Helping Your Dentist Figure Out Where You Fall on the “Chipped Tooth” Scale

If you’ve chipped a tooth, you need to get into the dentist right away . . . right? It actually depends. If you haven’t damaged any nerves and are not in pain, you may be just fine to schedule an appointment further out on your calendar. But again…

If you’ve chipped a tooth, you need to get into the dentist right away . . . right? It actually depends. If you haven’t damaged any nerves and are not in pain, you may be just fine to schedule an appointment further out on your calendar. But again, how do you know what constitutes an immediate intervention and what can wait?

According to one dentist, it’s often hard for patients to know the difference:

Deciphering the meaning of ‘I chipped a tooth’

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 . . .

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.

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Deciphering the meaning of ‘I chipped a tooth’

Even if your dentist doesn’t have a smartphone routine like the one mentioned in this article, it would greatly benefit both of you to send him or her a picture of your chipped tooth and explain everything that happened to cause it and every symptom–even details that seem unimportant–that you are feeling. According to Dr. Glenn Doyon, chipped teeth fall on a broad scale of mild to severe injury, so giving your dentist as much info as possible is vital for proper scheduling and for fitting you with the proper restoration. Dr. Doyan also says that chipped or cracked teeth are more common than you think and don’t always occur with extreme trauma. Natural wear that isn’t taken care of could chip enamel enough that a root canal may be required!

If you still have symptoms of chipped teeth (sensitive enamel, pain, etc.) but your dentist has already repaired any major damages, it may also benefit you to get a second opinion. reported a study that found that radiologist’s imaging equipment may be able to identify cracks that are difficult to spot on a physical dental exam. If you are able to complete these imaging methods, then you can take the results to a dentist for any further restoration.

You can read more about the study here:

Which imaging system is better for diagnosing tooth cracks?

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.”

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Stephen Nozaki, DDS, MPH, DIDIA

Dr. Stephen Nozaki is the owner and lead dentist at Image Dental in Stockton. He is a dedicated professional born and raised in California's Central Valley. With a commitment to his community, he brings advanced dental techniques learned from extensive education and continuous training from around the world. A third-generation Japanese American, Dr. Nozaki has a rich background that includes international living and a deep passion for both dentistry and outdoor activities. His focus in dentistry aligns with his passion for cosmetics and dental implants.