INTRODUCTION

It seems like cracked teeth are becoming a more and more prevalent finding in clinical practice. The ADA News and the New York Times recently published articles on this subject. One reason is people are living longer and are retaining their natural dentition. “Cracked teeth seem to be a result of repetitive stress injury, and so the longer teeth are in use, the more likely they will become cracked. This is a modern epidemic and something we have never before as a profession had to deal with,” said Rob Roda, past president of the American Association of Endodontists. “Cracked teeth are undergoing a time-dependent, load-related, progressive process that, without intervention, results in pain, infection, and splitting of the tooth requiring extraction.”

A cracked tooth can be defined as an incomplete fracture initiated from the crown and extending cervically and sometimes subgingivally, usually directed mesiodistally.¹ The depth and extent of the fracture are usually unknown and may progress to communicate with the pulp and/or periodontal ligament.

A cracked tooth diagnosis can be very perplexing because of the very vague nature of the presenting signs and symptoms. Do we treat, or do we extract? Studies show that the range of treatment for the cracked tooth can vary from conservative treatment modalities to extraction and replacement with implants. When a crack is suspected, guiding the patient to the proper treatment and then following up is paramount. The initial symptoms of a cracked tooth can often mimic those of pulpitis, necrosis, or apical periodontitis while there are clinically and radiographically no signs of caries. Most of the time, the involved tooth is minimally restored or not restored at all, making the diagnosis all the more difficult (Figure 1). The goal of this article is to help the practitioner navigate the complexities of diagnosing and treating the cracked tooth.

COMMON CRACK LOCATION

Mandibular first and second molars are the most susceptible to fracture, followed by the maxillary premolars. The crack is most often found on the mesial or distal marginal ridge or under an existing restoration.^2-4

DIAGNOSING THE CRACKED TOOTH

Understanding the extent of the crack is important as well. A craze line is a small crack that does not extend past the enamel. Teeth with craze lines will not cause any sensitivity to biting or temperature, and no treatment is necessary. Once a crack extends into the dentin, the patient can start to have temperature sensitivity and biting pain. As long as the crack does not extend into the root canal space, the crack can be managed by making a crown to establish complete cuspal protection. This treatment protocol is dependent on the patient’s symptoms.

If a tooth is minimally restored (or not restored at all) and has no caries yet presents with symptoms of pulpitis or necrosis, a cracked tooth should be suspected (Figures 1 and 2). These teeth can be retained if diagnosed and treated in a timely manner. The prognosis drops precipitously if the tooth has become necrotic. This would suggest that the crack has been there for a much longer period of time.⁵

Classic symptoms of a cracked tooth include sharp pain on biting (or release) and unexplained temperature sensitivity. Often, the patient has difficulty pinpointing the offending tooth, which makes reproducing the patient’s chief complaint all the more critical. One of the best ways to diagnose a cracked tooth is by testing each cusp of a suspected cracked tooth with a “tooth sleuth.”⁶ Cotton roll compression is another technique that can be employed.^2-4 Vitality testing is important as well. These tools will help to pinpoint the offending tooth.

Early diagnosis and detection are paramount in the management of the cracked tooth. With early detection, many teeth can be saved. Unfortunately, because the pain is intermittent, and due to the vague nature of the symptoms, there may be a delay in treatment. Many cracks are diagnosed when they have already extended deeply into the root structure, making the prognosis hopeless (Figures 2 and 3). These cracks also provide an avenue for bacteria to invade the pulp space, eventually leading to either an inflamed pulp (pulpitis) or an infected pulp (necrosis/apical periodontitis).^5,7 The cause of the sharp pain on biting is due to the movement of the fractured segments triggering fluid movement within the dentinal tubules. This fluid movement triggers nerve fibers located in and around the dentinal tubules.⁸

Figure 1 The patient in this case had been to multiple dentists over the past 2 years with a vague discomfort on the lower right side. Due to a lack of caries or restorations and the inability to reproduce the patient’s chief complaint, no treatment was rendered. A CBCT scan (Veraviewepocs 3D R100 [J. Morita]) revealed periapical radiolucency, as well as a narrow vertical defect, on the distal aspect of tooth No. 31. This was confirmed with clinical periodontal probing depths of 8 mm. This tooth also tested negative to vitality testing. A diagnosis of a cracked tooth with radicular extension was made, and extraction was recommended. All symptoms subsequently resolved. The extracted tooth revealed a crack running down the full extent of the buccal aspect of the mesial root. There was a second crack (not visualized) on the distal aspect corresponding with the distal bone loss.

Figure 2 The patient in this case presented with severe acute biting pain on the upper right. Tooth No. 4 was extremely tender to percussion and biting. There were no caries or restorations on tooth No. 4. You can see a crack line running mesial to distal on the occlusal table. A 7-mm periodontal pocket was probed on the mesial. A diagnosis of a cracked tooth with radicular extension was made. After the tooth was extracted, you can visualize the crack running from the mesial marginal ridge halfway down the root.

Figure 3 Tooth No. 18: The patient presented with severe pain to biting and continuous throbbing pain on the lower left. A diagnosis of pulp necrosis with symptomatic apical periodontitis was made. CBCT images revealed the cause being a cracked tooth extending in a mesiodistal direction and obliquely to communicate with the PDL on the lingual. The extent and direction of this fracture was not visualized on conventional radiography.

TREATMENT OF THE CRACKED TOOTH

There is a wide range of treatment options for the cracked tooth. Treatment will usually fall into 1 of 3 categories:

1. Crown

2. Root canal and crown

3. Extraction

The treatment depends on the status of the pulp and the depth of the crack. A surgical operating microscope is essential in determining the extent of the crack and the prognosis once the root canal is initiated.

If a cracked tooth is diagnosed with reversible pulpitis (no lingering sensitivity to biting or thermal stimulation), a temporary crown is advised for 6 to 8 weeks. If symptoms resolve, then proceed with a permanent crown. If symptoms don’t resolve, root canal therapy is indicated prior to permanent crown placement.^2-4

If a cracked tooth has a pulpal diagnosis of irreversible pulpitis (a crack that elicits spontaneous or lingering pain) or necrosis (infection) with or without a periapical lesion, then root canal therapy is indicated prior to crown placement (Table 1) (Figures 4 and 5). If root canal treatment is initiated and it’s discovered that the crack extends into the root, then extraction may be indicated.^5,9-13 A recent study showed very promising results when treating a cracked tooth, even when the crack extended into the radicular dentin.¹⁴ The technique employed used intra-orifice barriers placed apically to the apical extent of the crack in the radicular dentin. The goal was to prevent the ingress of bacteria and reinforce cervical dentin.¹⁴

Figure 4 The patient in this case presented with signs and symptoms of a cracked tooth (visualized clearly upon access of the tooth) and irreversible pulpitis associated with tooth No. 3. The patient was motivated to save the tooth with root canal therapy and a crown. The patient was completely asymptomatic after the first visit. The tooth was crowned one month after the root canal was completed. At the 2-year followup, the patient presented asymptomatic. The radiograph revealed no periapical pathology or marginal bony breakdown.

Figure 5 The patient in this case presented with acute biting pain on the lower left. A tooth sleuth revealed biting pain associated with the ML cusp of tooth No. 18. There was a lingering, painful response to vitality testing. Upon access, a crack line was noted running from the occlusal surface down to the level of the ML canal but not into the canal. A cracked tooth was diagnosed. The patient opted to have this tooth endodontically treated and then crowned. Upon the 3-year evaluation, the tooth was asymptomatic with no signs of periapical pathology or periodontal breakdown.

Figure 6 The patient in this case presented with a vague discomfort on the lower right. The gingiva adjacent to tooth No. 31 was inflamed and slightly swollen. The initial diagnosis was a periodontal abscess. Local curetting of the area temporarily relieved the patient’s pain. However, the patient returned with a similar discomfort after a short time. A CBCT scan was recommended and revealed a J-shaped radiolucency on the mesial root of tooth No. 31. A 10-mm periodontal pocket was probed on the mesiobuccal aspect of tooth No. 31. A diagnosis of vertical root fracture (VRF) was made, and extraction was recommended. After the tooth was extracted, a fracture was not only noted on the mesiobuccal, as expected, but surprisingly also along the distal root.

CRACKED TOOTH VS VERTICAL ROOT FRACTURE

A cracked tooth shouldn’t be confused with a vertical root fracture (VRF). VRFs are mostly found in previously endodontically treated teeth. These fractures are initiated at the apical end and progress coronally (Figure 6). They can also be found mid-root adjacent to the terminus of a post. On the other hand, cracked teeth are found mostly in teeth that have not had root canal treatment, and the crack is initiated in the crown and spreads apically toward the root (Figure 7). Cracked teeth can sometimes occur on endodontically treated teeth that have not been properly restored with cuspal coverage. Cracked teeth are often directed in a mesiodistal direction (Figure 8), while VRFs are mostly directed in a buccolingual direction within the root. The classic J-shaped or halo-shaped apical radiolucency, as well as the deep, narrow “isolated” periodontal pocket, is classically associated with VRFs (Figure 6). In contrast, classic symptoms of biting pain and unexplained temperature sensitivity are associated with cracked teeth.^15-18 While cracked teeth are amenable to a range of treatments, VRFs usually have a hopeless prognosis and require extraction and replacement with an implant. If the offending tooth is multi-rooted, it may be possible to resect the root with the VRF and retain the tooth with the remaining roots (Figure 9). Because the pain associated with VRFs may be fleeting and intermittent, the patient often doesn’t seek treatment until significant bone has been lost around the tooth.

Figure 7 The patient in this case presented with extreme pain on the entire right side of his face, extending into his ear. The patient reported on and off biting pain and temperature sensitivity over the prior 2 months. The pain had recently became unbearable. A clinical exam revealed that tooth No. 31 had pain on biting as well as a 7-mm probing depth on the distal. There was no response to vitality testing. A cracked tooth with radicular extension was diagnosed, and the tooth was planned for extraction. The extracted tooth revealed a crack running from the distal marginal ridge deep into the root structure.

Figure 8 The patient in this case presented with a chief complaint of on and off biting discomfort on the lower left. Tooth No. 19 was very sensitive to percussion and cotton roll compression. The cold test was inconclusive. A CBCT scan revealed PDL widening at the apex of the mesial and distal roots. Tooth No. 19 was planned for “exploratory” root canal therapy and a crown. After the amalgam was removed, a crack (cracked tooth) was seen running from the mesial to the distal. Once access was made into the pulp chamber, the full extent of the crack could be visualized running on both the mesial and distal aspects of the crown but not down to the pulpal floor. The patient returned for the second visit, reporting that all symptoms had subsided. The root canal was completed, and the patient was referred back to her dentist for the crown. The patient returned for the 10-month re-evaluation with a core buildup and permanent crown (no post). The tooth was completely asymptomatic, and the radiograph revealed no signs of periapical pathology or periodontal breakdown.

Figure 9 The patient in this case presented with a previously endodontically treated tooth No. 3. The chief complaint included a dull discomfort around the apical region of tooth No. 3. Radiograph examination revealed a periapical breakdown around the apex of No. 3. The J-shaped radiolucency around the MB root was strongly indicative of a VRF. The patient was very motivated to save this tooth, and a root resection was planned. Upon flap reflection and removal of granulation tissue, a VRF was clearly visualized. The MB root was resected.

ETIOLOGY OF THE CRACKED TOOTH

Cracked teeth are the result of repetitive stress to the dentition. They can also be the result of sudden stress on a vulnerable tooth. Repetitive stress would result from parafunctional habits such as bruxism and clenching, whereas a sudden stress injury could be the result of biting on ice, nuts, hard candy, etc.

CRACKS WITH AGE

Older patients have a more brittle dentin structure, and as such, their teeth are more prone to fracture. Rarely do we see classic cracked tooth symptoms in children or adolescents. One study found that the dentin is 50% weaker in those above 55 years old in comparison to those younger than 35 years old.¹⁹ It seems that the fatigue resistance of human dentin decreases with age.²⁰

PREVENTING CRACKS

One of the best ways to prevent cracking a tooth is to have the patient wear a nightguard if clenching or grinding is a habit.

A patient with a history of a cracked tooth should be evaluated for full-coverage restorations on teeth vulnerable to fracture in the future. It is very common to see a patient have a tooth removed due to a crack, only to return a short time later with a crack on another tooth because the edentulous space was never restored. The lack of a restoration after the loss of a tooth puts more stress on the remaining teeth, thus leading to greater vulnerability for fractures on the remaining teeth.

CONCLUSION

Diagnosing and treating the cracked tooth can be a complex endeavor. Many factors contribute to the proper diagnosis and treatment of the cracked tooth. With a better understanding of cracked teeth, more of these teeth can be saved than previously thought.

A chart outlining a few classic studies associated with cracked teeth and vertical root fractures is available here.

ACKNOWLEGEMENTS

The author wishes to thank Dr. Charles Solomon and Dr. Leslie Elfenbein for their valuable input.

REFERENCES

1. Rivera EM, Walton RE. Cracking the cracked tooth code: detection and treatment of various longitudinal tooth fractures. In: Colleagues for Excellence. Chicago: American Association of Endodontists; 2008

2. Cameron CE. The cracked tooth syndrome: additional findings. J Am Dent Assoc. 1976;93:971–5. doi:10.14219/jada.archive

3. Krell KV, Rivera EM. A six year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis. J Endod. 2007;33(12):1405–7. doi:10.1016/j.joen.2007.08.015

4. Kahler W. The cracked tooth conundrum: terminology, classification, diagnosis, and management. Am J Dent. 2008;21(5):275–82.

5. Berman LH, Kuttler S. Fracture necrosis: diagnosis, prognosis assessment, and treatment recommendations. J Endod. 2010;36(3):442–6. doi:10.1016/j.joen.2009.12.018

6. Türp JC, Gobetti JP. The cracked tooth syndrome: an elusive diagnosis. J Am Dent Assoc. 1996;127(10):1502–7. doi:10.14219/jada.archive.1996.0060

7. Ricucci D, Siqueira JF Jr, Loghin S, Berman LH. The cracked tooth: histopathologic and histobacteriologic aspects. J Endod. 2015;41(3):343–52. doi:10.1016/j.joen.2014.09.021

8. Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. J Endod. 1986;12(10):453–7. doi:10.1016/S0099-2399(86)80198-4

9. Kang SH, Kim BS, Kim Y. Cracked Teeth: Distribution, Characteristics, and Survival after Root Canal Treatment. J Endod. 2016;42(4):557–62. doi:10.1016/j.joen.2016.01.014

10. Rivera EM, Walton RE. Longitudinal fractures. In: Torabinejad M, Walton RE, eds. Principles and Practice of Endodontics, 4th ed. Philadelphia: Saunders; 2009: 108–28.

11. Tan L, Chen NN, Poon CY, et al. Survival of root filled cracked teeth in a tertiary institution. Int Endod J. 2006;39(11):886–9. doi:10.1111/j.1365-2591.2006.01165.x

12. Sim IG, Lim TS, Krishnaswamy G, et al. Decision making for retention of endodontically treated posterior cracked teeth: a 5-year follow-up study. J Endod. 2016;42(2):225–9. doi:10.1016/j.joen.2015.11.011

13. Krell KV, Caplan DJ. 12-month success of cracked teeth treated with orthograde root canal treatment. J Endod. 2018;44(4):543-548. doi:10.1016/j.joen.2017.12.025

14. Davis MC, Shariff SS. Success and survival of endodontically treated cracked teeth with radicular extensions: a 2- to 4-year prospective cohort. J Endod. 2019;45(7):848-855. doi:10.1016/j.joen.2019.03.015

15. Tsesis I, Rosen E, Tamse A, et al. Diagnosis of vertical root fractures in endodontically treated teeth based on clinical and radiographic indices: a systematic review. J Endod. 2010;36(9):1455–8. doi:10.1016/j.joen.2010.05.003

16. Fuss Z, Lustig J, Tamse A. Prevalence of vertical root fractures in extracted endodontically treated teeth. Int Endod J. 1999;32(4):283–6. doi:10.1046/j.1365-2591.1999.00208.x

17. PradeepKumar AR, Shemesh H, Jothilatha S, et al. Diagnosis of vertical root fractures in restored endodontically treated teeth: a time-dependent retrospective cohort study. J Endod. 2016;42(8):1175–80. doi:10.1016/j.joen.2016.04.012

18. Tamse A, Fuss Z, Lustig J, et al. An evaluation of endodontically treated vertically fractured teeth. J Endod. 1999;25(7):506–8. doi:10.1016/S0099-2399(99)80292-1

19. Yan W, Montoya C, Øilo M, et al. Reduction in fracture resistance of the root with aging. J Endod. 2017;43(9):1494-1498. doi:10.1016/j.joen.2017.04.020

20. Seo DG, Yi YA, Shin SJ, et al. Analysis of factors associated with cracked teeth. J Endod. 2012;38(3):288–92. doi:10.1016/j.joen.2011.11.017

ABOUT THE AUTHOR

Dr. Stern is a Diplomate of the American Board of Endodontics. He is the director of endodontics at the Touro College of Dental Medicine and lectures frequently on the subject of clinical endodontics. He has lectured at many local county dental societies, the New Jersey Dental Association Annual Session in May 2019, and the Greater New York Dental Meeting in 2020. He maintains a private practice, Clifton Endodontics, in Clifton, NJ. He can be reached at jstern5819@gmail.com.

Disclosure: Dr. Stern reports no disclosures.

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Queen Mary University of London is building a center at its Blizard Institute in Whitechapel designed to improve the survival rates of patients with squamous cancer, including oral cancers as well as skin, lung, and cervical cancer. It will bring together clinical and research experts to explore who is at risk of developing squamous cancers and why.

More than 70,000 people are diagnosed with squamous cancer every year in the United Kingdom, said the university, adding that it is the most common cause of solid tumors and results in many deaths.

The Barts Centre for Squamous Cancer is being established with a £2.6 million grant from Barts Charity. It will focus on oral cancer, which is a particularly common problem among the local East London population, the university said.

Oral cancer has increased by 58% over the past decade, the university continued. But despite more than 8,700 people being diagnosed each year in the United Kingdom, only one in five people know the main signs and symptoms, the university said.

Many patients won’t survive for five years after diagnosis. Also, treatment for survivors can be harsh and disfiguring, often leaving a devastating impact on a person’s appearance and ability to eat, drink, and speak.

Smoking, alcohol, diet, and the human papillomavirus (HPV) all increase an individual’s risk of developing oral cancer, and it is a particular problem in areas of high social deprivation and among certain groups such as South Asian communities.

In the London Borough of Tower Hamlets, the university said, the rate has risen by a third over the past decade to 21.5 people per 100,000, and it continues to increase among younger adults due to tobacco use.

“Oral cancer has been underfunded for many years, and we hope that by bringing our expertise together in this new center we will be able to develop a better understanding of mouth cancer,” said Paul Coulthard, professor of oral and maxillofacial surgery at Barts and the London School of Medicine and Dentistry at Queen Mary University of London.

“Awareness of risk factors and symptoms is still very low, and we hope our work will improve detection, diagnosis, and access to treatment,” Coulthard said.

“We know that the risk of being diagnosed with oral cancer is strongly associated with social deprivation, and this is a particular health challenge in London. This center will enable us to develop a much better understanding of who is at risk and why, so that we can improve treatment and the quality of life for all those affected, both in the UK and wider afield,” he continued.

The Barts Centre for Squamous Cancer will assemble clinical and research experts who will work with patient groups, run clinical trials, and build a human tissue bank to improve knowledge and understanding of squamous cancer, the university said.

East Londoner Steve Bergman, who lived in Walthamstow for more than 30 years, was diagnosed with stage 4 squamous throat cancer in May 2016.

“I was 56, fit  and healthy, eating a good diet, and was a keen cyclist and runner. It took me by complete surprise, and within two weeks I was admitted to Whipps Cross Hospital for what I thought was a routine exploratory operation,” Bergman said.

“However, I had to have radical surgery to remove a massive growth on my right tonsil, and I woke up to find I had been fitted with a tracheostomy. I was in hospital for a further two weeks to recover, and then came to a period where I underwent six weeks of chemotherapy followed by six weeks of radiotherapy,” he continued.

“I then went through a period of physical recovery, but the psychological and emotional impact of my condition affected everyday life. I would be doing the most routine of tasks, and all of a sudden a surge of panic would run through my veins. This went on for several months, and eventually I was diagnosed with post-traumatic stress disorder,” he said.

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“These results highlight a previously unknown role for STING in regulating the tumor response to DNA-damaging treatments,” said lead author Thomas Hayman, MD, PhD, assistant professor of therapeutic radiology at Yale Center.

“Excitingly, our results support the clinical evaluation of STING agonists in combination with DNA-damaging treatments in patients with head and neck cancer to improve responses to standard therapies,” said Hayman.

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Oral cancer is an ominous diagnosis. Its symptoms are debilitating, and five-year survival after diagnosis is approximately 60%. Improvements in oral cancer treatment can only be achieved through well-funded, meticulously designed, clinical and translational research.

I founded the New York University Oral Cancer Center (NYUOCC) to address the daunting clinical challenges posed by oral cancer. We address oral cancer pain in patients and simultaneously advance laboratory investigation dedicated to the study of oral cancer symptoms, diagnosis, and treatment.

A critical unmet need in oral cancer treatment is pain management. Oral cancer patients endure severe chronic pain during everyday functions such as chewing and speaking. As a surgeon, I am unable to adequately manage oral cancer pain in many of my patients. I continue to prescribe opioids to treat chronic pain, but efficacy is limited as patients develop opioid tolerance. The side effects of these drugs, including sedation, severely degrade quality of life.

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Our center draws clinicians and scientists to a single location in New York City to diagnose, treat, and study oral cancer. We translate scientific discoveries from the laboratory into better treatment for cancer and cancer symptoms. All patients seen at NYUOCC can be screened for enrollment in clinical studies, and scores of oral cancer patients have volunteered to participate in research.

Our researchers collect samples from the majority of patients who receive oral cancer treatment in our facilities. These samples are scrutinized at the cellular, molecular, and genomic levels in laboratories located within the same building. Analysis of laboratory findings obtained in preclinical studies can subsequently lead to clinical trials at the NYU Bluestone Center for Clinical Research.

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The settlement with Amity Dental Center, located in Brighton, and Christina Hsu, DDS, resolves allegations that they turned away, refused to see, and/or did not accept MassHealth members seeking treatment when they had not notified MassHealth that the practice had reached its maximum capacity of MassHealth members as required by state regulations.

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Since its launch in 2003, GKAS has provided dental healthcare to more than 300,000 underserved children.

“Helping 300,000 children in need is something to smile about, especially during this challenging time,” said ADA president Dr. Daniel J. Klemmedson, DDS, MD.

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Ana Flavia Piquera Santos, DDS, MSc, discusses the diagnosis and treatment of a dentigerous cyst in this continuing education article, which you can receive one continuing education hour for reading. Learning objectives include:

• Know the etiology and classifications of dentigerous cysts.
• Identify the options for treatment of dentigerous cysts.
• Learn why it is important to biopsy the cyst as part of the diagnosis process.

For the full article and CE credit, visit DentalCEToday.com.

Temporomandibular disorders (TMD) and sleep bruxism (SB) are destructive to the masticatory system, though the link is unclear, prompting researchers at the UTHealth School of Dentistry (UTSD) at Houston to assess the relationship between them via groups of patients with TMD only and with TMD and SB.

The researchers conducted a retrospective chart review via axiUm, UTSD’s electronic health system, to look at patients with a chief complaint of jaw pain referred to and seen at UT Dentists, the school’s faculty group practice, between November 1, 2015, and April 1, 2018.

The review looked at patients with completed International Network for Orofacial Pain and Related Disorders Methodology history questionnaires and Diagnostic Criteria for Temporomandibular Disorder clinical examinations. In total, 52 patients, including 12 with TMD only and 40 with TMD and SB, met the study’s criteria.

The researchers investigated descriptions and measurements of patient symptoms. They also conducted a statistical analysis using chi squared, also known as an X2 test, which compares two variables in a contingency table to see if they are related. They used Fisher’s exact test as well, a statistical assessment used to determine if there are nonrandom associations between two categorical variables.

The results showed that patients who had TMD with SB reported a significantly higher number and/or frequency of oral behaviors such as clenching and grinding during sleep and waking hours as well as oral habits such as prolonged chewing gum, compared with patients who had TMD only. Patients who had TMD with SB also exhibited significantly more signs and symptoms of headache attributed to TMD compared with patients who had TMD only.

The researchers concluded that their results provided clinical evidence that clinicians need to diagnose and treat patients with TMD and SB. Clinicians also should consider SB while making the diagnosis in patients with temporal headaches attributed to TMD, the researchers said.

The study, “When Should Sleep Bruxism Be Considered in the Diagnosis of Temporomandibular Disorders?” was published by Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology.  

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University of Toronto Faculty of Dentistry biomaterials expert and newly appointed assistant professor Bo Huang, DMD, MS, PhD, has long known that there is a big difference between the research conducted on the bench and how the results of that research eventually benefits patients, according to the school.

Huang, who begins a part-time faculty appointment this month, was a practicing dentist in China after earning her DMD at the Air Force Medicine University (formerly known as the Fourth Military Medicine University) in Xian, China, in 2007. She then earned a master of science degree in oral microbiology at Peking University in Beijing in 2010.

In 2011, Huang immigrated to Canada and began a PhD at the Faculty of Dentistry in biomaterials. She studied the biocompatibility of the most common materials used in fillings and how they became degraded in the oral environment.

Throughout the degree, which she completed in 2017, Huang came to see that the gap between research and practice was bigger and more problematic than she previously had thought.

“Whenever I went [to conferences] and presented my work, clinicians always asked, how can it benefit us? How long will it take for your results to be translated into the clinic?” she said.

Huang’s co-supervisors, professors Yoav Finer and Dennis Cvitkovitch, suggested that she undertake further specialty training “to think like a clinician again, to see how I can translate research into clinical applications,” she said.

The discussion was important for Huang, the school said, and it eventually shaped her future career. She entered the Master of Science in Prosthodontics program at the Faculty in 2017. For her thesis research, she studied the enzymatic activities of oral bacteria that can lead to the destruction of hard tooth structures.

But for Huang, the school said, research into those microscopic bacteria always comes back to the human factor.

“I have one advantage as a researcher,” Huang said. “I can go back to the clinic and treat patients and see what materials really work in patients’ mouths. I can ask, what are the requirements and needs from the patients’ standpoint? Then, I can better design my research.”

Huang recognizes the potential for all patients to gain from her research findings as well as the potential advances that can be made in biomaterials. That progress flows both ways, the school added, as Huang will use her clinical research experience as she teaches prosthodontics to undergraduates and continues her biomaterials research.

Huang won’t leave her patients behind either, the school said. She plans to continue seeing patients as a part-time prosthodontist, ensuring she always has a keen understanding of patients’ needs whether she heads into the lab, clinic, or classroom, the school said.

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