21 Feb 2011, 12:38am
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Treatment of Fractured Teeth

In my last post I discussed the classification of the various types of tooth fractures. So once a complicated fracture is found, what do we recommend as a treatment? The simple answer is one of two alternatives: (1) root canal therapy or (2) extract the tooth. Frequently, I have clients tell me that they have been told by their veterinarian that “It doesn’t look like it’s (the fractured tooth)  bothering the pet, so why don’t we just “watch it.” I would argue vociferously against that option as being bad medicine on one hand and promoting ill health and a negative quality of life for the pet. Let me explain why…

Notice that the tooth has a hollow center. This “pulp chamber/root canal” is filled with living tissue known as pulp. Like any living tissue, it contains blood vessels and a nerve supply. It is supplied via tiny tubules at the root tip which, collectively, are known as the “apical delta.” Pulp lives in a sterile environment and is protected from damage and infection by the tooth structure.

However, if the tooth sustains a complicated fracture, it is now open to infection by the hundreds of different species of bacteria living in the mouth. In addition, the sensitive nerve endings in the pulp are now being irritated and painful. The infection which starts at the fracture site moves slowly towards the root tip (apex) and will eventually cause an infection of the alveolar bone which anchors the tooth. One might ask how we know that the tooth is painful? After all, the pet can’t tell us it is in pain, and most pets are very stoic when it comes to pain. I have seen fresh fractures and I can attest to the fact that they are painful. All one has to do is pass a toothbrush over freshly exposed pulp to see pain. After a period of time, after the pulp has died and necrosed there is little to no pain at the fracture site because all of the nerves are gone. However, there will still be pain in the alveolar bone secondary to the infection. Ask yourself…would I be painful if that was my tooth?  So with “watch and wait” eliminated as a treatment option, we are left with extraction vs. root canal therapy.

Extraction is certainly a viable option but there are several considerations regarding extracting a tooth.

  • Most cat and dog teeth work with a mate on the opposite (upper or lower) jaw. Extraction will eliminate one of the mates
  • Extractions are painful. Root canals are not
  • Extractions create a defect in the jawbone which takes time to heal. Root canal therapy does not
  • Extractions may be almost as expensive as root canal therapy…therefore, why not spend a little more and get the best

Root canal therapy allows us to save a valuable tooth. It involves thoroughly cleaning and disinfecting the root canal then filling it with an impervious material called gutta percha. The entry hole into the root canal is then  sealed with a resin material called composite.

22 Jan 2011, 1:14pm
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How to Brush Your Cat’s Teeth

If you’ve gone through my website, you know how important I think daily homecare (including brushing) is to your pet’s oral health. Click on this link for a very nice video put out by Cornell University on brushing your cat’s teeth.

http://tinyurl.com/45zj99

Classification of Tooth Fractures in Pets

Tooth fractures are common in dogs and cats. Pets fight, they are hit by cars, and they run into things as they play…just to name a few of the many causes. In simple terms, fractures are classified as complicated (the pulp is exposed) or uncomplicated (the pulp is not exposed). For a more complete discussion see www.avdc.org > nomenclature > fractures. Complicated fractures are the ones we worry about because they are painful and will get infected 100% of the time. However, that said, just because there is no pulpal exposure does not mean that the pulp is healthy. It could still have been damaged or be in danger of dying.  All seeming uncomplicated fractures should be thoroughly assessed and then followed by regular radiographs (x-rays) over a period of a year or two to ensure the health of the tooth. In addition, most uncomplicated fractures result in porous dentin being exposed. We will commonly use dentin bonding agents to seal the dentinal tubules and thus prevent tooth sensitivity or retrograde infection of the pulp from intraoral bacteria.

All images courtesy of the American Veterinary Dental College

The importance of a thorough oral exam

A fracture of an incisor is easy to miss because small fractures are not always obvious. However, whenever the fracture is deep enough to expose the pulp, there are only 2 treatments available, root canal therapy and extraction

A fractured incisor from the front would be easy to

miss.

Another view of the fractured incisor showing necrotic pulp

Notice the root which has been shortened by resorption secondary to infection

This tooth was extracted because it is a small and relatively unimportant tooth and the root resorption would have made root canal therapy more difficult

11 Feb 2010, 11:31am
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Welcome to Dental Digest

Dental Digest is a publication of Dentistry for Pets. Dental Digest was created by Dr. Rob Yelland in an effort to pass on topical veterinary dental information to both pet owners and other veterinarians. We will try and include new scientific information regarding dentistry as well as interesting cases we see in our practice. Unfortunately, due to time constraints we will not be able to accept comments or questions. If you have questions, please contact Dr. Yelland or one of his staff members at Berkeley Dog & Cat Hospital.