Manhattan Dental Nov 2017

The Doctor’s Dentist TM

Nov/Dec 2017

635 Madison Ave, 19th Floor New York, NY 10022 212-928-1000 117 Kinderkamack Rd. Suite 200 River Edge, N.J. 07661 201-881-0660 www.MANHATTANDENTALHEALTHNJ.COM

It’s All It’s Cracked Up to Be What’s With All the Cracked Teeth?


t’s actually amazing. Our foods are getting softer and more processed, and yet, I see more and more cracked teeth. What’s happening? In the last several weeks, I saw six people who had cracked teeth. Thankfully, all but one were saved. For years, I’ve been saying that cracked teeth are the single most common emergency complaint we see. While there are many scientific articles discussing the topic, none of the research is, in my mind, comprehensive or adequate. In 2007, a dental magazine (not a scientific one) said that there’s an epidemic. Broken teeth are “the third leading cause of tooth loss in industrialized nations.” The Mayo Clinic suggests that there are over 200,000 cases of cracked teeth per year, making it a “common” problem. I must have been a very annoying child. I always wanted to know why . Some would say that annoying quality has never left. At least I’ve channeled it productively toward a use. Since 9/11, I’ve noticed a marked increase in this epidemic of broken teeth. Of course, I’ve been asking myself why . Here’s what I think. Aside from a generalized increase in stress, we’re keeping our teeth longer. In the ’70s, I was taught that at age 60, half of American adults lose their teeth. Today, that number is less than 25 percent. I think the problem is more prevalent.

Dentistry has succeeded in preventing tooth loss by promoting preventive care. It works!

Teeth that have had root canals are in even greater peril. Teeth are kept moist by the nerve inside the tooth, and once removed, the tooth is less flexible. Think of a tree that dies. It can still stand upright, but when a stiff wind comes and it can no longer flex, it breaks. Teeth flex too.

Not only are we keeping our teeth, we’re also living longer. How many people do you know who are in their 80s or 90s? I even know a few in their 100s! One of the reasons we’re keeping our teeth is that we’re restoring teeth damaged by decay. It’s my belief that the process of tooth restoration has contributed to the tooth- cracking epidemic. We use drills to remove decay. There’s really no other option. We’ve tried using lasers, but they can’t remove enamel, old fillings, or caps well. So, unfortunately, we still use the “you know what.” Silver fillings, which are actually mercury and silver, do not support the tooth. It just fills the hole left by the decay and removal process. Newer fillings that are bonded to the tooth do provide some measure of support, depending on how much of the chewing surface is lost. The more biting surface lost, the less likely any filling can help prevent fracture.

What’s the cause of such a “stiff wind” in the mouth?

The culprits are many. Bite discrepancies, muscle imbalances, grinding, and clenching are all causes. Accidents, too, take their toll. I can’t tell you how many people mistakenly bite down on forks. And, people abuse their teeth all the time by using them instead of scissors,

nutcrackers, and bottle openers. Teeth are not meant to replace those implements.

The materials used to make fillings, caps, crowns, bridges, implants, and veneers all wear out at different rates than tooth enamel. This difference in wear rate can become more apparent as the materials age and normal tooth wear progresses (or not). Some materials, such as porcelain and the newer zirconia, are much, much harder than teeth and have the potential of wreaking havoc down the line, as bite changes can result.

As older fillings deteriorate, the silver ones can expand and the tooth-colored ones break down, putting the tooth at greater risk of cracking.

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