2022 Fall | Cracked Teeth and Vertical Root Fractures: A New Look at a Growing Problem
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.
Key:
Complete
Next
Failed
Available
LockedKeith V. Krell, D.D.S., M.S., M.A.
Dr. Krell has been an endodontist for 44 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. In 1993, he retired from the United States Army National Guard as a lieutenant colonel after 22 years of service. He was also an adjunct clinical Professor in the department of Endodontics at the University of Iowa, College of Dentistry until July 1, 2025 completing a 50 year career with the University of Iowa. He received the University of Iowa, Distinguished Service Alumni Award Sept 26, 2025. He is a past president of the American Association of Endodontist, and also a past president of both, the American Board of Endodontics and the Foundation for Endodontics. He is a Diplomate of the American Board of Endodontics and is a both a Fellow in the American College of Dentists and in the International College of Dentists.
Dr. Krell has been married for 54 years to Diane and they have two grown children, and five grandchildren. He still has research interests in cracked teeth and vertical root fractures and has provided continuing education nationally and internationally for the past 40 years. He has played guitar for more than 50 years and has collected guitars for the past 30 years.
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.