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Correlation between symptoms and external characteristics of cracked teeth: Findings from The National Dental Practice-Based Research Network.

ABSTRACT: BACKGROUND:Cracked teeth are ubiquitous in the adult dentition. The objective of this study was to determine which patient traits and behaviors and external tooth and crack characteristics correlate with cracked teeth being symptomatic. METHODS:Dentists in The National Dental Practice-Based Research Network enrolled a convenience sample of patients each with a single, vital posterior tooth with at least 1 observable external crack in this observational study; they enrolled 2,975 cracked teeth from 209 practitioners. The authors collected data at the patient level, tooth level, and crack level. They used generalized estimating equations to obtain significant (P < .05) independent odds ratios (OR) associated with teeth that were symptomatic for a crack. RESULTS:Characteristics positively associated with cracked tooth symptoms, after adjusting for demographics, included patients who clenched, ground, or pressed their teeth together (OR, 1.30; 95% confidence interval [CI], 1.12-1.50), molars (OR, 1.58; 95% CI, 1.30-1.92), teeth with a wear facet through enamel (OR, 1.22; 95% CI, 1.01-1.40), carious lesions (OR, 1.31; 95% CI, 1.07-1.60), cracks that were on the distal surface of the tooth (OR, 1.31; 95% CI, 1.13-1.52), and cracks that blocked transilluminated light (OR, 1.31, 95% CI, 1.09-1.57). Teeth with stained cracks were negatively associated with having cracked tooth symptoms (OR, 0.68; 95% CI, 0.55-0.84). CONCLUSIONS:The greatest likelihood of a cracked tooth being symptomatic was found when patients reported clenching or grinding their teeth and had a molar with a distal crack that blocked transilluminated light. PRACTICAL IMPLICATIONS:This information can help inform dentists in the decision-making process regarding the prognosis for a cracked tooth.

SUBMITTER: Hilton TJ

PROVIDER: S-EPMC5376224 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Correlation between symptoms and external characteristics of cracked teeth: Findings from The National Dental Practice-Based Research Network.

Hilton Thomas J TJ Funkhouser Ellen E Ferracane Jack L JL Gilbert Gregg H GH Baltuck Camille C Benjamin Paul P Louis David D Mungia Rahma R Meyerowitz Cyril C

Journal of the American Dental Association (1939) 20170202 4

<h4>Background</h4>Cracked teeth are ubiquitous in the adult dentition. The objective of this study was to determine which patient traits and behaviors and external tooth and crack characteristics correlate with cracked teeth being symptomatic.<h4>Methods</h4>Dentists in The National Dental Practice-Based Research Network enrolled a convenience sample of patients each with a single, vital posterior tooth with at least 1 observable external crack in this observational study; they enrolled 2,975 c ...[more]

PMID: 28160942

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Project description:ObjectivesThe study objective was to: (1) quantify symptom (pain) and crack changes during one year of follow-up, among teeth that had at least one visible crack at baseline but which did not receive treatment for those cracks; (2) identify any patient traits/behaviors and external tooth/crack characteristics correlated with these changes.MethodsIn this observational study, 209 National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2858 subjects, each with a single, vital posterior tooth with at least one observed external crack; 1850 teeth remained untreated after one year of follow-up and were the cohort for analyses. Data were collected at the patient-, tooth-, and crack-level at baseline, one-year follow up (Y1), and interim visits. Associations between changes in symptoms and cracks were identified, as were changes in symptoms associated with baseline treatment recommendations.ResultsChanges in pain symptoms were observed in 32% of patients; decreases were twice as common as increases (23% vs. 10%). More changes were observed in cold pain than in biting pain and spontaneous pain combined; 2% had increases in biting pain and 2% in spontaneous pain. Only 6% had an increase in the number of cracks. Changes in pain symptoms were not associated with an increase in the number of cracks, but were associated with baseline treatment recommendations. Specifically, pain symptom changes (especially decreases) were more common when the tooth was recommended for treatment at baseline.ConclusionsCracked teeth that have not received treatment one year after baseline do not show meaningful progression as measured by increased symptoms or number of cracks during follow-up.Clinical significanceUntreated cracked teeth, most of which were recommended for monitoring at baseline and some of which were recommended for treatment but did not receive treatment, remained relatively stable for one year with little progression of cracks or symptoms.

Project description:OBJECTIVES:The objective of this study was to determine which patient traits, behaviors, external tooth and/or crack characteristics correlate with the types of symptoms that teeth with visible cracks exhibit, namely pain on biting, pain due to cold stimuli, or spontaneous pain. METHODS:Dentists in the National Dental Practice-Based Research Network enrolled a convenience sample of subjects each of whom had a single, vital posterior tooth with at least one observable external crack (cracked teeth); 2858 cracked teeth from 209 practitioners were enrolled. Data were collected at the patient-, tooth-, and crack-level. Generalized estimating equations were used to obtain significant (p?<?.05) independent odds ratios (OR) associated with teeth that were painful for 10 outcomes based on types of pain and combinations thereof. RESULTS:Overall, 45% of cracked teeth had one or more symptoms. Pain to cold was the most common symptom, which occurred in 37% of cracked teeth. Pain on biting (16%) and spontaneous pain (11%) were less common. Sixty-five percent of symptomatic cracked teeth had only one type of symptom, of these 78% were painful only to cold. No patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Positive associations for various combinations of pain symptoms were present with cracks that: (1) were on molars; (2) were in occlusion; (3) had a wear facet through enamel; (4) had caries; (5) were evident on a radiograph; (6) ran in more than one direction; (7) blocked transilluminated light; (8) connected with another crack; (9) extended onto the root; (10) extended in more than one direction; or (11) were on the distal surface. Persons who were <65 yo or who clench, grind, or press their teeth together also were more likely to have pain symptoms. Pain was less likely in teeth with stained cracks or exposed roots, or in non-Hispanic whites. CONCLUSIONS:Although pain to cold was the most commonly noted pain associated with symptomatic cracked teeth, no patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Characteristics were only associated with pain on biting and/or spontaneous pain with or without pain to cold. CLINICAL SIGNIFICANCE:Although often considered the most reliable diagnosis for a cracked tooth, pain on biting is not the most common symptom of a tooth with a visible crack, but rather pain to cold.

Dataset Information

Correlation between symptoms and external characteristics of cracked teeth: Findings from The National Dental Practice-Based Research Network.

Publications

Correlation between symptoms and external characteristics of cracked teeth: Findings from The National Dental Practice-Based Research Network.

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