Dealing with Chipped Teeth is More Difficult Than You Might Think
Trying to figure out a dental emergency can be a bit tricky–if you’re in pain, then you obviously would want to get in ASAP, right? However, the best course of action is to call your dentist first so they can figure out just how bad the situation is. For instance, if your pain can be soothed with oral analgesics, then you most likely can wait. Teeth, crowns, inlays, onlays, and other restorations that have been knocked out often warrant a visit.
But what about a chipped a tooth? Is the problem just cosmetic or is there functional damage as well? While you may think that figuring out the severity of a chipped tooth is difficult, believe it or not, it can be difficult for practitioners as well!
The Daily Grind reiterates how important it is to call dentists first to assess the situation, since the term “chipped tooth” can cover a wide range of issues:
I know this is something you hear all the time: “I chipped a tooth.” This can mean so many things, especially if it is coming from a nondentist.
“I chipped a tooth” in the posterior can be a chip off the marginal ridge next to a class II restoration that you did five years ago. And if you saw this, you might just say, “It is fine,” or you might just smooth it off. Or a broken tooth in the posterior could mean the ling cusp of tooth No. 12 just broke to the gumline and below.
The question that usually comes up at our office is: How do we schedule patients who call and say, “I chipped a tooth.”
I am a doctor who does not like to schedule a “come in and we will see” visit. I know how difficult it can be for people to take time off of work or get a babysitter just so I can tell them, “Yep, you have a chipped tooth, and we can see you in three weeks to take care of this.”
Sometimes I schedule 50 minutes for a chip on the anterior that you couldn’t see with a microscope, or I might schedule 20 minutes for a “chip” when, actually, a child fell off his bike and “chipped” the heck out of teeth Nos. 8 and 9, to the point where the nerves were hanging out.
Because I refuse to do a “look-and-see” appointment, about a year ago, we bought a smartphone for the office. First, we bought it to be able to send text messages to people to confirm their appointments. We all know that calling someone at home and leaving a message on their voicemail is about as effective as sending a smoke signal (but we tried for 10 years). And nearly everyone has a smartphone these days, and everyone sends text messages (except for Grandma Nel, who we still just call). Now that we have this designated smartphone, we just ask people to send us a photo of the tooth via text message.
Hopefully more and more dentists implement this smartphone picture idea. Although a poorly lit picture off your phone isn’t the most ideal diagnosis tool, it is a start and can weed out non-emergencies.
When you do get to see your dentist for a chipped tooth, you may want to ask him or her about visiting a radiologist. According to one Chinese study, it may be beneficial to visit a radiologist as well as your dentist, since their imaging equipment may be more thorough when checking for potential chips and cracks that aren’t immediately apparent:
When it comes to examining images of a tooth and identifying a crack, should you use periapical radiography or cone-beam CT (CBCT)? Also, who is better trained to identify these cracks on images, an endodontist or a radiologist?
Researchers from China noted that cracks in teeth present practitioners with a challenge in designing a treatment plan. Using both periapical radiography (PR) and CBCT, they investigated the best imaging method to identify these cracks while also comparing the performance of different practitioners (PLOS One, January 4, 2017).
“In clinical practice, it is a huge challenge for endodontists to know the depth of a crack in a cracked tooth,” the authors wrote . . .Early enamel cracks have no obvious symptoms and may not be visible on examination. Yet they can lead to patients coming to your office because of pulpitis, periapical periodontitis, or even root fracture. As creating an appropriate treatment plan and assessing the long-term prognosis for these teeth can be difficult, there’s a need to understand the best way to diagnose this condition . . .
“Within the limitations of this study, on an artificial simulation model of cracked teeth for early diagnosis, we recommend that it would be better for a cracked tooth to be diagnosed by a radiologist with CBCT than PR,” the authors concluded.
If you aren’t sure what constitutes an emergency or how to take care of a chipped tooth, you can find more information at lagunavistadental.com/services/general-dentistry/emergency-dentist/.