Baseline characteristics as 3-year predictors of tooth fracture and crack progression: Findings from The National Dental Practice-Based Research Network

Was the Coronavirus Disease 2019 Pandemic Associated with an Increased Rate of Cracked Teeth?

INTRODUCTION

There is lack of data on whether the coronavirus disease 2019 (COVID-19) pandemic was associated with changes in the etiology of pathosis in endodontic patients. The aim of this study was to determine the rate of cracks and other etiologic factors during the period of March 16th to May 31st in 2020 (COVID-19 initial outbreak) and 2021 (COVID-19 ongoing pandemic) compared with figures from the same period in 2019 (pre-COVID era) in 2 endodontists' practices.

METHODS

The etiologies of patients' chief complaints were determined from records of 2440 teeth (740 in 2019, 651 in 2020, and 1049 in 2021). Changes in the proportion of etiologic factors among all 3 periods were analyzed. The association between the rate of cracked teeth and patients' age and sex was determined using a logistic regression model.

RESULTS

The rates of all etiologies collectively during the studied periods showed a significant change (P < .0001). The rate of cracks significantly increased in 2020 (11.8%) (P = .0001) and 2021 (8%) (P = .0018) compared with 2019 (4.3%). The rate of persistent infections decreased in 2020 (22.3%) (P = .0013) and then increased in 2021 (27.5%) (P = .0153) compared with 2019 (30%). Cracked teeth were associated with the age group of 40-60 years (odds ratio [OR] = 1.882; 95% confidence interval [CI], 1.063-3.330) in 2020 and with age ranges of 40-60 years (OR = 2.051; 95% CI, 1.120-3.759) and >60 years (OR = 2.038; 95% CI, 1.050-3.956) and male sex (OR = 1.599; 95% CI, 1.019-2.510) in 2021.

CONCLUSIONS

The rate of cracked teeth increased during the initial outbreak of the COVID-19 pandemic and 1 year later. This study provided evidence on the association between the COVID-19 pandemic and changes in the rate and presentation of endodontic etiologic factors.

Onset and resolution of pain among treated and untreated posterior teeth with a visible crack: Three-year findings from the national dental practice-based research network

OBJECTIVE

Cracked teeth may be associated with pain, especially biting pain, and to a lesser degree cold and spontaneous pain.  Described are how commonly these pains remain constant, develop, or resolve over time, none of which have been well-described, especially among untreated cracked teeth.

METHODS

Cracked teeth from the Cracked Tooth Registry (CTR) study were followed for 3 years.  Assessments of cold, biting, and spontaneous pain and treatments performed were completed at enrollment (Y0) and at each annual recall visit.

RESULTS

209 practitioners enrolled 2,858 patients, each with a visible crack on a posterior tooth; 2601 (91%) patients attended at least one recall visit. Overall, 960 (37%) were treated, primarily with crowns. Among both treated and untreated cracked teeth with biting pain or spontaneous pain at Y0, the vast majority (92-99%) had their pain resolved by the time of a recall visit and 85-93% remained pain-free after initial resolution. The observations for cold pain were similar: 68% (untreated) and 78% (treated) became free of cold pain at some point during follow-up, and 84% of these stayed free of cold pain after initial resolution. Few teeth developed biting or spontaneous pain (4-8%) and 44-67% of these had pain resolution during the follow-up period.

CONCLUSION

In this study, treatment resolved a preponderance of pain associated with a cracked tooth.  Pain was also resolved for most untreated cracked teeth, especially biting pain, and to a lesser degree spontaneous and cold pain, although not to the same degree as with the treated cracked teeth.