Enamel infraction explained

Enamel infractions are microcracks seen within the dental enamel of a tooth. They are commonly the result of dental trauma to the brittle enamel, which remains adherent to the underlying dentine. They can be seen more clearly when transillumination is used.^[1]

Enamel infractions are found more often in older teeth, as the accumulated trauma is greatest.^[2] Enamel infractions can also be found as a result of iatrogenic damage inadvertently caused by instrumentation during dental treatments.^[3]

As of 2024, the prevalence of pathology reaches over 90%.^{[4] [5]} In patients aged 20 years, an average of 4 intact teeth with enamel cracks are identified.^{[6] [7]} 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.^[8]

Reasons

Physiological

Destruction processes are activated by the reaction of the surface layer to internal and external irritations. Microfractures are caused by:^{[9] [10]}

• eating foods that are too different in temperature (e.g., hot tea after cold ice cream);
• smoking in the cold (same as the first point, temperature contrast is created);
• excessive consumption of acidic fruits, juices and carbonated drinks;
• abuse of whitening toothpastes or using brushes that are too stiff;
• progression of caries or periodontitis.

Mechanical

Fracture occurs due to the forces exerted on the dental unit. The enamel is splintering:^{[11] [12] [13]}

• after an unfortunate fall, bump or contusion of the jaw;
• due to excessive chewing, eating too hard food, and chewing nuts and seeds;
• grinding of teeth and a bad habit of chewing on things, such as pencils, pens, etc.;
• due to stresses caused by the seal. Expansion over time of the silver amalgam creates stress in the body of the dental unit. This process contributes to chipping and even deep longitudinal cracking, up to and including breaking the tooth in half. Modern white fillings have a compression process going on. It also contributes to the stress from which horizontal cracks appear.

Treatment

Minor infraction may not require any treatment, however major infraction may require treatment including smoothing, fluoride treatment and crown restoration.^[14]

Notes and References

1. Ravn. J.J.. Follow of permanent incisors with enamel cracks as a result of an acute trauma. European Journal of Oral Sciences. 1981 . en. 89. 2. 117–123. 10.1111/j.1600-0722.1981.tb01661.x. 0909-8836.
2. Web site: Dental Trauma - an overview ScienceDirect Topics. 2021-12-21. www.sciencedirect.com.
3. Milic. T. George. R. Walsh. Lj. Evaluation and prevention of enamel surface damage during dental restorative procedures. Australian Dental Journal. 2015. en. 60. 3. 301–308. 10.1111/adj.12230. 25283817. free.
4. Web site: Cracked tooth: common causes. 2024-10-05. www.deltadental.com.
5. Web site: The Causes, Prevention, and Treatment of Enamel Erosion. 2024-10-05. www.thantakit.com.
6. Web site: Early Diagnosis and Treatment of Asymptomatic Vertical Enamel and Dentin Cracks. 2024-10-05. cced.cdeworld.com.
7. Web site: The Cracked Tooth: Diagnosis and Management. 2024-10-05. www.oralhealthgroup.com.
8. Web site: Causes of Enamel Disruption. 2024-10-05. rezadentalcare.com.
9. Web site: Cracked Tooth: Things To Know. 2024-10-05. www.jacksonavedental.com.
10. Web site: Cracked teeth. 2024-10-05. tetrismile.com.
11. Web site: Fractured Tooth (Cracked Tooth): What Are The Causes of This Dental Emergency?. 2024-10-05. www.emergencydentalclinics.ca.
12. Web site: Is a Cracked Tooth Treatable?. 2024-10-05. www.twinkledental.com.sg.
13. Web site: Weak Enamel: The Truth about Tooth Erosion. 2024-10-05. www.azfd.com.
14. Web site: Infraction – Dental Trauma Guide. dentaltraumaguide.org. en-US. 2018-02-07.