"Doc, My Filling Came Out." (w/ PICTURES)

When someone visits our office and reports that a "filling came out," in most cases, it is actually part of the tooth that broke and not the filling.

Having been an ENGINEER before becoming a dentist, I look for tooth problems created by chewing and grinding forces. I look for clues that teeth might be weak and need reinforcement. One of my goals is to evaluate structural integrity of teeth, and to help every patient keep and enjoy their teeth for a lifetime.

The below photos show some broken teeth. Documentation helps to calibrate my understanding of when a tooth is truly at risk, so I can make better recommendations in the future. As they say, a picture is worth a thousand words. Enjoy!

CASE 1: "BUT IT DOESN'T HURT"

Yellow A: Corner of tooth broke and missing.
Red B: Worn spot on adjacent crown. Metal showing through.
Green C: Shiny wear spots on filling.
Despite multiple clues indicating occlusal problems, the patient was not interested in treating tooth at this time. The patient stated it was not hurting them. 

Yellow A: Original break.
Red B: New break causing pain.
Green C: Tongue.
The second break (Red B) was much more severe, and it was unknown at this point if the tooth could be saved. We needed to numb the patient and remove the tooth piece to see the extent of the break. 

Yellow A: Very deep break.
To restore the tooth, it required root canal therapy and gum surgery in addition to the originally needed crown procedures. The patients was sorry they didn't get just the crown when that would have prevented this more extensive treatment.

Outside view of broken piece.

Inside view of broken piece.

CASE 2: SURPRISE!

Yellow A: Wear patterns on teeth. Enamel layer worn off. Softer dentin showing through.
This tooth was weaker than I expected. Before we were able to replace the filling, the tooth broke. I did not give enough urgency to these wear patterns.

Yellow A: This outlines shows the extent of missing tooth.

Saliva is filling the hole left by the missing tooth piece.

Outside view, broken tooth.

Inside view, broken piece.
Notice how sharp the break is at the bottom.

CASE 3: BACK TOOTH BREAK

Back, tongue-side cusp of back tooth is broken.

Numbed patient and removed broken piece of tooth.
No root canal therapy was needed. Crown procedures restored function and strength.

Outside view, broken piece. Note gum attachment at bottom of piece.

CASE 4: NON-RESTORABLE BREAK

Top back tooth presents with crack under old filling.

Filling was removed without needing to drill. Older silver fillings are not bonded and are only mechanically retained.

Depth of crack prevented ability to restore tooth. Tooth was extracted.