Asymptomatic cracked tooth
What do you do when you discover an asymptomatic crack in a molar tooth?
Let’s say that you’ve treatment planned the replacement of an MOD filling in an upper first molar but when you remove the old filling you find a crack running all the way mesial to distal in the tooth.
Most dentists would agree that when we see such a crack it’s only a matter of time until the tooth breaks. Maybe it will break next week or maybe it will break two years from now, but it will break.
For now, the crack is not producing any symptoms and the patient is totally unaware of it.
And, the patient is just expecting a filling.
What do you do?
That’s an interesting challenge and I’ve seen some dentists struggle with it.
One option is to say nothing and complete the filling as treatment planned. I’ve seen several dentist take that approach.
The benefit of that approach is that there is no immediate possibility of upsetting the patient. The patient gets exactly what they were expecting. No surprises.
The downside is that you’re not being honest with your patient — you’ve found a problem and you’ve chosen to ignore it. If the tooth subsequently breaks then you are at fault.
Also, when that happens, there is a good chance that the patient will not be happy:
“You drilled too much and made my tooth weak!”
or
“My tooth was OK until you worked on it.”
A better option
A better option in my view, is to inform the patient and let them make the decision.
It’s the honest approach and it gets you off the hook if the tooth subsequently breaks.
The patient can then either choose to take the risk of the tooth breaking or they can get something done to prevent it.
Here’s what I’d do
First I’d stop working on the filling and take a picture of the tooth that shows the crack.
Then, I’d sit the patient up, remove their bib and safety glasses and have a conversation. The conversation would run like this:
Me: “Now that I’ve removed the old filling I can see a crack in the tooth. You can see it here on the screen.
That crack tells me the tooth is weak and the tooth might split.
You have two options…
The first one is that I can complete the filling as planned. The advantage with that is that there is no extra cost but the disadvantage is the tooth is weak and it might break.
The other option is that I can make a porcelain onlay for this tooth.
A porcelain onlay is a cover that goes over the top of the tooth and makes it stronger.
The disadvantage is that doing this will cost an additional $960 over what I quoted you for the filling but the advantage is that it will strengthen the tooth and make it much less likely to break.
What would you like to do?”
What will happen
My experience with this approach is that about 80% of the time the patient will go for the porcelain onlay.
About 20% of the time the patient will go for the filling.
But, at least if they make that choice they are warned of the downside and will not hold you responsible when the tooth breaks.
What do you do when you find a crack under an old filling?
