General information

Cracked tooth syndrome


Cracked tooth syndrome is the discomfort and pain experienced when a tooth develops a crack that affects the nerve of the tooth.

A tooth may crack and break without any pain. This is where either the tooth is already dead, or the crack does not impinge on the nerve of the tooth.


There are many reasons why a tooth may become more susceptible to developing a crack and below are a few of the more common reasons :

  • Trauma
  • A hard diet
  • Tooth grinding in the night
  • Large fillings which weaken the tooth

Signs and Symptoms

Classically with cracked tooth syndrome the tooth initially gives a sharp twinge on biting and may also show signs of sensitivity to hot and cold foods and drinks. The pain associated with biting is normally on release of pressure and to begin with only lasts for a few moments.

As the crack gets worse over time the symptoms can become more severe. The pain to biting or temperature can last for a few hours or even be persistant.

Prevention and Treatment

Sports players and those involved in contact sports especially should wear sports mouth guards to help prevent against trauma.

Patients should be careful what they eat and avoid chewing or biting into something hard e.g ice, boiled sweets or meat bones.

For patients who suspect they tooth grind through the night, mouth guards are an easy and quick solution to helping prevent the trauma caused by this action.

If you suspect you have a cracked tooth and have had recurrent symptoms as those described above for more than a few weeks, please contact the surgery straight away. As a cracked tooth is a structural fault in the tooth, it stands to reason that this problem cannot cure itself. Early intervention means the chance of success of treatment is that much better and usually far less involved.

If the nerve in the tooth appears to be intact and healthy, a crown can sometimes solve the problem with a view that the nerve may need further treatment at a later date. In worse cases where the nerve has been damaged beyond repair a root treatment and crown may be required.

And of course in the worse can scenario where the crack has gone too far or even split the tooth in two, an extraction may be the only option available.

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Fissure Sealants

Fissure sealants are flowable composite resin restorations that are used to fill the fissures in the biting surfaces of teeth to assist in cleaning and the prevention of tooth decay.

Commonly fissure sealants are placed in molars and pre molars ( back teeth ) that have deep, narrow and hard to clean fissures. They ideally are placed soon after the tooth has erupted into the mouth.

Not all teeth require fissure sealing. Please also note that fissure sealants assist in the prevention of tooth decay only in the areas that they are placed. Good oral hygiene and a good diet are still essential. Please feel free to consult your dentist if you have any questions relating to your children’s teeth and their suitability for fissure sealants.


The tooth is first cleaned, prepared with a special solution, washed and then dried. The tooth is now ready for the application of the sealant. This is carefully placed in the fissure and made to set hard with the use of a dental blue light. The procedure is pain free and does not require the use of a local anaesthetic.

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Dental Radiographs or Dental X-rays

A radiograph is the actual image that is produce from the x-ray beam. A common and accepted mistake is to call the image an x-ray.

Radiographs up until recently have always been shown on a film that requires developing. At Harpenden Dental Centre we use digital radiography. This is important and advantageous for the following reasons :

  • Immediate imaging, and hence no waiting for developing of films.
  • Chair side screen for ease of viewing for both dentist and patient.
  • Lower dosage of radiation than with conventional radiography making them safer for the patient.
  • Less exposure time than conventional radiography making them safer for the patient.

Radiographs are important to take and below are just a few of the reasons why :

  • They assist in the diagnosis of dental decay in areas that may not be visible to the dentist during a routine oral inspection. These areas are commonly between teeth and under fillings.
  • They help detect infections of the root.
  • They help to see the bone levels around teeth.
  • They help in showing the position of unerupted teeth in children and the detection of congenitally missing teeth in children.
  • They help to show the position of potentially troublesome wisdom teeth.

Once taken the dentist will spend time going over the findings of the radiographs. Please note that radiographs are an aid to clinical diagnosis. On their own they cannot be used to diagnose a problem and hence they are used to assist the clinical findings after an oral examination.

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Dry Mouth or Xerostomia


This is a condition of the mouth that affects the flow of saliva, making your mouth feel dry.

Saliva is important as it contains enzymes to help break down food and also helps to wash and cleanse teeth in the fight against tooth decay and gum disease, hence good oral hygiene is very important for these patients.

Signs and symptoms

These can include thick and sticky saliva, a prickly/burning sensation and/or sensitivity to certain foods, difficulty swallowing. Soft tissues may become red and shiny. Taste and speech may be affected and patients are more likely to suffer from bad breath.


There are many different causes for this condition including old age, women going through the menopause, a side effect of medication ( including HRT) or radiotherapy treatments and as a direct result of medical conditions including diabetes, lupus and Sjrogren’s syndrome.

Prevention and treatment. It is difficult to prevent and patients should seek advice from their dentist if they suspect they have this problem. There are sprays and gels available at chemists to help provide moisture and comfort. Some patients have described sipping water or sucking sugar free sweets to help.

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Dental Decay or Dental Caries


The dissolving and then destruction of tooth tissue, enamel and dentine, from acid attack.


Dental decay is caused from plaque acids that are produced when the bacteria in plaque on the surface of a tooth reacts with sugars in food and drinks. Each time you eat something containing sugar, the bacteria in plaque reacts to form an acid that dissolves and then destroys tooth tissue. Please note it is not the amount of sugar consumed that is of most importance, but instead the frequency of which sugar is consumed.

Signs and symptoms

To begin with there may be no pain while decay is progressing and a cavity is developing. Later as the cavity gets larger you may begin to experience sensitivity to hot, cold and sweet drinks and foods. This pain may only be momentary in the early stages of decay. As the decay approaches the centre of the tooth where the nerve and blood supply are located the pain associated with temperature may become longer lasting and may be so severe that painkillers may become necessary to control the pain.


The most common sites for developing decay are in the biting surfaces of teeth and also on the surfaces between teeth.

Prevention and treatment

Reduce how often you consume sugary and acidic drinks and foods. Maintain good oral hygiene, brushing your teeth twice daily with a fluoride tooth paste and flossing or using another form of a cleaning instrument interdentally. In certain circumstances fissure sealants can be placed in the biting surfaces of teeth that help protect the tooth by filling in the little crevices in the tooth and creating a flat surface that is easier to clean.

Visit your dentist regularly so that they can check for cavities when they examine or x-ray your teeth. Remember that small cavities are much easier to treat than when the decay is more advanced. If a cavity is found the tooth may require a filling. If the decay has damaged the nerve in the tooth, the tooth may still be saved with a root canal filling. If the tooth is very badly decayed it may require an extraction.

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Halitosis or Bad Breath


There are many different causes including the following:

  • Food trapping between teeth.
  • Gases released by plaque that coats your teeth.
  • Gum disease.
  • Tooth decay.
  • Tooth and gum abcesses.
  • Dietary e.g garlic, onions and coffee.
  • Dry mouth or xerostomia.
  • Various medical conditions affecting the stomach, nose throat or lungs e.g sinusitis.
  • Smoking.


This clearly depends on the cause of the halitosis, and your dentist can help in identify the problem. Please make sure you go for regular check ups and ask the hygienist or the dentist about the problem. Ensure that your cleaning and flossing techniques are correct and effective and that you are performing these tasks twice daily with the use of a fluoride tooth paste.

For those patients with dry mouths try sucking on sugar free sweets or chewing with sugar free gum. These both help to improve saliva flow. There are also various sprays and gels to improve moisture and comfort that you can get from the chemist.

If you smoke, stop. If you are struggling to stop, seek help from your GP or chemist in aids to help you stop smoking.

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Flouride is a naturally occurring mineral that is present in our drinking water to varying degrees and is also present in many foods and drinks, e.g fish and tea.

Flouride is important as it assists in the prevention of dental decay in two main ways. Firstly, it helps strengthen teeth by increasing the mineralization of enamel. And secondly, it reduces acid production by plaque.

The amount of fluoride in your drinking water can be found out from your water supplier. It has been suggested that 1ppm of fluoride in drinking water has the best desired affect against tooth decay. Fluoride in water has been proven to help reduce dental decay by up to 60%.

Supplemental fluoride can be taken from the age of 3 onwards up to the age of 7 to help reduce the risk of dental decay in those patients that live in areas where the water is not fluoridated but one must seek dental advice prior to doing this as too much fluoride in a childs diet can lead to dental fluorosis. As most toothpastes contain fluoride care must be taken to ensure the child is not swallowing the tooth paste especially if they are already taking supplemental fluoride as this too can lead to dental fluorosis.

Dental Fluorosis

This is what happens when one has too much fluoride in the diet and results in mottling, pitting and staining of enamel.

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Baby’s and Children’s Teeth

Baby/Primary teeth

Children start developing their baby/primary teeth before they are born and they start erupting into the mouth at about 6 months of age. In all there are 20 baby teeth of which the last come through at about two and a half years of age.

Adult/Secondary Teeth

These first appear at about six years of age and are usually all through at about thirteen years of age with the exception of their wisdom teeth. The first to appear at six years of age are the first adult molars and lower central incisors.

Please note that these are the average times at which teeth appear and that all children will develop at different rates.

First Dental Examination

At Harpenden Dental Centre we encourage you to bring your children with you as early you can. Initially this is not to examine them, but more to get them used to the environment of the practice and also for them to view you as parents having dental check ups. Children have a strong behavioural response and will want to copy your actions. At a very early age the child is usually examined on the dental chair but while on the parents lap. Over time as confidence increases, children become happy to sit on the dental chair by themselves.

It is especially important in these early years that bad dental experiences are avoided as these can stay with patients and are difficult to overcome. If as a parent you have dental fears, please do your best not to pass these onto to your children.

Cleaning Your Children’s Teeth

Cleaning of your children’s teeth should start as soon as their first teeth appear. For cleaning try and find a fun coloured tooth brush that is small headed with soft nylon bristles suitable for your child’s age. Current advice suggests a pea-sized smear of toothpaste containing at least 1000ppm of fluoride. Make sure after cleaning the tooth paste is not swallowed but instead spit out. Cleaning of teeth should be carried out twice a day, morning and before bed and it is suggested that children should be supervised up to the age of 7.

Preventing Tooth Decay

Reduce the frequency of consumption of sugary foods and drinks. Remember it is not the amount of sugar in the diet that is the main cause of tooth decay, but instead how often it is eaten or drunk. Get your child into good and healthy eating habits from the outset. Make sure their teeth are being brushed twice a day.

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Dental Filling Materials

There are various different materials your dentist can utilise to restore your tooth. Below is a list of the most common types of filling materials.

  • Amalgam
  • Glass Ionomers
  • Composites
  • Gold
  • Porcelain

Amalgam Fillings

Amalgam is a silver coloured restorative material that is commonly used to repair broken or decayed teeth at the back of the mouth on molars or premolars. It is an alloy of mercury, tin, silver and copper. Amalgam is a very hard wearing restorative material and is retained in the tooth through mechanical retention.

Once mercury is combined with the other components of the alloy it becomes harmless. For any patients that have any concern as to the use of amalgam, please ask your dentist for further information.

Composite Fillings

Composites are a tooth coloured restorative material that are commonly used to restore front teeth ( incisors and canines ). They can also be used to restore small to medium size cavities on back teeth. They are made of powdered glass quartz, silica or other ceramic particles which are then added to a resin. Composites are chemically bonded to tooth tissue. It is viscous when inserted into the tooth and then with the use of a blue light, the filling material is polymerised or set, so that it becomes hard.

Composite fillings are not as hard wearing as amalgam and they also stain with time.

Glass Ionomers Fillings

Glass ionomers are a tooth coloured filling material. They have the advantage of being fluoride leaching and self adhesive but are fairly weak and are not as aesthetic as composites. Glass ionomers are an ideal restorative material for baby teeth and for cavities around the necks of teeth.

Gold Fillings

Gold fillings are strong, non corrosive, malleable and make an excellent restorative material. They are mainly used on back teeth and can either be placed solely in the biting surface of the tooth ( a gold inlay ) or can cover the cusps of the tooth aswell ( a gold onlay ). Disadvantages of using gold are obviously poor aesthetics, they are expensive and also two visits to the dentist are required as the inlay/onlay is made in the dental laboratory. During production of the restoration the tooth is restored with a temporary filling. Gold is retained in the tooth via the use of a dental cement.

Porcelain Fillings

Porcelain fillings are very similar to gold fillings in many ways. They come in the form of inlays and onlays, they are hard wearing, they are cemented into the tooth with the use of a dental cement, they are generally quite expensive and they are also made in the laboratory, hence requiring two visits to the dentist. However, they also have the added advantage of being tooth coloured.

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Dentures, Denture Maintenance and Denture Stomatits


A denture is a removable appliance that replaces lost or missing teeth.

A partial denture is a denture that fills in the spaces left by lost or missing teeth in the upper or lower arch.

A complete denture replaces all the teeth in the upper or lower arch.

Dentures can either be made completely of acrylic or be part acrylic where the framework is made of cobalt chrome.

An immediate denture is a denture that is fitted immediately after the teeth have been removed. All measurements and impressions are taken prior to the teeth be removed.

It is extremely important to be aware that with an immediate denture the gums and bone will shrink under the denture as the sockets heal. This will continue over a 6 month period. During the 6 month healing phase it may be necessary to have the denture relined or adjusted. At the end of this period it may be necessary to have a new denture if the change in the mouth has been dramatic.

In some cases it may make more sense to remove the teeth, wait 6 months for healing to occur and then make a new denture in a mouth that is then stable. The main advantage of this is that, as a patient, you are not paying for two dentures.

With immediate dentures it is important to wear them as much as possible especially immediately after the teeth have been extracted. This is because the soft tissues will heal to the shape of the denture. If the denture is not in place, the soft tissues will swell haphazardly and then subsequent placement of the denture will be difficult and uncomfortable.

Denture Maintainance

Denture cleaning is important to help prevent gum disease, inflammation and fungal infections. Dentures should be cleaned twice a day.

When cleaning dentures, always perform this task over a bowl of water so that they do not break if you drop them. Use soap and a soft nail brush to clean the denture or toothpaste and a tooth brush. One can use an effervescent denture cleaner to help remove stubborn stains.

Please avoid bleaching products where possible, as these will weaken the denture and affect its appearance.
Overnight dentures should be left in water to prevent them drying out. Dehydration of the denture will cause the shape of the denture to change and will also weaken the denture.

Hard to remove staining and tartar can removed by your dentist.

Your denture should be changed every two to three years.

Denture Stomatitis

This is an infection of the mouth otherwise known as ‘thrush’ caused by candida which is a fungus. Basically the fungus colonises on the surface of the denture in contact with the gums (the fit surface) and the patient gets an inflammatory response from this.

Signs and symptoms.

Redness under the denture and red sore areas at the corners of the mouth.

Treatment and prevention.

Maintain good oral hygiene and avoid smoking.

Leave the denture out at night. Use warm soapy water and a soft nail brush to clean the fit surface of the denture. The denture can then be soaked over night in a denture cleaner. Ask your local chemist about the best ones on the market.

If denture stomatitis still persists, the dentist may advise the use of antifungal agents to help alleviate the problem.

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The Avulsed Tooth


An avulsed tooth is one that has been knocked out of the mouth.


The most likely cause for an avulsed tooth is trauma, and the most likely tooth to be avulsed is a front tooth.

Prevention and Treatment

During sporting activities it is important to wear an appropriate sports mouth guard to prevent tooth avulsion.

If a tooth is avulsed, to control bleeding use a rolled up handkerchief and bite down onto the wound maintaining pressure to the site.

If you have the avulsed tooth, it is in one piece and is an adult tooth it may be possible to place it back into the socket. Avoid washing or handling the root where possible as this will damage the cells on the root and make re-implantation less successful. If it is very dirty then rinse it in milk. Do not clean with disinfectant or water or let it dry out.

If the tooth is fractured it may not be wise to place it back into the socket. If it is a baby tooth it is generally considered best not to reinsert the tooth.

When placing the tooth back into the socket, hold the tooth by the crown and push it back into the socket with firm pressure until seated, that is pushed back into its original position. Ensure the tooth has been orientated correctly. Hold the tooth in position for 30 minutes.

If the tooth does not go back into the socket, then place it in your cheek or in milk and call the emergency dentist.

Further dental treatment

If the tooth does not take it may be necessary to replace it by other means, for example a dental implant, bridge or denture.

If the tooth has taken but is still mobile it may be necessary to splint the tooth to the other adjacent teeth temporarily until it becomes firm.

The tooth will then need to be monitored with x-rays and examinations to determine whether any further treatments will be necessary eg a root canal treatment.

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The TMJ or temporo-mandibular joint is the joint connecting the lower jaw or mandible to the skull. When stress is placed on this joint it leads to pain in the joint and the associated muscles. This is called TMJ syndrome or TMJ dysfunction.

Signs and symptoms

  • Signs of wear on the biting surfaces of teeth.
  • Constantly fracturing teeth, crowns and fillings.
  • Tenderness associated with biting on or constantly aching teeth.
  • Patients may develop loose teeth and the gums may show signs of advanced recession.
  • Grinding teeth or clenching the jaw at night.
  • Pain opening the jaw with or without an associated clicking sound on opening.
  • Muscle spasms, frequent headaches and pain in the neck and shoulders.


When a patient’s bite is misaligned and the upper and lower teeth do not meet correctly this can lead to stress placed on the TMJ and on the muscles that move the upper and lower jaw.

Many people with an imperfect bite adjust to these problems and have no day to day difficulties. However, in moments of stress these symptoms can surface as muscle tension increases.


If you suspect that you have TMJ syndrome or related problems contact your dentist for an assessment.

Bite Splint

The dentist will check for sore muscles, signs of an incorrect bite or bite interferences. An incorrect bite can sometimes be helped with a bite splint (a hard plastic appliance that is worn over the teeth either all the time or at night only ).
Tooth Adjustment. Teeth can sometimes be carefully adjusted so as to remove bite interferences so that the teeth can meet and slide against each other evenly. This then allows for normal positioning of the jaw.

Replacement teeth

Patients that have missing teeth and only chew on one side can increase the stress on the TMJ on the working side. Hence in these cases it may be important to replace the missing teeth and so create an even bite.

Soft Diet

This can be helpful as well as certain relaxing jaw exercises.

Muscle Relaxants

In extreme cases these can be prescribed but only help alleviate symptoms temporarily.

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