Any Dentists Here?

[wdfifteen]

While eating breakfast part of my upper left second bicuspid broke off. The missing part is the inside 1/4 to 1/3 of the tooth, from the top down to under the gum line. It took about 20 minutes of wiggling it after it broke to get the broken piece out of my gum. There was/is no pain associated with it. My dentist can't see me until Tuesday, and he was very busy when I called but he did look at my X-rays and said it is a virgin tooth - no cavities or work done on it ever.
So what am i looking at here? Is there anything I should be doing for it until Tuesday? Will he likely put a crown on it, or is it broken too far down for that?

[1990C4S]

Dentist90....

[Gogar]

I'll ask ms Gogar

[Gogar]

Ms Gogar said you should ask your dentist. Lol!

[LEAKYSEALS951]

Usually that tooth cracks like that when there is a filling through the middle/and or a root canal, which weakens the tooth, and a cusp will split off the inside or the outside.

That is weird the dentist mentioned it was a virgin tooth. If it was a virgin tooth that split like this, I would expect at least some thermal hypersensitivity of at least some sort, unless you are older than dirt and the nerve has completely shrunken away to nothing.

At this point, if you aren't in pain, waiting until next week probably wont hurt anything worse than has already happened. The solution will depend on how bad the tooth cracked and how subgingival the fracture was. A lot of times, you can crown something like that and it works fine. It all depends on how much tooth structure is left.

You are looking at anything from a crown, to a buildup and crown, to a crown, buildup, and a root canal, to an extraction. good luck

[recycled sixtie]

Originally Posted by Gogar

Ms Gogar said you should ask your dentist. Lol!

^^^^^^^^^^^^^^

This is your best answer. Having said that I was at the dentist two days ago. Filling was falling apart and dentist said I had a root canal done on that already. After much drilling, replacing the post from the root canal, drilling what felt like two-thirds of the tooth, he refilled it. I thanked the dentist profusely. Amazing what they can do with a little bit of tooth left. No pain from drilling due no nerve in the tooth. Hope this helps!

[Targa Me]

if it cracked down to the gum, there is no saving it. its probably going to get pulled.

Same damn thing happened to me and they yanked it.

[jcommin]

I'm living with a cracked tooth now - it has got to go. I'm not sure it is a virgin tooth. It doesn't hurt me as of yet.

Go see a dentist. If you have pain, take Advil.

good luck!

[A930Rocket]

Just got back from the dentist a few hours ago for the same tooth.

Broke off the inner third of the tooth.

Had a temp crown installed while a new one is made. My cost was $740 AFTER insurance.

[wdfifteen]

Well. thanks....
Even my loving wife looked at my shattered, destroyed, and potentially painful tooth and reminded me about her experience of giving birth.
I can't get no respect. This might possibly cause me discomfort people!!

Look at these crappy iPhone images if you are not squeamish:





PS Thank you Leakyseal for the comprehensive answer.

[LEAKYSEALS951]

^Wish you were in Virginia.
Scotty would say something like "Aye Aye Capt'n.... Yer cuttin' it close!"
That fracture looks to be down near/ or to the alveolar ridge of bone. A lot would depend on how thick the fracture is at that point, how long the root is. I would want to see the remaining tooth in place. At that point of fracture- I've done crown lengthening as well as reshaping the remaining root to allow something referred to as a "biological width"- which is a fancy way of saying the gums need a certain amount of root structure to attach to the tooth somehow. Even with a place for the gums to attach, there needs to be enough tooth structure to hold the crown with a good mechanical advantage, or even that will flex and fail. There is also the issue of the nerve, which very well may need a root canal. Without seeing it in person, I am at a loss.

I can bend the law of physics, but can't break it. You are right in between!

Until then, Ms. Gogar's answer reigns supreme!

[Por_sha911]

Don't ignore it because it doesn't hurt yet. Once it starts to hurt, there are a lot of other issues to deal with. Get it fixed ASAP.

[Gogar]

I don't think you're gonna save whatever is left.

[wdfifteen]

Thank you so much leakyseal & Mrs Gogar. I assume it's OK to wait until my Tuesday appt to do anything? It will be fun to tell him, "Doc, it seems to be down near or possibly to the alveolar ridge of bone and I am concerned." He will totally crack up!

[LEAKYSEALS951]

Originally Posted by wdfifteen

Thank you so much leakyseal. I assume it's OK to wait until my Tuesday appt to do anything? It will be fun to tell him, "Doc, it seems to be down near or possibly to the alveolar ridge of bone and I am concerned." He will totally crack up!

Tell him in these words "Doc- I am concerned that this may be at the level of alveolar bone, or perhaps even subcrestal considering it took me so long to extract myself...."

(edit)... unless you have a history of periodontal treatment and bone loss. In this instance, inform him your overall strategy has been that you have known of this impending fracture for some time, and you have actively avoided periodontal maintenance to allow the bone to recede to a point whereas this fracture would be easily amenable.


If you aren't hurting now- you will probably be fine until tue.
Basically, if you had a vital nerve that was exposed by this fracture, you would be in some sort of pain right now- and you aren't, so either the nerve is dead, shrunken, or isn't exposed.

If a vital perfectly good nerve WAS exposed, it would have been exposed to bacteria even if you had of gone in this morning asap, and it would have more than likely needed a root canal anyway.

Right now, this tooth is really pushing the limits of periodontic and restorative considerations. Endodontic concerns are also a factor, but at this point almost play second fiddle to the first two. Your second picture almost seems to indicate a pulp horn on the internal aspect of the fracture, but if that were the case, you wouldn't be sitting here typing in ppot (of parf ) tonight.

If the nerve is schlerotic, or necrotic, it has been so for some time. The recent fracture will not be a big deal in the course of those two things (meaning it could have blown up 6 months ago, or 6 months from now, or if schlerotic- never...).

Don't ignore it, and don't sit on it for 6 months/ year- but next week should be fine. If it does flare up- call your dentist's emergency off hours line.

[Nickshu]

Your PPOT resident periodontist here.

Here's what's on the menu:

1.) Crown lengthening/Crown...may or may not need root canal, will probably need core buildup
2.) Extraction/implant...may or may not need bone graft first
3.) Extraction no replacement
4.) Extraction/conventional bridge using the adjacent teeth
5.) Extraction/removable partial denture...silly to do this for one tooth but it's an option.

Since it was an acute fracture there is probably minimal risk in waiting until Tuesday. As said above, keep the area clean and do warm salt water rinses a few times per day. Eat on the other side, but you are probably already doing that.

Then get to the root of the issue...if you are fracturing a virgin tooth...why? Clearly it very likely had years of occlusal (bite) overload, barring some malformation in the enamel and dentin, which would be rare. Is your bite off? Do you clench and grind (well we all do to some degree)? Does your bite need to be equilibrated? Do you need a bite splint? Would orthodontics help? Is this the first of several? I think an examination of the possible root causes (no pun intended) is in order...at least that's what I do in my practice.

Good luck!!

[wdfifteen]

Originally Posted by Nickshu

Then get to the root of the issue...if you are fracturing a virgin tooth...why?

Over the past 30 years I've broken parts off of 3 or 4 teeth. Every time I was eating something. Once I was eating mussels and one had a grain of sand in it. This time I was eating raspberry jam on toast - lots of hard seeds. I'm guessing it was the seeds.

[jhynesrockmtn]

It is amazing the variety of talent and experiences on this board! My wife's a dental asst. I'm typing this after having some gum grafts done yesterday. Sounds like Nick has all of the advice you'll need. I wear a night guard after grinding for years and luckily a dentist investigated it several years back. Can't sleep without the damn thing now but I'm sure it has saved several of my teeth.

[berettafan]

hey just had a crack and subsequent filling yesterday!

small world!

[Steve Carlton]

Yeah, but I wouldn't want to paint it.