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.

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