Chipped a tooth after filling came out, exposed dentin but doesn't hurt

May 28, 2006 7:49 AM

InTheMeantimeFilter: I've got a formerly filled, chipped tooth with exposed dentin that doesn't hurt .. yet. What can I do in the meantime before the dentist visit?

About last Tuesday (today is Sunday), I was chewing gum and a filling came out. That day, I got scheduled for a dentist appt -- for JULY (!!, my dentist is very very good and thus very popular) -- but chewing on a jelly bean this last Friday broke off part of the tooth itself so that dentin (pale cartilage-colored structure that is flimsy) is exposed. Pardon the hideous limited color selections used in my craptacular illustration:



It is on the top, left side just behind the canine.

In the meantime (I have not yet told him about the new chippage, being the Memorial weekend, but I'm certain I can probably get it bumped closer with cancellations) what can I do to prevent the eventual and anticipated pain from setting in and not being quite so bad? Is dentin supposed to hurt? I can move it around and it's flimsy, but it doesn't hunt unless I tug up on the little dentin corner piece that will open up like a flap and even then it's just a general soreness.

I've got some Orajel/Anbesol that supposedly makes a coating over any toothache/sores in the mouth to prevent infection (and also in anticipation of needing to numb myself) but is that all I should do? I also plan to use mouthwash throughout the day to be double-darn safe. Would brushing over this dentin damage it and possibly quicken the onset of the terrible pain I am anticipating at the office?

I've had loads of fillings before, and usually do it without injected anaesthetics (nitrous only, set on a special "mike" setting as I am somewhat of a celebrity there for not getting numbed) but I'm afraid I may have to go with a numb on this one, and especially fearful because I hear top-jaw numbs only tooth by tooth while lower-jaw numbs the whole side at a time.

posted by vanoakenfold to health & fitness (11 answers total)

Large doses of ibuprofin, like 8 tablets at a time, will work but only for a few days.

When I had the long-weekend-cracked-tooth experience, I found that keeping warm water in my mouth stopped the pain. The problem with that was it hurt even worse if I didn't have the water, so I was stuck sitting up all night sipping warm water.
posted by StickyCarpet at 7:56 AM on May 28, 2006

He said it doesn't hurt yet, so ibuprofen is premature. However, if pain does hit, I suggest combining ibuprofen (Advil) 3 at a time with acetaminophen (Tylenol) 2 at a time. You can pretty safely exceed the recommended ibuprofen dosage and I've found that 3 is the absolute minimum that does anything for me for anything but a headache, but DO NOT exceed the acetaminophen dosage, it's hell on your liver, by which I mean you can get liver failure pretty much immediately if you overdose.

The two drugs block pain by two different pathways, so they work well with each other. It's worked for me many times in the past, like when I twisted my ankle badly.

The only thing you have to watch out for is that you take the ibuprofen every 4 hours while the acetaminophen every 6. You might try naproxen (Aleve) in place of the ibuprofen (take two the first dose, then 1 every 12 hours). However, it's my understanding that naproxen is harder on the liver than ibuprofen, which, with the acetaminophen, could be a no-no, so I'd stick with the ibuprofen.
posted by kindall at 8:38 AM on May 28, 2006

Oh yeah, DO NOT drink alcohol if you are taking acetaminophen. I don't drink so I always forget to mention that.
posted by kindall at 8:38 AM on May 28, 2006

Perhaps physical protection would be useful? You can buy bite splints at pharmacies and larger stores like Target. Look in the section with the teeth whitening products. If you don't have any luck there, look in a sporting goods store for mouth guards.

Something in your mouth would be good physical cue to yourself to not to bite down on that tooth too hard.
posted by SuperSquirrel at 9:02 AM on May 28, 2006

Dental wax (also called "braces wax".) You can glop the stuff around the soft part of the tooth to protect it from further damage, and it also seals out the air and liquids.
It's a temp fix, but it may hold until you can get in.

If they do it right, they'll slop that topical anesthesia around so you won't feel the needle go in, which I suspect is why you keep doing this without anesthesia. Just shut your eyes and don't watch, it'll be OK.

If it does start hurting: My dentist shared a bottle of the local a while back, I was using it on a bone chip that was reluctant to leave. If you ask, they might give you one, just put it on with a Q-tip so you don't contaminate the bottle, and it keeps a long time. It doesn't last too long, but it'll kill anything for a short time, and the fact that you asked may convince them you're in trouble and they might move up the appointment. (It's the stuff that tastes vaguely like bubble gum. If you can't stand to have them cleaned, BTW, they will often rub it around for cleanings if you ask. That's for anyone with that problem who might be passing through.)
posted by unrepentanthippie at 9:24 AM on May 28, 2006

What the heck kind of dentist doesn't build in emergency time into his schedule? July? That's ridiculous. But having no pain mitigates the urgency a bit, so that's good for you anyway.

Most often, if a tooth is going to hurt after breaking a portion of it, it will hurt immediately with the exposed dentin. If it doesn't now, it most likely won't over time, provided you are keeping it clean and there isn't rampant decay going on. A little cold sensitivity is a good, healthy nerve response to a broken tooth. Sensitivity to hot that lingers or gets better when cold is put on it is a bad sign.

What I would do: Inform the dental office of the new circumstance, ask to be moved up in the schedule if a cancellation opens a spot up. Do not back away from brushing and flossing that area, if you don't rinse with Listerine(or warm salty water), do so. Keep the bacteria levels down to battle any infection. Do not shock the area with extremes of hot or cold, you have a nerve on the other side of that dentin under enough stress as it is. Don't give it a reason to die on you.

Putting a temporary filling on yourself is not usually a good idea, you could seal in bacteria which could create a great environment for it to multiply and go to work on destroying tooth material beneath it. Better to leave it open so you can keep it clean. If you have a ragged or sharp edge, you could take a nail file and gently smooth the point.

Best for tooth/oral pain: Ibuprofen usually can be taken in higher doses for short periods of time safely.
posted by Jazz Hands at 10:06 AM on May 28, 2006

Forgot: Loose piece, honestly if it is painful and is just flapping there, I'd suck it up and see if I could tease it out, it isn't doing anything for the strength or protection of remaining tooth. I wouldn't work too hard at it, because if it doesn't come out easily, leave it to the dentist.

As far as the anesthetic goes, on the upper arch numbing is done for each individual tooth. The injection is very local, keeping to a small area of tissue. On the bottom, the injection has to catch a nerve bundle back where the jaw joint is. It deadens from middle of lip and chin, and the tongue, back to the joint and sometimes down the neck or around to the ear. No kidding, I had a lower block numb the outer rim of my ear once. My opinion, much rather have work done on an upper tooth.
posted by Jazz Hands at 10:13 AM on May 28, 2006

Seriously, if your dentist doesn't schedule you for that afternoon when you call, ask them to make a recommendation for another dentist in the area.
posted by j at 11:31 AM on May 28, 2006

When this happened to me I let it go for years without seeing a dentist. Very bad idea, but my point is, it may never hurt. If it does start hurting, though, be sure to mention "pain" on the phone to your dentist, which will usually get you a sooner appointment. And definitely get your appointment moved up as soon as possible.
posted by nevers at 12:52 PM on May 28, 2006

I have the same exact problem that happened a few days ago with my lower molar. Half of my tooth is just a hunk of gold right now and if I bite down on it I get some intense pain.

Would be nice if a drug store offered an over the counter temorary cap for cases like this. Various sizes for different teeth.

If this problem gets real bad for you you can go to a sports
store and buy a Boxers mouth guard.

(trivia) Buddy Holly used a Chicklet when he chipped his tooth minutes before appearing live on the Ed Sullivan show.

Anyway, this subject reminds me of another dental subject.
I remember back in the 80's seeing some TV show that reported on fantastic new oral medication that could work wonders for all kinds of natural tooth decay problems. WTF ever happened to that? I wonder if the Dental profession quashed that medication so it wouldn't lose business.
posted by SwingingJohnson1968 at 1:37 PM on May 28, 2006

If it starts to hurt, get a whole clove. Bite down very lightly on it, just to bruise it. Stick it between the gum and cheek right by the tooth that hurts.

Dentists used to use clove oil for numbing.

This also works for nausea, although then, it doesn't matter where you place it.
posted by QIbHom at 5:47 PM on May 31, 2006