A Tale of Two Teeth

Six Lessons Approach Podcast by Dr. David Alleman

Throughout dental school and into his early career, Dr. David Alleman had a tooth with an occlusal amalgam that experienced intermittent pain on biting. The tooth was examined, but no cause for the symptom was found. Years later, after thoroughly studying adhesive dentistry, Dr. Alleman understood that there must be a crack in the tooth. Having recently acquired an intraoral camera in his office, he could now visualize the crack and, with the help of his assistants, dissect the crack and restore the tooth himself. The symptoms resolved and the tooth is still healthy and functioning to this day.

A few years after restoring the first tooth, the tooth directly above it chipped. Dr. Alleman assumed the chip was only in the enamel because the tooth was asymptomatic, so he thought further treatment could wait. But in 2011, to his regret, the tooth fractured through the root and had to be extracted. This unfortunate incident taught Dr. Alleman a valuable lesson about the urgency and importance of timely and accurate crack diagnosis, which he now teaches to his colleagues and students.

Both teeth had vertical cracks. One tooth was saved with proper diagnosis and treatment, but the other was not. This happens to patients every day, but understanding how cracks in teeth propagate and how cracks are treated outside the field of dentistry [engineering] can significantly contribute to saving more teeth. This knowledge empowers us as dental professionals and students, motivating us to learn more and improve our practices.

Articles discussed in this episode:

• Abbott P, Leow N. Predictable management of cracked teeth with reversible pulpitis. Australian Dent J. 2009; 54:306-315.
• Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457

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