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.
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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.
