Causes of Enamel Disruption

Enamel cracks are linear enamel defects of a non-carious nature that occur during the functioning of teeth. Cracks are usually detected accidentally during a preventive inspection. In deep multiple defects, hyperesthesia may occur. Diagnosis of enamel cracks includes collecting complaints, analyzing the history of the disease and clinical examination data. Superficial enamel cracks are detected with a monocular or binocular loupe and using the transillumination method. Remtherapy is performed to eliminate hyperesthesia. Lamination of teeth with composite or ceramic veneers is indicated in case of complaints of aesthetic defect. 

General information

Enamel cracks – disruption of the integrity of the hard tooth tissue. To date, the prevalence of pathology reaches over 90%. In patients aged 20 years, an average of 4 intact teeth with enamel cracks are identified. Before 30 years of age, this rate increases 3 times and after 45-50 years of age it is 100%. In 60% of cases there are single fissures, multiple fissures are found in 40% of examined patients. In the study, researchers found that every decayed or treated tooth has deep multiple enamel cracks on its surface. In the prevailing majority of cases (90%) there are vertical longitudinal defects, less often the lines of enamel integrity violation have transverse direction, very rarely (3%) oblique enamel cracks are detected. 

Causes of enamel cracks

As a rule, enamel cracks are the result of several etiologic factors, among which the influence of physical and mechanical stimuli is of great importance. Hard foods, contrasting beverages, and trauma to the teeth can all compromise enamel integrity. Enamel cracks can also occur during medical manipulation. The surface layer is chipped due to temperature overheating during preparation, due to vibration of the instruments. There are reports that even polymerization shrinkage and contraction stresses at the filling-tooth tissue interface can, to some extent, cause the formation of surface enamel defects. 

Almost all teeth after the whitening procedure on their surface have deep multiple cracks of enamel, which is due to the aggressive effect of highly concentrated preparations based on hydrogen peroxide. Violations of the integrity of dental hard tissues are found in patients with wedge-shaped defects, increased erasability. In addition to pathologic enamel cracks, physiologic age-related damage also occurs. In the teeth of senile people, the prism faces are completely obliterated, with only the arrangement of the crystals indicating their boundaries. Enamel defects on the vestibular surfaces of the incisors are a sign of age-related changes. Small hydroxyapatites and mineralized bacteria resembling tartar are identified in them. 

Symptoms and classification of enamel cracks

In dentistry, all enamel cracks are roughly divided into 3 categories:

• Surface longitudinal cracks in enamel. They can be detected only with the help of special equipment – monocular or binocular loupe, as well as by the method of transillumination. 
• Deep longitudinal cracks in the enamel. Become visible under light after first drying the surface with a pouster or cotton ball. 
• Multiple (longitudinal, oblique, transverse) deep enamel cracks. Can be detected during a routine clinical examination without the use of additional instruments. 

The main complaint arising in patients with deep multiple enamel cracks is dental hyperesthesia. Increased sensitivity occurs when cold drinks are consumed. In most cases, there is no pronounced aesthetic defect with fractures. The lines of enamel integrity are determined not only on carious and depulped teeth, but also on intact teeth. On the cheek and oral surfaces, type 1 longitudinal enamel cracks are much less common than type 2 and 3 breach lines. 

The deepest linear defects are localized on the vestibular side of incisors and premolars. Relatively few enamel cracks are identified on the surface of the wisdom tooth due to its shorter lifespan. Although enamel cracks are considered non-carious lesions, they inherently serve as entry gates for microorganisms to enter, contributing to the development of the carious process. Due to the deposition of nicotine, food pigments enamel cracks can be dark colored. 

Diagnosis of enamel cracks

Diagnosis of enamel cracking is based on the analysis of the patient’s complaints, anamnesis data, results of clinical examination. During the physical examination, the dentist examines all tooth surfaces: vestibular, oral, aproximal, and occlusal surfaces. Those lines of disruption that are visible to the naked eye without the use of additional equipment are classified as type 3 enamel cracks. After isolating the teeth from saliva, drying all surfaces with a pouter or cotton ball, the examination is performed under the influence of intraoral light sources powered by the dental chair. At this stage it is possible to diagnose deep longitudinal enamel cracks of type 2. 

Treatment of enamel cracks

Along with physiological restoration of integrity and functional fullness of the tissue, superficial enamel cracks may self-correct, as the fluid produced by the pulp contributes to the restitution of enamel in the areas of defect formation. That is why enamel cracks, the presence of which does not cause hypersensitivity, do not require special treatment. If patients complain of hyperesthesia, a course of remineralizing therapy with successive applications of calcium- and fluoride-containing preparations is carried out.

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