Thomas J Hilton1, Ellen Funkhouser2, Jack L Ferracane3, Michele Schultz-Robins4, Valeria V Gordan5, Bobby J Bramblett6, R Mack Snead7, Walter Manning8, Jeffrey R Remakel9. 1. Alumni Centennial Professor in Operative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, Ore. Electronic address: hiltont@ohsu.edu. 2. Associate Professor, School of Medicine, University of Alabama, Birmingham Ala. 3. Chair, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, Ore. 4. Clinical Assistant Professor, Restorative Department, Rutgers School of Dental Medicine, Newark, NJ. 5. Professor, Department of Restorative Dental Sciences, University of Florida, Gainesville, Fla. 6. Private practice, Leeds, Ala. 7. Private practice, Fort Worth, Texas. 8. Private practice, Albany, Ore. 9. Private practice, St Louis Park, Minn.
Abstract
STATEMENT OF PROBLEM: Despite the high prevalence of posterior cracked teeth, questions remain regarding the best course of action for managing these teeth. PURPOSE: The purpose of this clinical study was to identify and quantify the characteristics of visible cracks in posterior teeth and their association with treatment recommendations among patients in the National Dental Practice-Based Research Network. MATERIAL AND METHODS: Network dentists enrolled patients with a single, vital posterior tooth with at least 1 observable external crack. Data were collected at the patient, tooth, and crack levels, including the presence and type of pain and treatment recommendations for subject teeth. Frequencies according to treatment recommendation were obtained, and odds ratios (ORs) comparing recommendations for the tooth to be restored versus monitored were calculated. Stepwise regressions were performed using generalized models to adjust for clustering; characteristics with P<.05 were retained. RESULTS: A total of 209 dentists enrolled 2858 patients with a posterior tooth with at least 1 crack. Mean ±standard deviation patient age was 54 ±12 years; 1813 (63%) were female, 2394 (85%) were non-Hispanic white, 2213 (77%) had some dental insurance, and 2432 (86%) had some college education. Overall, 1297 (46%) teeth caused 1 or more of the following types of pain: 1055 sensitivity to cold, 459 biting, and 367 spontaneous. A total of 1040 teeth were recommended for 1 or more treatments: restoration (n=1018; 98%), endodontics (n=29; 3%), endodontic treatment and restoration (n=20; 2%), extraction (n=2; 0.2%), and noninvasive treatment, for example, occlusal device, desensitizing (n=11; 1%). The presence of caries (OR=67.3), biting pain (OR=7.3), and evidence of a crack on radiographs (OR=5.0) were associated with over 5-fold odds of recommending restoration. Spontaneous pain was associated with nearly 3-fold odds; pain to cold, having dental insurance, a crack that was detectable with an explorer or blocked transilluminated light, or connected with a restoration were each weakly associated with increased odds of recommending a restoration (OR<2.0). CONCLUSIONS: Approximately one-third of cracked teeth were recommended for restoration. The presence of caries, biting pain, and evidence of a crack on a radiograph were strong predictors of recommending a restoration, although the evidence of a crack on a radiograph only accounted for a 3% absolute difference (4% recommended treatment versus 1% recommended monitoring).
STATEMENT OF PROBLEM: Despite the high prevalence of posterior cracked teeth, questions remain regarding the best course of action for managing these teeth. PURPOSE: The purpose of this clinical study was to identify and quantify the characteristics of visible cracks in posterior teeth and their association with treatment recommendations among patients in the National Dental Practice-Based Research Network. MATERIAL AND METHODS: Network dentists enrolled patients with a single, vital posterior tooth with at least 1 observable external crack. Data were collected at the patient, tooth, and crack levels, including the presence and type of pain and treatment recommendations for subject teeth. Frequencies according to treatment recommendation were obtained, and odds ratios (ORs) comparing recommendations for the tooth to be restored versus monitored were calculated. Stepwise regressions were performed using generalized models to adjust for clustering; characteristics with P<.05 were retained. RESULTS: A total of 209 dentists enrolled 2858 patients with a posterior tooth with at least 1 crack. Mean ±standard deviation patient age was 54 ±12 years; 1813 (63%) were female, 2394 (85%) were non-Hispanic white, 2213 (77%) had some dental insurance, and 2432 (86%) had some college education. Overall, 1297 (46%) teeth caused 1 or more of the following types of pain: 1055 sensitivity to cold, 459 biting, and 367 spontaneous. A total of 1040 teeth were recommended for 1 or more treatments: restoration (n=1018; 98%), endodontics (n=29; 3%), endodontic treatment and restoration (n=20; 2%), extraction (n=2; 0.2%), and noninvasive treatment, for example, occlusal device, desensitizing (n=11; 1%). The presence of caries (OR=67.3), biting pain (OR=7.3), and evidence of a crack on radiographs (OR=5.0) were associated with over 5-fold odds of recommending restoration. Spontaneous pain was associated with nearly 3-fold odds; pain to cold, having dental insurance, a crack that was detectable with an explorer or blocked transilluminated light, or connected with a restoration were each weakly associated with increased odds of recommending a restoration (OR<2.0). CONCLUSIONS: Approximately one-third of cracked teeth were recommended for restoration. The presence of caries, biting pain, and evidence of a crack on a radiograph were strong predictors of recommending a restoration, although the evidence of a crack on a radiograph only accounted for a 3% absolute difference (4% recommended treatment versus 1% recommended monitoring).
Authors: Michael S McCracken; David R Louis; Mark S Litaker; Helena M Minyé; Rahma Mungia; Valeria V Gordan; Don G Marshall; Gregg H Gilbert Journal: J Am Dent Assoc Date: 2016-08-01 Impact factor: 3.634
Authors: Thomas J Hilton; Ellen Funkhouser; Jack L Ferracane; Valeria V Gordan; Kevin D Huff; Julie Barna; Rahma Mungia; Timothy Marker; Gregg H Gilbert Journal: J Dent Date: 2017-12-28 Impact factor: 4.379
Authors: Ellen Funkhouser; Jack L Ferracane; Thomas J Hilton; Valeria V Gordan; Gregg H Gilbert; Rahma Mungia; Vanessa Burton; Cyril Meyerowitz; Dorota T Kopycka-Kedzierawski Journal: J Dent Date: 2022-02-25 Impact factor: 4.379
Authors: Thomas J Hilton; Ellen Funkhouser; Jack L Ferracane; Gregg H Gilbert; Valeria V Gordan; Sandra Bennett; Jennifer Bone; Peggy A Richardson; Hans Malmstrom Journal: J Dent Date: 2019-12-30 Impact factor: 4.379
Authors: Thomas J Hilton; Ellen Funkhouser; Jack L Ferracane; Gregg H Gilbert; Valeria V Gordan; Dorota T Kopycka-Kedzierawski; Cyril Meyerowitz; Rahma Mungia; Vanessa Burton Journal: J Am Dent Assoc Date: 2020-12-24 Impact factor: 3.634