One Dental Emergency, Two Stories

Let’s borrow the idea of parallel worlds from science fiction. We’ll use it to illustrate the better and worse cases for the same dental emergency. In one world, the victim has a good outcome. In the parallel world, the “same” person with the same emergency has a poor outcome. The difference? One key decision.

IT HAPPENS
Melanie, 42, was crunching on roasted almonds one afternoon when she bit down hard on a piece that just wouldn’t give. She off-handedly spit it out. A little while later, cleaning up, she noticed the chunk she’d spit. It didn’t look like almond.
A closer look told the tale. It was a big piece of a molar with a dark filling stuck in it.  Feeling with her tongue, she found the broken back tooth. Felt like more than half of it was gone. It didn’t hurt at all. Melanie wondered whether she should call her dentist. She checked her calendar. She’d scheduled coffee with a sister-in-law that day.

WORLD ONE – THE WRONG FORK TAKEN
Melanie wanted very much to keep that date. The two women had become close friends. Melanie had a lot on her mind and felt she really needed to confide. She showered, dressed, and as she was leaving gave the kitchen a quick tidying up. Later she realized she’d thrown out the chunk of a molar.
Melanie enjoyed her coffee time that afternoon. Her sister-in-law commented that Melanie’s tongue seemed to be poking around her mouth a lot. She told the story of the almonds and the broken molar. Her sister-in-law urged Melanie to get to her dentist right away. Melanie promised she would, but the afternoon slipped away.
So did the next day, and the day after. Melanie quickly adapted to the changed landscape in her mouth. As each day passed, her resolve to get to her dentist dwindled. After all, it didn’t hurt. It didn’t interfere with chewing or with speaking. She wondered sometimes whether her breath had developed a foul odor, and began to chew gum more.  Her full, active life went on. Most of the time she was completely unmindful of her broken molar. In fact, it was her new normal. The weeks and months flew by.
Then, she woke up in the middle of the night with pain. She found herself poking the broken molar with her tongue. That seemed to be the area that hurt. She took two ibuprofen but had trouble falling back to sleep. At first light, she brewed up a pot of coffee, but the first sip felt like a red-hot nail driving into her jaw. Melanie knew she had a problem.
Her dentist, like many others, leaves some flexibility in his schedule so he can treat emergencies. She was in his chair by eight-thirty that morning. The pain had worsened considerably.

WORLD  ONE – THE DIAGNOSIS
The dentist’s exam didn’t produce any good news for Melanie. The tooth, he told her, had broken because of extensive decay under the filling. He explained that over time the stresses of chewing and for some, grinding, wear fillings away. When the seal between the filling and the tooth breaks, bacteria go through the gap. There, out of sight and out of reach of brushing, they thrive. The result is decay. In fact, Melanie’s decay had progressed to the point where that last bite down on an almond broke the molar.

WORLD ONE – TREATMENT
The worst news was yet to come. After reviewing his findings and x-rays, the dentist concluded that Melanie’s tooth could not be saved. Worse yet, he felt that a surgical extraction would be required since the bit of molar remaining wasn’t strong enough to permit him to perform a simple extraction. He prescribed antibiotics and made a few phone calls.
Her dentist referred Melanie to an oral surgeon, who worked her into his schedule a few days later. Those were among the worst days of Melanie’s life. The pain was excruciating at times, even with medication. She lost days of work.
The surgical extraction was performed under general anesthesia. It went well, without incident. The toothache was gone, and the post-op discomfort passed soon. Twelve weeks later Melanie returned to the dentist, who prepared her for a bridge to fill the gap. The cost of the surgical extraction and the bridge totaled nearly $6,000.

WORLD TWO – THE RIGHT FORK TAKEN
In the parallel world, Melanie made a decision that led her to the best resolution of that broken molar. The moment she discovered that the hard bit she’d spit out wasn’t almond but tooth, she called her sister-in-law. The two did some quick googling. Consequently, Melanie was on the road to her dentist’s office an hour later, her tooth fragment in a plastic bag.
The dentist commended her for recognizing a dental emergency and acting accordingly. His exam and x-rays showed the decay under the filling had weakened the tooth. That last almond had been the straw that broke the camel’s back. He recommended root canal therapy and a crown to save the tooth. Melanie agreed. She was back home by dinnertime with a temporary crown, and a week later had a permanent crown in place.
The entire episode was painless, except some dull aching the morning after her root canal treatment. Her dental bill was $2,200.

IS THIS A DENTAL EMERGENCY?
The key difference between the two Melanies’ outcomes was Melanie Two’s recognition of a dental emergency. In contrast, the absence of pain fooled Melanie One when she broke her molar. Thus, Melanie One didn’t see any emergency until it hurt, and by then it was too late to save her tooth.
Melanie Two’s decision to call her sister-in-law triggered the research that helped her understand she should act immediately. Straightaway, she learned something everyone should know. The three things that should raise a red flag are displacement, deformation, or intolerable distress in teeth or supporting tissues. If a tooth is not where it used to be, if its shape changes, or if there’s bleeding, severe pain, or any other intolerable distress, it’s a dental emergency. We should preserve anything that falls out of our mouths and bring it to the dentist.
Pain, as the tale of the two Melanies illustrates, is not always there to draw attention to a dental emergency. On balance, this isn’t helpful to outcomes. When dental emergencies are painful, they can be extremely painful. Strange as it may seem, this is a good thing if it results in the victim seeking emergency dental care immediately. By the time it hurts, it’s late in the game.
We don’t have to go to dental school to make smart decisions about dental emergencies. If anything out of the ordinary happens inside our mouths, we can consult 24/7 with Dr. Google and quickly determine whether we should call the dentist. During normal working hours, we can just call the dentist. If anything in the mouth is cracked, broken, moving, missing, bleeding, stinking, or hurting, the right thing to do is to make that call. As soon as possible.
Melanie Two did the right thing. Be like Melanie Two.