Unfortunately, a simple filling does nothing to help strengthen the tooth or stop you from getting a broken tooth. A filling sits within the fracture (almost like a wedge in a log). It is only a matter of time for the crack to grow.

The ideal strategy for keeping your own tooth is to use restorations that reinforce the tooth, holding it together and making it strong. You thereby dramatically improve the chances of avoiding more extensive treatment. The longer we wait, the greater the chance that pain and loss can occur.

Insurance companies bet it all happens on someone else’s plan. Unfortunately, as a patient you are confronted with a choice. Do you invest in your own preservation or bet that when the tooth finally splits, it will be minor and the insurance company will then help out?

From almost 25 years of experience here is a close estimate of the risks:

• Teeth with angular cracks at the corners of a filling usually break off a corner or a half of the tooth to the gumline. These teeth are successfully treated with a build up and a type of crown. We see this almost every week.
• Teeth with a vertical crack eventually become occasionally tender to biting. If restored early enough, we avoid the additional need for a root canal about 80% of the time. We see this many times a month.
• If a cracked tooth always hurts upon biting, it probably needs a root canal, build-up and crown to save it. We see this a couple or few times a month. If the fracture runs deep there remains a small chance of fracture progression.
• If a large part of the tooth breaks away under the gumline, it becomes increasingly difficult and risky to treat and save the tooth. We see this a few times a year.
• If the tooth splits in half or far under the gumline, it needs to be extracted. Replacement, usually means a three tooth bridge or an implant. We see this several times a year.
• Every day we see prominent stress cracks growing under fillings we are removing. Crown type restorations save these teeth.

With each of the above situations, the increased treatment of a root canal and tooth build-up doubles the cost. If a tooth is lost and you have a bridge or implant, the cost is 3-4 times a single overlay or crown.

At Donaldson and Guenther, your personal best interest is our foremost concern. We repeatedly see patients and their teeth stay happier when appropriate treatment is done “in time” before something breaks or becomes painful. We understand dentistry is expensive. That is why we try to do the right thing – the first time. Nothing is more expensive and frustrating than needing more extensive treatment later because an insurance company encouraged people to gamble against themselves.

Of course not. We all understand that the situation can become much worse if we let fractures expand. However, many dental insurance companies eliminate coverage for restorations that are designed to make a broken tooth strong again. Why? And why is it an important issue to you?

Why do insurance companies have an elimination clause on fractures and wear?

• Many broken teeth have relatively small fillings or none at all. So, from looking only at an x-ray that doesn’t show the crack, it can look like over-treatment. (That is why we also send photos, but even that does not usually help)
• There may not be pressing painful symptoms at the time.
• Broken teeth may take several years to split or need a root canal treatment.

Also, insurance companies “bet” that you will be gone before the problem becomes a crisis. They know the average subscriber will be on a different plan in two years, which means another company will have to pay. Insurance companies eliminate benefits on fracturing and heavily worn teeth as a short term strategy to get cash flow savings.

We wish we could predict exactly when teeth will fracture away, need a root canal treatment, or be lost due to splitting in half. We do know that timely, adequate treatment most often prevents bigger problems later. The next post will describe the risks of not investing in early preservation of your teeth.

Thanks for your inquiry about alternatives to root canals. I took the liberty to watch a Mercola video to learn where he was coming from.

Your tooth has a big filling. That means the tooth is weakened a bit because a traditional filling does nothing to reinforce the tooth. Teeth like that often get stress cracks over time because of fatigue. If the crack goes off at an angle, a part of the tooth might break away and is easily repaired. However, if the crack moves vertically up the tooth, it can move into the nerve area or even split the tooth in half.

To strengthen a tooth with a crack, the tooth needs to be held together. The most common way to do that is with a crown. A crown is like a new strong outer shell for the tooth ; binding it together. Often an insulating build up is done to clean up , and strengthen the deeper areas where the old filling and or decay was.

When the nerve of a tooth becomes involved, either from a fracture, decay bacteria, or inflammation from trauma; the tooth can slowly or abruptly die. As Dr Mercola describes, a root canal seals the main micro tubes inside the tooth; usually three on a molar. However, like a river system, there are microscopic tributaries or side canals that the cleaning instruments don’t enter. However, as the tooth canals are cleaned out, the tooth is repeatedly irrigated with a disinfecting bleach solution. That important irrigation cleans the auxiliary canals.

About ten years ago the technology for doing root canals dramatically improved. Post operative discomfort and infections are rare. Millions of people enjoy keeping their teeth, thanks to root canals. Do some fail? Sure, but that is fairly rare these days– IF, the root canal is done well.

Back to the crack. The further a crack goes up a tooth, the poorer the outlook. When you bite, it stresses the tooth. The gross majority are saved without a problem, but depending on the situation, it’s possible to overload anything– even a tooth with no prior treatment.

Alternatives: Dr Mercola says extract all root canal teeth. Or maybe your fracture is far gone. Or the infection has gone on so long that a lot of bone has been destroyed around your tooth. OK, the tooth is lost.

The tooth can be left as a space, replaced with a removable appliance, replaced as a bridge, or done as an implant. For an implant to work, you need enough bone. In most cases these days, it is the preferred way too replace a tooth because it is strong, you can floss it normally and it does not force you to treat the adjacent teeth.

It is a complex subject. A good look at what is happening, and an understanding of your personal preferences should help you solve your problem. The tooth sounds like it is feeding an on going infection. Antibiotics help you short term, but are unable to treat the infection at its source inside the tooth (no longer a blood stream to deliver the drug and the pulp tissue inside and it won’t regenerate or heal).

If you are interested in seeing me for an exam, please set up an appointment. You will probably speak with Ann. 734-971-3450

I hope this was helpful to you — and I learned about Dr Mercola. I do disagree with him fundamentally though. I have seen way too many happy patients who have successful root canals, including myself.

Sincerely,
Kirk D.