Complex Dental Problems and Dental Trauma

Cracked tooth syndrome is something that we see quite often in our practice. It’s usually very painful and there is constant acute pain. The first thing that we normally do is we try to assess how bad the crack is. If the crack is so bad that the tooth has split into two, and there’s no way to salvage the tooth, then the treatment for such a scenario would be to extract the tooth. However, if the crack is actually not too bad and there’s enough tooth structure left, we normally would start by commencing root canal treatment to remove the inflamed nerves inside the tooth.

That’s a good question. When a patient has dental trauma and the trauma isn’t that severe, that means the tooth can be saved, the first step is always to do root canal treatment to save the tooth. After root canal treatment you might need to do a porcelain crown to cover the tooth. But the dentist would also say that the root canal treatment doesn’t last forever. Root canal treatment just buys the tooth extra time. It could be 5 years, it could be 10 years, it could be 15 years or even 20 years.

I will leave it as long as there’s no symptom. When a tooth is ankylosed, it means that it is fused together with the bone. So unless it’s giving issues I would leave it alone. The only consideration is that if ankylosed teeth are cracked or require a root canal, eventually if the root canal fails you will need to remove the tooth. It is very difficult to extract ankylosed teeth because the tooth and the bone is fused together. The extraction is very difficult and 99% of the time it’s got to be surgery to remove the tooth.

First of all, when I see patients who have been involved with car accidents, immediately after the car accident, you’re not really thinking so much about your tooth. You’re thinking about your spine, your neck, your brain. After a serious car accident, the ambulance will rush the victim to the hospital to stabilise the patient, to make sure that there are no major injuries to the body, brain, or spine. So by the time all these other body injuries are settled, then the tooth is kind of secondary importance.

If you have a root canal-treated tooth that has failed, you can extract it. I mean if it is a hopeless case, there’s no way of saving it, you have to extract it. But the problem with extracting root canal-treated teeth is that they are very weak and brittle. So when the dentist tries to extract the tooth, there’s always a chance that the tooth may shatter and it may break or fracture. Extracting wisdom teeth could be simple if the dentist is skilled and is able to remove the tooth in one piece but if the tooth breaks or fractures, it becomes a very difficult extraction.

Yes. When sleeping you could also be suffering from a condition called bruxism, which is the professional term for night grinding or teeth grinding at night. Some patients grind their teeth so heavily at night that over many years of constant grinding, you can see vertical cracks on their teeth and severe wear and tear on their teeth. And a lot of patients who grind their teeth don’t even realise that their teeth are so damaged because there is simply no pain just yet.

Well, this is an interesting question. The most memorable case of dental trauma that I’ve seen in my career involves a patient who was a victim of domestic violence. This lady was severely beaten up by her then-husband, who used a baseball bat at home and swung it at her face when they got into a huge fight. The ex-husband actually carried her and threw her off the balcony of their condominium. So she plummeted three storeys down but she survived. She did not die. She fell down three storeys, was thrown off the balcony, so it was, of course, a police case.

Yes. If the tooth splits right down. If the tooth is cracked right down the middle, and if it splits and shatters into small bits and pieces, then there’s no hope in saving the tooth. Then it’s down to extraction and replacing the tooth with a denture, dental implant or a dental bridge.

If you detect the crack early, a simple reinforcement could be to do a plastic filling over the crack. If the crack is bigger and more extensive, it could involve a dental crown, a porcelain crown or cap, or you could even have a porcelain inlay or onlay which is slightly smaller and not as aggressive as compared to a dental crown.

Yes. Let me give an analogy, think of your teeth as a glass window. You have a glass window, a piece of glass, and then you can have a very minor hairline crack on it. But if you keep on hitting that piece of glass, that minor hairline crack will get bigger and bigger and it’ll split in whichever way. It could split to the left, it could split to the right, it could crack all over the place if you hit that piece of glass hard enough. So it’s like that for teeth as well.