Don’t wait until it breaks!
I was doing an exam on a patient recently. The patient had quite a few silver fillings that were probably 20 years old or older. I had some concerns for some of the teeth. Not because of the age of the fillings. Fillings like these can often last 20 years or more. It was because of the fracture lines I could see.
I put took a photo with a digital camera and it popped up on the screen of the iPad after a couple of seconds.
“This tooth is showing signs of trouble. Can you see these little lines?”
I zoomed in the cracks.
“Those little lines are fractures in the tooth. Incomplete fractures. In other words, it’s a broken tooth waiting to happen.”
“I see, Doc. But it doesn’t hurt at all.”
“Interesting. Sometimes they’re painless. Often they’ll become sensitive on biting, but occasionally they’re free of any kind of symptom until they break.”
“Maybe I should just wait until it breaks. I mean, it doesn’t hurt.”
“We absolutely can do that. A lot of times, nothing bad happens by waiting. If it breaks, we’ll fix it. But sometimes the tooth breaks in an unpredictable way. Like underneath your gum, or even under the bone. When that happens fixing it can involve a crown and a root canal and possibly even gum surgery. Sometimes the tooth can’t be saved if it breaks in a bad way. That’s why I would recommend putting a crown on it before it breaks.”
“How do you know if it’s going to break badly?”
“I don’t. So really, I recommend you fix it the day before it breaks.”
The patient gave me an exasperated look.
I know, I know. That is a very cheesy line. I use it all the time because it’s so true. A tooth with this kind of crack, particularly a stained or diagonal fracture is at great risk of breaking. The very best thing we can do for it is to cover it with a crown or onlay. As soon as possible!
In many cases there are internal fractures underneath fillings that have been in place for a long time. Sometimes we don’t see those until we remove the existing filling. These internal cracks are much more likely to be sensitive on biting. Sensitivity to biting is another symptom that shouldn’t be ignored and should be treated right away!
The moral of this story is…don’t wait! A tooth is less likely to have complications (like needing a root canal) if it’s treated as soon as problems are diagnosed. This dentist REALLY prefers no complications!
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