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Prevalence and Clinical Characteristics of Teeth Extracted with a Diagnosis of Cracked Tooth: a Retrospective Study

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Prevalence and Clinical Characteristics of Teeth Extracted with a Diagnosis of Cracked Tooth: a Retrospective Study Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 2017 Prevalence and Clinical Characteristics of Teeth Extracted with a Diagnosis of Cracked Tooth: A Retrospective Study Riley B. Sturgill Virginia Commonwealth University Follow this and additional works at: https://scholarscompass.vcu.edu/etd Part of the Dental Public Health and Education Commons, and the Endodontics and Endodontology Commons © The Author Downloaded from https://scholarscompass.vcu.edu/etd/4820 This Thesis is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. © Riley B. Sturgill, DMD 2017 All Rights Reserved Prevalence and Clinical Characteristics of Teeth Extracted with a Diagnosis of Cracked Tooth: A Retrospective Study A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University. by Riley B. Sturgill, DMD, BS, King University, 2008 DMD, Arizona School of Dentistry & Oral Health, 2013 Director: Garry L. Myers, DDS Director, Advanced Education Program in Endodontics, Department of Endodontics, Virginia Commonwealth University School of Dentistry Virginia Commonwealth University Richmond, Virginia May, 2017 ii Acknowledgement The author wishes to thank several people. I would like to thank my husband, family, and friends for all of their many prayers, love, and support. I would also like to thank Drs. Best, Myers, and Coe for their help and guidance with this project. iii Table of Contents List of Tables .................................................................................................................................. v List of Figures ................................................................................................................................ vi Abstract ......................................................................................................................................... vii Introduction ..................................................................................................................................... 1 Materials and Methods .................................................................................................................... 7 Results ........................................................................................................................................... 11 Discussion ..................................................................................................................................... 23 References ..................................................................................................................................... 28 Appendix A ................................................................................................................................... 29 Vita ................................................................................................................................................ 91 iv List of Tables Table 1. Number of Extracted Teeth per Patient ...........................................................................12 Table 2. Characteristics of Extracted Teeth and Crack Prevalence .............................................. 15 Table 3. Adjusted Odds Ratios for Teeth Characteristics ............................................................. 22 v List of Figures Figure 1. ........................................................................................................................................ 13 Figure 2. ........................................................................................................................................ 16 Figure 3. ........................................................................................................................................ 18 Figure 4. ........................................................................................................................................ 19 Figure 5. ........................................................................................................................................ 20 Figure 6. ........................................................................................................................................ 21 Abstract PREVALENCE AND CLINICAL CHARACTERISTICS OF TEETH EXTRACTED WITH A DIAGNOSIS OF CRACKED TOOTH: A RETROSPECTIVE STUDY By Riley B. Sturgill, DMD A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University, 2017. Director: Garry L. Myers, DDS Director, Advanced Education Program in Endodontics, Department of Endodontics The body of knowledge that exists regarding cracked teeth is limited. The purpose of this study was to determine the prevalence of cracks among extracted teeth. This retrospective longitudinal cohort study included patients of the Virginia Commonwealth University School of Dentistry that underwent extraction procedures over a 6 year period. The sample consisted of 20,408 patients and 40,870 teeth. Statistical analysis software was used to identify diagnoses of a crack, fracture, or split tooth prior to extraction of the tooth by analyzing the Electronic Health Record (EHR) (axiUm™, Version 6.03.03.1035, Exan Corporation, Vancouver, BC, Canada). There were 3,228 teeth identified as cracked in the 40,870 extracted teeth—an overall prevalence of 7.90%. The percentage of cracked teeth were compared using a chi-square test of homogeneity. The prevalence of cracked teeth varied according to tooth type (chi-square = 95.5, df = 7, p < .0001). Tukey’s multiple-comparison procedure identified the groups of tooth types with a significantly different cracked prevalence. The mandibular 2nd molar had the highest prevalence (9.72%). Age and gender were also significantly correlated with cracked teeth. Introduction Cracked teeth or “cracked tooth syndrome,” as coined by Cameron (1) is a significant and complicated problem in dentistry. Restoring the cracked tooth has always been somewhat of a dilemma due to the unpredictability of the long-term prognosis. As the population ages, and more and more people are retaining their natural dentition for longer periods of time, this problem will continue to manifest itself, often with vague symptoms (2). Dental providers should seek to gain as much knowledge about the prevalence of common diseases encountered in their practice. The scope of the impact of cracked teeth on dentistry could be better understood if we knew how often it leads to tooth loss. It would be important for the dentist to have the capability of describing the projected outcome of a cracked tooth with a statistic. More research is needed in the area of cracked teeth so that dental professionals can be aware of the current best evidence in regards to treatment being rendered for teeth that have been diagnosed as cracked or fractured. It would be interesting to understand how and why some teeth are diagnosed as cracked and when they may exhibit vague symptomology. Learning about the characteristics of teeth that are extracted due to the diagnosis of a crack or fracture could give insight into possible risk factors or trends. The human dentition is subject to numerous forces during functional and parafunctional habits. Destructive forces applied to teeth will negatively affect the longevity of a tooth and the dentition. The body of knowledge that currently exists regarding cracked teeth is limited. It is theorized that nocturnal bruxism can elicit much greater occlusal force on the teeth than 1 conscious effort due to inhibition of cortical suppressors (3). Other factors such as removal of tooth structure during restorative care can weaken a tooth’s overall strength. Hiatt (4) was the first to posit that factors such as parafunctional habits, eccentric interferences, the wedging effect of cusp/fossa relations in posterior teeth, the lack of protection of transverse ridges in mandibular molars, and the lever principle of greater forces located more posteriorly near the fulcrum of the temporomandibular joint (TMJ) were factors that may predispose a tooth to fracture. Hiatt also noted that lack of placement of a cuspal coverage restoration greatly affects the likelihood of a crack in posterior teeth that are endodontically treated (4). There are numerous theories on the causations of cracks, but once a crack is found to be present in a tooth, the clinician must be ready to offer treatment options with predictable outcomes. Many patients present complaining of diffuse pain, discomfort with chewing, and sensitivity to cold and sweets (5). The decision making process following a diagnosis of a crack in a tooth can be quite subjective. Some of the diagnostic aids employed by practitioners to diagnose cracked teeth include the common endodontic diagnostic testing regimen, i.e. cold, hot, EPT, percussion, palpation, bite test, periodontal probing and a radiographic exam. Seo, et al. found the most common clinical feature of cracked teeth was pain to the bite test (6). Age was also a factor, with persons over the age of 40 having a higher prevalence of cracked teeth (6). Previous studies have found different common methods for successful detection of cracks. Often, a clinician will
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