Are You Using Your Teeth as Tools?
By Roman J. Fedorciw, DDS
mon. When a tooth breaks, it is usually caused by misuse. Most people do not realize that chewing on ice, biting finger- nails or cuticles, holding pens or other objects between the teeth or just clench- ing during sleep, exercise or anger can permanently damage teeth. Teeth have three basic layers. The in- nermost section is the pulpal chamber. It contains blood vessels and nerves, and is the softest part of the tooth. The next layer is the dentin. This layer surrounds the pulp and contains small water-filled tubules that act like conductors of sensation to the nerve. The dentin also is responsible for the shade of the tooth. Being yellow, it affects the color as it is seen through the semi translucent third potion of the tooth, the enamel. This outermost layer is the only non-living part of the tooth. It is com- posed of an inorganic mineral matrix that is more brittle than dentin and susceptible to fracture. The jaw utilizes four main muscles in
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the chewing process. The strength of these muscles, combined with the small surface area and sharpness of teeth, impart the tremendous forces that are necessary to tear and shred food. When these forces are improperly directed by misuse, the enamel absorbs them, causing microfractures. These hairline fractures can be compared to the crackling (known as craze) seen in old porcelain; yet unlike a broken bone that can be identified on x-ray, these lines can only be seen via transillumination, a process of shining a bright light onto the teeth to view imperfections. On posterior or back teeth, these
microfractures present with symptoms, including sensitivity to cold in conjunction
8 Natural Nutmeg June 2012
rantic calls from patients, exclaiming that a large part of a tooth splintered or fractured away, are not uncom-
with an intermittent quick sharp pain upon chewing. Usually, the affected tooth has a large filling due to past decay and restora- tion. Subsequently, clenching, chewing on ice or accidentally biting into a raw popcorn kernel causes a wedging effect that initiates the craze. This fault slowly propagates through the enamel and upon reaching the dentin, the chewing and cold sensitivity begin. The treatment modal- ity for this situation is usually a crown or onlay, which provides partial or circum- ferential support to a compromised tooth preventing it from fracturing. The crown process involves the
removal of the defective enamel down to the healthy dentin and then cementing or bonding the replacement that restores the tooth to proper strength and function. If left untreated, these microfractures can cause the affected piece to break away or cause the stress fracture to continue into the pulpal chamber necessitating a root canal.
Microfractures on anterior or front six teeth present differently than their counter- parts in the posterior. Anterior teeth with microfractures usually have no pain, but present with roughened or slightly jagged edges. When transilluminated, vertical lines can be seen joining the ‘V’ shaped irregular chips at the edges. Under contin- ued misuse, the microfractures coalesce causing a larger rectangular piece to flake away. Repair of these situations is not as simple as bonding. Bonding is the chemi- cal attachment of a white filling to both the enamel and dentin. Bonding adheres, not by having long rebar-like projections that go into the healthy tooth, but by use of shallow plugs that attach to the adja- cent surface. If the adjacent surface is also comprised, then the filling will just fall off taking more enamel with it.
Once again, the accepted treatment
modality would be to remove the dam- aged enamel down to the healthy dentin and replace it with porcelain. When indicated, not only is the finished product beautiful, but it will also restore the tooth to its original strength and function. Whether the damage is repaired on the front or back teeth, if the misuse is not identified and stopped, eventually the pro- cess of fracturing will continue even in the new porcelain. If you are clenching your teeth, try consciously placing the tip of your tongue between your teeth to prevent further damage. However, if your actions are done subconsciously, then visit your dentist for a properly fitted occlusal guard. Teeth are not tools. Thinking before putting something in your mouth could save you a great deal of time with your dentist!
Dr. Roman Fedorciw is a graduate of New York University College of Dentistry. He com- pleted his residency at Long Island College Hospital in New York and is a member of the American Academy of General Den- tistry, American Dental Association, and the Connecticut State Dental Association. Since 1990, Dr. Fedorciw has maintained a private family practice in Cromwell, Connecticut which focuses on general restorative and cosmetic dentistry.
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