and the American College of Dentists. Dr. Gluskin has served on numerous AAE committees including the Educational Affairs Committee and the Research and Scientific Affairs Committee, as well being General Chair for both AAE10 and AAE18. Dr. Gluskin has just completed his tenure on the Executive Board of Directors of the American Association of Endodontists as Immediate Past President of the AAE. He additionally functions on the editorial boards of the Journal of Endodontics and the International Journal of
Endodontics. Dr. Gluskin is the 2017 recipient of the University of the Pacific’s Eberhardt Teacher-Scholar Award. He is co-editor of the textbooks Decision Making in Dental Treatment Planning and Practical Lessons in Endodontic Treatment.Speaker Disclosure
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
Louis H. Berman, D.D.S., F.A.C.D.
Dr. Berman received his dental degree from the University of Maryland School of Dentistry, and his Certificate in Endodontics from Albert Einstein Medical Center, where he is currently a clinical instructor and guest lecturer. He is also a clinical associate professor of endodontics at the University of Maryland School of Dentistry. He has lectured internationally and published in several peer-reviewed journals, and is a member of the Journal of Endodontics' Scientific Advisory Board. Dr. Berman is the co-author for the chapter on Diagnosis in the ninth, tenth and eleventh editions of Cohen’s Pathways of the Pulp and is the co-editor of the current eleventh edition along with Dr. Kenneth Hargreaves. Dr. Berman is also the senior editor and contributing author of the comprehensive textbook, A Clinical Guide to Dental Traumatology. A Diplomate of the American Board of Endodontics, Dr. Berman has been in full-time private practice for 32 years.
Marcus D. Johnson, DDS
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.