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.

Over the past 15 years, I have watched dental insurance companies pay less and less of the true cost of dental care. Patients are having to assume greater financial responsibility for their care and are planning their treatment more strategically. At D & G, our patients learn about their current, emerging, and optional dental issues. By prioritizing and dividing treatment into phases, I help patients plan their care for the next year so it optimizes their combined insurance and pre-tax plan benefits. This strategic approach to dental care often allows our patients to elect treatment options that are longer lasting and/or more beautiful than the typically lower levels of care encouraged by the insurance companies.