Assessing the Outcomes of Cracked Teeth in Northwest PRECEDENT

Objectives: To identify risk factors for predicting adverse outcomes in both symptomatic and asymptomatic cracked teeth for patients in practices of Northwest PRECEDENT.

Methods: Practices assessed for cracks in a posterior tooth of randomly selected subjects and subjects reporting pain symptoms.  Teeth were assessed via visual examination with magnification, tactile perception, transillumination.  To be included, cracks had to block transilluminated light.  Various patient-, tooth-, and crack-level criteria were assessed, along with treatment recommendations.  Various components of crack progression (length, depth, staining, direction, # surfaces, # cracks, periodontal pocket) were assessed. All patients had at least 12 months follow-up. GEE logistic regression adjusted for practice was used to assess crack progression vs. covariates (p≤ 0.05).

Results: 34 practices in NW PRECEDENT evaluated 634 subjects with an eligible cracked tooth, 248 of which had at least one-year follow-up and were included in this analysis. 87 (35%) reported pain from either patient self-report or dentist assessment at baseline; 16 patients developed pain symptoms in the following year. 66(27%) showed at least one component of crack progression in one year.  Recommended treatment included: extraction:5(2%), endo:3(1.2%), restorative: 99(40%). Among asymptomatic subjects, teeth with an oblique (OR=2.12[0.88,5.21]) crack showed a slight trend towards crack progression, and teeth with a horizontal (OR=14.1 [4.96,41]) or oblique (OR=5.2[1.99,13.6]) crack were significantly more likely to be recommended for restorative treatment than teeth without those same cracks, respectively. Restored teeth were less likely to show crack progression compared to teeth without restorations.  However, the likelihood of a recommendation for restorative treatment increased with the number of restored surfaces for both asymptomatic (OR=1.51[1.10,2.07]) and symptomatic (OR=1.28[0.75,2.20]) teeth.

Conclusions: Findings show considerable progression of cracks in teeth in just one year.  Factors responsible for crack progression are many but appear unrelated to restorative treatment recommendations.