Perhaps the emergency phone call I received last Saturday from a patient with a cracked tooth was a portent of the week to come…
My long-time patient Alan was driving along in his car last Saturday, happily munching from a freshly opened bag of tortilla chips. Suddenly he bit down and felt a crack accompanied by a jolt of pain so intense that it forced him to pull over to the side of the road (and call me.) As an exam in my office would later reveal, he had a cracked tooth – it had literally split in half. The only viable treatment course, unfortunately, was to extract the fragmented tooth. Then bone-graft the remaining socket and so it is ready for an implant that I’ll place in three to four months. When he was finally relieved of pain and ready to leave the office, Alan told me that he was amazed – actually flabbergasted! – that the tooth he cracked on something as seemingly innocent as a tortilla chip had been perfectly healthy and unblemished. Why was it that tooth that cracked instead of one that had a filling?
Tooth enamel is the hardest substance in your body, yet a cracked tooth is one of the most frequent reasons patients have dental emergencies. The reason is the force of biting is immense. Biting forces can exceed 500 pounds per square inch, so chomping down on an unanticipated obstacle such as an olive pit, an un-popped popcorn kernel, or an incompletely milled corn meal (as was present in Alan’s tortilla chip) can lead to dental disaster.
Alan’s Cracked Tooth Was A Harbinger Of Things To Come…
Monday morning found me back in the office looking forward to a busy week ahead and the Memorial Day weekend to follow. The plan for that week was this: business as usual taking care of patients, on Monday, Tuesday and half of Thursday. Wednesday I would be teaching at the Implant Program at NYU. Thursday afternoon the office would be closed to eveyone but the staff for a long-planned office meeting. (We think of our practice as a happy family and make sure that we are always at the top of our clinical game, too). After the meeting, a photoshoot was planned so we could have new images for the website. Friday – I gave everyone, including myself, the day off. In short, with only two-and-a-half days available to care for patients before the holiday weekend, we planned for and were ready for an invigorating week with little time to spare. Working lunches were part of the plan, too.
I began the week, as usual, seeing patients. At one point I reached out to see how Alan was feeling and found out he was doing fine. As I was gulping down a quick cup of coffee, I felt an earache coming on. Not terrible, but unexpected. As the day wore on, I became aware of a diffuse distracting discomfort that was difficult to pinpoint. Was it in my ear? Was it from TMJ? No. The dentist in me suspected a tooth was the culprit. I am somewhat of a veteran as a dental patient and have personal experience with root canal treatments – I’ve had five and counting. (I loved going to the candy store as a child.)
As I was saying, my pain was not acute, but I couldn’t pinpoint the source. I had an x-ray taken – it was unremarkable. So Advil to the rescue – I had a busy day to get through. At one point, one asked me if I was alright. (I guess I wasn’t being my usual cheery self. I later discovered that the staff noticed I was “out-of-sorts” (code word – grouchy). I took more Advil and got through the day passed without any more distractions from my tooth due in part to the wonders of modern pharmaceuticals and my focus on patient care
I had no trouble eating. No pain from hot or cold to speak of. Yet, I detected a vague tenderness to finger pressure along the base of my two lower molars. Through it all, I was cognizant of my commitments for the week. Wishing away a problem you have no time to deal with is a human characteristic and non-dentists don’t hold a monopoly on self-denial.
Before I left for the day I called a root canal specialist Dr. Howard Aaronson whose office in the same building as mine. I set up an appointment for the next afternoon, the only available time that both he and I were free.
Doctor, Heal Thyself? Not A Chance
Tuesday morning started off absolutely fine. I brushed my teeth. I ate breakfast. I began seeing patients. All good – until I grabbed that first cup of coffee (you’d think I’d learn from my Java incident from the day before, right?). Suddenly mushrooming pain began emanating from my left second molar and fanned across my lower jaw. I swiftly made my exit from the office after giving everyone the lowdown and arrived at Dr. Aaronson’s six hours early for my appointment.
Another root canal for me, I thought. Dr. A. agreed. But as treatment commenced he discovered that the tooth was fractured and could not be saved. A cracked tooth – the second one of the week – first Alan’s and now mine.
Dr. Aronson’s exemplary first aid relieved my distress and before long I was back in the office exhibiting slurred speech and a droopy, lopsided smile. I continued the day’s purpose of practicing dentistry while regaling my patients with the story of my dental misadventure. Laughter was the common response to my embellished tale of woe from the staff and patients. They chuckled and chortled at the idea of me being on the receiving end of dental treatment. So, I just had to ham it up a little (or a lot). Hey, it is what it is!
The Surgery Was Hilarious
The next day was Wednesday, my teaching day at the NYU Implant Department. I arrived with my diagnosis in hand and a treatment plan in mind. Dr. Ehab Shahid, one of my mentors, colleagues, and friends, had the honor to perform the tooth extraction, assisted by the very capable Dr. Donald Spitzer. My other mentor and dear friend Dr. John Como was also in attendance. I mention them here so they can see their names in print!
So the tooth was extracted. It was a first for me. I’d had all my teeth including my wisdom teeth. Having the tooth removed was utterly painless – I mean it! Lots of local anesthetic and capable hands made the procedure seem like a non-event. I actually found myself laughing during the surgery. There I was, laying back in the dental chair with three friends’ faces hovering within nine inches of mine. They looked like bobbleheads as they kept nodding up and down. It was really funny. The socket was bone-grafted and I was sent on my way (dental implant would be placed in about four months).
I Am Not Thrilled That I Lost A Tooth
Yep, it’s weird to have a hole in the back of your mouth. It’s annoying when your tongue won’t stop exploring it. And, now I realize how much concentration it takes to chew on only one side of your mouth and stay away from crunchy food such as crackers or pretzels. (It’s not worth the jolt of pain that results from a rogue remnant jamming into a raw gum.)
This dental misadventure of mine has led to a heightened awareness of the many nuances associated with the experience of having a cracked tooth. Because I’m a dentist, I had the clinical knowledge to understand what was unfolding in my mouth and causing physical distress. This enabled me to consciously observe and feel what a patient experiences, but I didn’t have the angst and anxiety that accompanies pain of unknown origin. Everyone feels pain a little differently, and I am more aware of that, too. I guess when it comes to a cracked tooth I can tell my patients that I practice what I preach – get thee to the dentist asap!
My cracked tooth increased my understanding of the patient experience and enhanced my empathy for the people receiving care at my office.
Thanks for reading,
Michael Sinkin DDS
Here’s more reading about what to do if you have a cracked tooth – and other related musings: