Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

October 25, 2007

Saving a cracked tooth

Filed under: Fractured teeth — mesasmiles @ 8:04 am

Dr. Hall,
I have been reading your article on Restoration of fractured teeth.

In Sept 2007 I had a filling in #14 which caused a lot of pain. On Oct 1, 2007, an endodontist started a root canal, but quit after removing the pulp because she detected a vertical mesial to distal fracture. My dentist doesn’t believe her, wants a second opinion including its depth, position, and whether she can “describe” the tooth.

I need an endodontist who understands your article, but your categories do not cover this problem. I have called the endodontist and requested that she remove the temporary filling and collect the data my dentist requested, but she has refused to work on it any further. She feels that “no cracked tooth is worth saving.”
– Sharon in Illinois

Sharon,
I don’t know any endodontist to send you to.

As far as my research on saving fractured teeth, this is kind of a blockbuster, revolutionary idea, and it usually takes ideas like that some time to get credibility in the dental community. I think someone’s going to need to get inspired to duplicate my research, and maybe a couple of people to do this, before the idea takes hold. When you’ve got an idea like that, people who just read the study tend not to believe that you saw what you say you saw.

And then remember, there is a stringent set of requirements for actually saving the tooth, as far as the nature of the fracture, the timing in catching it, and the methods for treating it. The article makes all of that clear. It’s a minority of fractured teeth that can be saved.

And then the other obstacle is that there is a strong sentiment among dentists to take the safe course. It’s a much safer feeling for a dentist to just extract a fractured tooth. No one would ever give the dentist trouble over that. But you start saving teeth that might not make it and if it doesn’t make it, that’s when the dentist could have trouble. That’s one of the unintended consequences of the great compassion that trial lawyers have engendered for patients who have suffered from treatments–dentists have learned that it’s smart to play it safe.

A dentist has to have enough passion for saving teeth to be willing to risk that the treatment might go bad in order to pursue this kind of treatment or research. And I haven’t found many endodontists, curiously, with a passion for saving teeth. They tend to be perfectionists and conventional thinkers. Their dental school professors told them cracked teeth can’t be saved, so they’re not going to go out on a limb. I even had one tell me a tooth was cracked and couldn’t be saved when it wasn’t cracked at all.

I’d print out the article and share it with your general dentist and see what he or she can do. It sounds like your dentist is dedicated to saving teeth, because he or she isn’t giving up easily on this. – Dr. Hall

Related information from the www.mynewsmile.com web site:
Root canal treatment
Failed root canal treatment

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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