Lessons learned from the Cracked Tooth Registry: A 3-year clinical study in the Nation's Network.

Background: This article reviews the most salient lessons learned from a large, multisite, 3-year observational study of posterior teeth with cracks conducted by The National Dental Practice-Based Research Network.

Types Of Studies Reviewed: Eight articles published over a 6-year period (2017-2022) describing clinical characteristics of posterior teeth with cracks and their treatment and outcomes are reviewed and discussed to answer 3 common questions faced by oral health care clinicians: Which cracked teeth will get worse? When should practitioners intervene? What is the best treatment?

Results: Although cracks in teeth are prevalent, few will fracture (3%) or show crack progression in 3 years (12%). Characteristics that guide the clinician to treatment include active caries, biting pain, and to a lesser degree, having a crack detectable with an explorer, connecting with a restoration, or blocking transilluminated light; the main treatment chosen is a complete crown.

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.

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

Background: The authors of this practice-based study estimated the risk of experiencing tooth fractures and crack progression over 3 years and correlated baseline patient-, tooth-, and crack-level characteristics with these outcomes.

Methods: Two-hundred-and-nine National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2,601 participants with a cracked vital posterior tooth that had been examined for at least 1 recall visit over 3 years. Data were collected at the patient, tooth, and crack levels at baseline, annual follow-up visits, and any interim visits.

Symptom changes and crack progression in untreated cracked teeth: One-year findings from the National Dental Practice-Based Research Network.

Objectives: The study objective was to: (1) quantify symptom (pain) and crack changes during one year of follow-up, among teeth that had at least one visible crack at baseline but which did not receive treatment for those cracks; (2) identify any patient traits/behaviors and external tooth/crack characteristics correlated with these changes.

Methods: In this observational study, 209 National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2858 subjects, each with a single, vital posterior tooth with at least one observed external crack; 1850 teeth remained untreated after one year of follow-up and were the cohort for analyses. Data were collected at the patient-, tooth-, and crack-level at baseline, one-year follow up (Y1), and interim visits.

Recommended treatment of cracked teeth: Results from the National Dental Practice-Based Research Network.

Statement Of Problem: Despite the high prevalence of posterior cracked teeth, questions remain regarding the best course of action for managing these teeth.

Purpose: The purpose of this clinical study was to identify and quantify the characteristics of visible cracks in posterior teeth and their association with treatment recommendations among patients in the National Dental Practice-Based Research Network.

Material And Methods: Network dentists enrolled patients with a single, vital posterior tooth with at least 1 observable external crack.

Observable characteristics coincident with internal cracks in teeth: Findings from The National Dental Practice-Based Research Network.

Background: This study determined if there are observable patient-, tooth- and crack-level characteristics markedly associated with whether a tooth with an external crack also has an internal crack.

Methods: Two hundred nine dentists in The National Dental Practice-Based Research Network enrolled 2,858 adults with a vital permanent posterior tooth having at least 1 observed external crack. Presence and characteristics of internal cracks were recorded for 435 cracked teeth that were treated.

Associations of types of pain with crack-level, tooth-level and patient-level characteristics in posterior teeth with visible cracks: Findings from the National Dental Practice-Based Research Network.

Objectives: The objective of this study was to determine which patient traits, behaviors, external tooth and/or crack characteristics correlate with the types of symptoms that teeth with visible cracks exhibit, namely pain on biting, pain due to cold stimuli, or spontaneous pain.

Methods: Dentists in the National Dental Practice-Based Research Network enrolled a convenience sample of subjects each of whom had a single, vital posterior tooth with at least one observable external crack (cracked teeth); 2858 cracked teeth from 209 practitioners were enrolled. Data were collected at the patient-, tooth-, and crack-level.

Correlation between symptoms and external characteristics of cracked teeth: Findings from The National Dental Practice-Based Research Network.

Background: Cracked teeth are ubiquitous in the adult dentition. The objective of this study was to determine which patient traits and behaviors and external tooth and crack characteristics correlate with cracked teeth being symptomatic.

Methods: Dentists in The National Dental Practice-Based Research Network enrolled a convenience sample of patients each with a single, vital posterior tooth with at least 1 observable external crack in this observational study; they enrolled 2,975 cracked teeth from 209 practitioners.

Polymerization stress--is it clinically meaningful?

Objectives: The objective of this article is to discuss the evidence for polymerization shrinkage and shrinkage stress of dental composite restoratives in terms of its potential relevance to the clinical situation

Methods: Articles relating to the issue of polymerization contraction stress generation in dental composite materials, and the factors that influence it, were reviewed and included. Particular attention was paid to evidence derived from clinical studies. Articles were identified through PubMed and through the bibliographies of other articles.

Concordance between clinical practice and published evidence: findings from The National Dental Practice-Based Research Network.

Background: Documenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network ("the network").

Methods: Network dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors.

Information-seeking behaviors of dental practitioners in three practice-based research networks.

Research on the information-seeking behaviors of dental practitioners is scarce. Knowledge of dentists' informationseeking behaviors should advance the translational gap between clinical dental research and dental practice. A cross-sectional survey was conducted to examine the self-reported information-seeking behaviors of dentists in three dental practice-based research networks (PBRNs).

Critical appraisal: preheating composites.

Resin composite is the most commonly used material for direct placement restorations. In particular, composite is now used more frequently than amalgam for direct posterior restorations. However, resin composite still suffers from some disadvantages, including the use of an adhesive interfacial bond that degrades with time, moisture, and function in the mouth, and certain key mechanical properties (e.

Association between caries location and restorative material treatment provided.

Objectives: This cross-sectional study by the Northwest PRECEDENT practitioners correlated the location of caries diagnosed in the past 12 months with treatment provided.

Methods: An oral health survey was conducted on up to 20 patients per practice for 101 practises in the Northwest PRECEDENT network. A total of 1943 eligible patients were randomly assessed for the location of and treatment provided for caries lesions diagnosed within the past 12 months.

Unmet dental needs in rural primary care: a clinic-, community-, and practice-based research network collaborative.

Background: Oral health is an essential component of general health and well-being, yet barriers to the access of dental care and unmet needs are pronounced, particularly in rural areas. Despite associations with systemic health, few studies have assessed unmet dental needs across the lifespan as they present in primary care. This study describes the prevalence of oral health conditions and unmet dental needs among patients presenting for routine care in a rural Oregon family medicine practice.

What's in a dental practice-based research network? Characteristics of Northwest PRECEDENT dentists, their patients and office visits.

Objectives: The authors conducted a study to describe the general dentists, practices, patients and patient care patterns of the dental practice-based research network (PBRN) Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT).

Methods: Northwest PRECEDENT is a dental PBRN of general and pediatric dentists and orthodontists from five U.S.

Cracked teeth: a review of the literature.

Although cracked teeth are a common problem for patients and dentists, there is a dearth of evidence-based guidelines on how to prevent, diagnose, and treat cracks in teeth. The purpose of this article is to review the literature to establish what evidence exists regarding the risk factors for cracked teeth and their prevention, diagnosis, and treatment.

Tooth wear: prevalence and associated factors in general practice patients.

Objectives: To estimate the prevalence of tooth wear and to investigate factors associated with tooth wear in patients from general practices in the Northwest United States.

Methods: Data on the diagnosis and treatment of oral diseases during the previous year were collected in a survey with a systematic random sample of patients (n= 1530) visiting general dentists from the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) (n=80). Prevalence ratios (PRs) of moderate to severe occlusal and incisal tooth wear by patient characteristics were estimated using cluster-adjusted multiple binomial regression for adults (18+ years) and children/adolescents (3-17 years).

Detection of dentinal cracks using contrast-enhanced micro-computed tomography.

A new technique using contrast enhanced micro-computed tomography (micro-CT) was developed to improve the ability to detect dentinal cracks in teeth and assess associated risks to oral health. Extracted, whole human molars that exhibited visual evidence of external cracks following extraction and machined, partially fractured elephant dentin specimens were labeled by BaSO(4) precipitation and imaged by micro-CT. Contrast-enhanced micro-CT was demonstrated in vitro to enable non-destructive, 3-D imaging of the presence, morphology and spatial location of dentinal cracks in whole human molars and machined specimens.