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Tooth Be Told
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Week 4- What are my options for repairing broken teeth?

I have been seeing a lot of broken and cracked teeth as of late. The COVID-19 shutdown has elevated people’s stress level, and all the teeth clenching and grinding caused by the stress is contributing to the damage.

The best thing one can do is to prevent the damage from occurring. That will save him/her money and time. This is definitely easier said than done, but regular biannual dental visits help because your dentist can detect early signs of breakdown.

Teeth can break due to various reasons, but I believe that the number one culprit is less than ideal jaw relationships or bites. In an ideal jaw relationship, upper and lower teeth come together like a shoebox. Think of the upper teeth as the lid, the lower teeth as the box. Chewing force is evenly distributed among all the teeth in such a bite.

This is what I like to call a “shoebox bite.” The “lid” and the “box” fit together nicely, and you can see that the lid covers the box just a little bit. 

In a less than ideal relationship, however, some teeth are subject to heavier pounding and grinding than the others, and significant damages result. Below are some examples of “less than ideal” bites:

Deep Bite– The “lid” covers the “box” entirely

Deep Bite– The “lid” covers the “box” entirely

Crossbite– The “box” sticks out more than the “lid”

I have become a big believer of Invisalign and orthodontics over the years for that reason. Straightening teeth is not just about enhancing appearance; it improves the longevity of your teeth! If you repeatedly experience the breaking of your teeth or dental restorations, this most likely is a sign that your bite is not ideal and will benefit from orthodontic therapy. For those who exhibit cracks and a lot of tooth wear but absolutely have no desire to consider orthodontic therapy, I recommend night guards to minimize further damage.

Treatment options vary depending on the size of the damage. A filling will suffice for a small fracture, assuming that the bite/jaw relationship is close to being ideal. When I see a cusp (“peak”) or cusps that are broken, I recommend a crown (“cap”) or an onlay. Fillings usually don’t last a long time in a scenario like this. Crowns and onlays are more extensive than fillings and often made by dental laboratories. These restorations work by bracing the remaining tooth structure.

Crown is the most ideal treatment option for a tooth like this

Cracks in the tooth can extend from the chewing surface all the way to the roots. If the root is in decent condition but the nerve inside of the tooth is damaged and causes pain, a root canal is the treatment of choice. After a root canal, a filling or a crown is placed to restore the damaged tooth. 

Once I see that a tooth is split into two or more pieces like what you see below, the only option I am left with is removing the tooth and replacing it with either a dental implant or a bridge. A dental implant is the best tooth replacement available today. A dental bridge is my second option. I normally recommend an implant first because doing a bridge requires reshaping at least two teeth whereas a dental implant does not require any reshaping of your natural teeth. The less drilling we have to do on your natural teeth, the better!

This tooth is not salvageable

If you notice any sort of tooth fracture, please see your dentist ASAP. With that said, I created a decision tree that shows treatment options. 

The decision tree is optimized for viewing in Desktop and Tablet modes. I recommend zooming in on the screen when in mobile mode. 

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