Digital photography & patient communication

In today’s world, when dental patients are increasingly savvy about dental care, but also increasingly worried that they’re being taken advantage of, developing the critical trust between a patient and our team is occasionally difficult.  This is where the power of digital photography is so evident, and why I recently wrote about it on my photography blog (http://cdpayetphotography.wordpress.com), because communication is so much easier, and trust is so much easier to establish when you – the patient – see everything that we see.  That’s one of the reasons that we document our work so extensively with Canon Digital Rebel XTi’s.  Of course, the other reason we do is because we are proud of our work and love to show off what we can do to serve you and help you keep your teeth for your life.  🙂

Yesterday was a perfect example (although this patient has been with us for some time and we’ve already established that trust, plus she was having some pain).  This old silver filling had provided many years of use for Mrs. X, but she was having off-and-on soreness and throbbing and wanted it looked at.  When we took the picture and showed her the tooth, it was easy for her to understand why it was bothering her, as well as why we recommended a crown to save it; a root canal may well be needed, too, but we’re keeping our fingers crossed for her that she won’t.

Remember my last post about cracked teeth?  Take a look at this tooth — SEVEN CRACKS!  No wonder it was hurting.  It’s almost a miracle that the tooth had not split in 1/2, to be honest.

And this is how the tooth looked after we’d shaped it for a crown (which we’ll make with our CEREC CAD/CAM system); the crack extends well below the gum line and very deep into the tooth from both sides.

If you ever have questions about the treatment that’s being recommended — ask to see pictures.  X-rays are often very inadequate in diagnosing these problems.  The cracks that are so evident here do NOT show up on x-rays; they’re too small.

Digital dental photography — the PATIENT’S friend.

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Cracked teeth – Act early

One of the most common reasons that patients come to us for dental emergencies is cracked and broken teeth.  For some reason, this always seems to happen on weekends, when you’re out at dinner, or right after we’ve closed for a long weekend – go figure.  This is avoidable, though, if you act preventively.  Here’s the key, though, and this is one of the reasons we use digital photography so extensively to communicate with our patients — very often these teeth won’t hurt at all until they break.  Don’t ask me why – noone really knows.  But so often, what we’ll here is, “Doctor Payet, it never bothered me at all, and then last night I was chewing on a banana and a big chunk of the tooth just broke off!”

Many doctors still go by the philosophy of, “If it ain’t broke and it don’t hurt, leave it alone.”  The problem with that philosophy (in my humble opinion) is that when it finally does break, it will take more time, cost more money, and until it’s fixed is often pretty painful than if it had been treated before it broke.  If it’s a small crack, treat it with a nightguard and a filling.  If it’s a big crack, treat it with a nightguard and a crown.  But if it breaks, you might well need a nightguard, root canal, build-up filling, and a crown.  And all because the small crack wasn’t treated with a filling.

Research tells us that teeth with tooth-colored (composite resin) fillings crack  just as often as those with silver fillings.  My experience over 10 years, however, tells me that teeth with LARGE silver fillings crack much more frequently than with composite fillings.  But even the bonding process can’t stop a crack from forming if the stress isn’t relieved.  I’d like to show you some examples of what we often see:

It does seem that these cracks form around old fillings most of the time……..but they can even happen in teeth that have never had any work done.  All it takes is a lot of force (usually grinding and/or clenching your teeth) and enough time.  Here’s an example from a young man in his late 30’s who clenches his teeth so hard that he split this back molar completely in 1/2.  It had NEVER had any dental work, and in fact, it didn’t even have a cavity.  But he split it so far that it had to be extracted.  Obviously I recommended a nightguard to help him not do this to any other teeth!

So what’s my point?  Simply this: if you have been told that your tooth is cracked, at the VERY least, please make sure that you have a nightguard, because clenching and grinding of your teeth is the most common cause.  But also — get it treated BEFORE it breaks.  It’s less expensive and a lot less uncomfortable that way.   And you won’t have to worry about it breaking over that long weekend or holiday when we’re out of the office.