broken tooth

Have you ever had a new patient come in with a broken front tooth that looks something like this?

While we all want to help patients in this situation as quickly as possible, it is important to ask ourselves what caused the broken tooth. In this particular case, the cause of the broken tooth was pretty straight forward – there were clearly functional bite issues causing excessive wear which also led to this fracture.

Tell Your Patient What Caused the Broken Tooth

This brings us to another SUPER important point: once you have determined what caused the broken tooth, share it with your patient so they know what to expect moving forward.  Think about it. They have a broken front tooth and want it fixed quickly, but if you just jump right into fixing it and don’t share the fact that they can expect it to break again – possibly very quickly – you will now be known as the dentist who did a “bad job.”

If, on the other hand, you ensure they are educated as to what to expect until their bite is addressed, in their eyes you will then be the guy who “predicted the future.”

So once you are past the point of discovery and education, which can happen very quickly in many cases, what do you do next?  While every case is a bit different when it comes to specific details, there a few general tips that apply to just about every case.

First, make sure your patient is “with you”– meaning they “get” the reasons behind what it going on in their mouth and that they know you alone can’t make everything all better.  Sure, you can and will help a bunch, but they have to have ownership of their oral health and understand that it is going to take a team, of which they are a part, working together for the best outcome.

Second, in cases such as the one of above, if you and the patient decide to attempt an interim/emergency fix prior to a comprehensive diagnosis of their entire mouth, do as little as possible and make whatever you do as minimally invasive as possible.  For example, in this case I did some minor bonding in the area, which by the way had issues fracturing as both the patient and I expected until the bite was corrected.  While this was no fun, it was WAY better than if I had done a crown that fractured or kept coming loose.

Third, both you and the patient need to expect the fact you may not be able to meet 100 percent of their goals quickly – it may take considerable time.  Had I made this patient’s tooth exactly like she wanted right way, it would have been a VERY short term fix as she would have fractured even faster than the occasional fracture of bonding material she experienced as we worked to correct her bite. Of course, our patients typically want the end result right way, as do I, that is human nature after all.  We have to realize, however, that just like almost everything in life, achieving significant changes and goals with our dentistry typically takes significant time and effort.

(Enjoy this article? Check out these other articles by Dr. John Carson.)

John R. Carson, DDS, PC, Spear Visiting Faculty and Contributing Author www.johncarsondds.com


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Comments

Commenter's Profile Image Panks
December 21st, 2014
All these ideas sound realistic, but how did you eventually end up managing the case? How did you satisfy the "human nature" when in the chair. Panks
Commenter's Profile Image John R. Carson
December 21st, 2014
Great question! We ended up doing ortho and jaw surgery along with restoring the worn anteriors. The patient is actually still in some provisional bonding in the anterior and provisional crowns in the posterior which she will now change out as she is ready but as expected she is a bit tired from the journey she has been on and considering she is stable and looks good I expect she will take her time doing chaining these out
Commenter's Profile Image Karen L.
October 26th, 2015
How did you make the temporary crown? Traditional chairside acrylic? How long would those provisionals be ok before the patient needs to change them to permanent? When they break do you charge them again for provisional?
Commenter's Profile Image John C.
October 26th, 2015
Karen, the only place I had provisonal crowns was in the posterior. They were made with my CEREC and put on with perm cement since she was doing ortho. The anteriors were all handled with direct bonding. As far as fees due to breakage, it depends on if she is in active tx or not meaning when she was not sold on ortho and not ready to start it I think I told her I would fix it once for free and then after that there would be a fee and I was very clear I expected it to break fast, which it did and then she started ortho. We then did not bond the anteriors until my orthodontist had made me room. As far a longevity of both the provisionals and bonding, ortho and jaw sx was about 2yrs and she is still in them so it's been several years and everything is doing fine and she is enjoying getting a break from tx other than recalls, I suspect we will start changing stuff out before too long....at least I hope so because I want final photos :) but for now there is no "health" reason.