After some sort of accident or trauma to the oral cavity, patients with zero dental training often wonder if they have a true dental emergency or if they should wait. A good rule of thumb is to always call your dentist first before going in. If you have lacerations or other injuries, your trip to the dental office may be in vain since you may need to go to the ER or another specialist first.
Obvious emergencies include things like unbearable pain, avulsed teeth, or damaged restorations, but what about chipped enamel? According to Dr. John Gammichia, figuring out the severity of a chipped tooth can be difficult:
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.
Even if your dentist doesn’t have this kind of system in place like Dr. Gammichia, it wouldn’t hurt to send in a picture of your injury if it can streamline the process. Hopefully, more dentists follow suit so patients can avoid unnecessary “look-and-see” appointments. If your dentist deems that you should come in to fix the tooth chip, you may want to consider veneers.
Although often used for cosmetic reasons, veneers can be great for people with multiple structural problems or discoloration from trauma.
Along with the wide spectrum of tooth chipping as seen in Dr. Gammichia’s article, diagnosing these problems can also be difficult without the best imaging systems according to drbicuspid.com:
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.
So again, if you’ve gotten lacerations or have fractured multiple teeth, it’s best to call your dentist first since he or she may send you to a radiologist or another specialist before treating you. As this study from drbicuspid.com illustrates, certain imaging equipment may be able to pick up smaller chips that cannot be seen to the naked eye during a quick dental evaluation. Once you have a clearer picture of all the enamel that was damaged, then a dentist can help you with the appropriate restorative treatment, whether that’s veneers, crowns, fillings, etc.