Puppy Has Broken Teeth
Diagram of an ucomplicated crown fracture. Several different types of tooth fractures may occur in pets, with crown fractures being the most common. There are basically 2 types of crown fractures; Complicated crown fractures (charted as CCF) and Uncomplicated crown fractures (charted as UCF). Regardless of how the patient is acting or how long the owner thinks the fracture has been pre-sent, all fractured teeth should be treated. Your patient’s will rarely show any sign of pain.
When you treat the teeth, however, they almost always show signs of improvement. Selection of appropriate treatment modalities depends on the type of fracture, radiographic appearance of the tooth and, in some cases, the duration of the fracture. Picture of a fractured tooth, with exposure of the dentin. Note the thin layer of enamel. Complicated crown fractures are fractures in which the pulp (nerve) chamber has become exposed. These teeth should be treated with root canal treatment or extraction. Despite rumors to the contrary, pulp exposure will never spontaneously heal, except in experimental germ-free rats.
The presence of bacteria in the oral cavity always results in pulp necrosis and endodontic infection. The brown spots seen on some teeth are stained dentin, and do not rep-resent prior pulp exposure that has healed. Occasionally, Vital Pulp Therapy (aka- pulp cap therapy) may be used to treat a very recent pulp exposure, but root canal therapy is almost always a better choice and is associated with a much higher success rate. I would only choose Vital pulp therapy over root canal therapy in recent fractures when the patient is 14 months of age or younger.
In these patients, the walls of the root are still very thin, and maintain-ing the vitality of the tooth allows for continued development and strengthening of the tooth. After 14 months of age, the tooth should be strong enough to last for the life of the patient, and root canal therapy is a more appropriate choice. Diagram of a complicated crown fracture In uncomplicated crown fractures the pulp is not exposed. Because the enamel of dogs and cats is so thin, these fractures almost always result in exposure of the dentin, which makes up around 80% of the tooth structure. Dentin appears to be a solid substrate, but it contains 40,000 plasma filled tubules/mm2. Exposure of these dentin tubules is painful, and the tubules are large enough to allow direct bacterial migration into the pulp chamber, resulting in endodontic infection. What appears to be a solid substrate is not.
These teeth should all be radiographed and assessed for vitality. If they are still vital (alive) they may be treated by smoothing the fracture site and applying bonded resin sealants to the site. The bonded sealants block the dentin tubules, decrease pain, help prevent bacterial migration into the pulp chamber, and assist the tooth in healing itself from inside the pulp chamber. We teach this technique in our Level II class (see sidebar). Bonded sealants should not be performed in complicated crown fractures or teeth with near exposure of the pulp, as you will trap bacteria inside the tooth, leading to endodontic infection and death of the tooth.
If a tooth with an uncomplicated crown fracture is found to be non-vital or infected inside, then it should be treated with root canal therapy or extraction. You can never tell what treatment is appropriate unless you utilize dental radiographs. In many cases, restoration of normal anatomy with composite restorative materials is also indicated, which can serve to restore full function and strength. Picture of a fractured canine tooth with pulp exposure. The amount of visible damage to the tooth is often a poor predictor of whether or not the pulp has been compromised.
Some large fractures may result in no pulp pathology and some small fractures result in pulp necrosis that lead to an abscess. Fractured and worn teeth require careful clinical and radiographic evaluation to determine what treatment, if any, is indicated. Bonded sealants or composite restoration of a tooth does not ensure that the tooth will not abscess!
Follow-up radiographs should be obtained in 6-12 months and periodically thereafter to verify that treated teeth remain healthy. Do:.
Radiograph all fractured, discolored or worn teeth. Offer root canal treatment as an alternative to extraction for complicated crown fractures or uncomplicated fractures in which the tooth has become non-vital or endodontically infected. Chart and note all tooth injuries on the patient’s dental chart. Recheck all treated teeth regularly with dental radiographs. Don’t:. Assume if tooth fracture “looks minor” that no injury or infection of the pulp has occurred. Always obtain dental radiographs.
Perform bonded sealants or restorative treatment without obtaining quality dental radiographs first. Perform bonded sealants or other restorative treatment without advising recheck dental radiographs in 6 months. Perform bonded sealants on teeth with exposed pulp (complicated crown fractures). Take Home Message: Improperly diagnostics and dental restorative treatment may doom the pet to continued pain and infection because symptoms of dental pain in dogs and cats are not noted in most cases. The radiographic signs of teeth that are non-vital or endodontically infected can be very subtle or non-existent, taking years to develop in some cases. Abscessed teeth rarely swell up or have any associated drainage.
A dog with an improperly treated fractured limb will continue to limp and show obvious signs of the ineffective treatment. A dog with an improperly treated fractured tooth that is non-vital or has abscessed rarely show signs of pain.
They continue to eat, drink and play, but live with chronic subclinical pain and infection. This will be illustrated dramatically in next month’s case report.
Broken teeth are one of the most common dental problems seen. In dogs, fractured teeth commonly occur after chewing on an inappropriately hard item, after forceful trauma (such as a baseball bat or golf club accidents), or when a pet gets in a fight with another animal housemate. In puppies, broken teeth are sometimes seen when teeth are intentionally 'clipped'. In cats, fractured teeth are most often seen after hit-by-car trauma. Fractured teeth hurt and become infected.
The tooth is comprised of three main layers: the outer enamel, the middle dentin, and the inner pulp. The pulp contains living tissue made up of arteries, veins, lymphatics, connective tissues, and nerves. This is where the sensory pain receptors are located.
The pulp, when exposed, may appear pink or black (as seen above). Sensitivity occurs when teeth have enamel or dentinal damage. If the inner pulp is exposed, it is painful, and infection will develop. Even the cleanest mouth has bacteria.
Once pulp is exposed, bacteria take advantage of the opportunity and invade the tooth. With time, bacteria spread to surrounding tissues; this progression of infection can lead to tooth root abscesses, draining tracts, and weakening of the jaw bone. Depending on where the infection is located, other nearby structures could be affected - e.g.
Broken Teeth Band Wiki
Facial swelling, eye problems, chronic nasal discharge, etc. It is important to note that most pets never show overt signs of pain or discomfort. Pets tend to show more subtle signs. Animals will sometimes avoid chewing on the same side as a fractured tooth and increased plaque and calculus at the affected tooth results. Other pets may be seen pawing at their face, be reluctant to play with toys, or may stop eating hard food and treats. Flinching, drooling, vocalization, change in temperament, inattention, reduced sense of smell, or inexplicable circling to the affected side may also be seen. In people, fractured teeth are painful, yet dogs and cats are unreliable in displaying obvious signs of oral pain.
Diagnosis and Treatment Detailed examination and are required when assessing and deciding the proper treatment for fractured teeth like the one seen to the right. Fractured teeth with no pulp exposure and no radiographic changes can often be treated with a dentinal sealant and/or composite restoration. It is important to note that teeth treated with sealants or composites may still get infected, so follow up recheck radiographs are obligatory. If pulp exposure is present in a fractured tooth of a pet under 2 years of age who fractured it within the last 48 hours, could be considered. If pulp exposure is present in a fractured tooth, root canal therapy or extraction should be performed as soon as possible. Is ideal because the tooth can be saved and no extensive surgery is necessary.
Puppy Has Broken Teeth In Dogs
It must be assumed that these fractured teeth are painful, even if the pet is not showing obvious signs. Infection can spread at any time. When a fractured tooth with pulp exposure is noted, treatment should be performed as soon as possible.
Puppy Has Broken Teeth
A watch and see approach is never advised. If the tooth that is fractured is a deciduous (baby) tooth, it should be as soon as possible with extreme care to avoid damage to the developing adult tooth. Waiting for the damaged deciduous tooth to exfoliate on its own is risky because infection could spread to the unerupted developing adult tooth. Prevention To help prevent tooth fracture, the chewing of safe items should be encouraged and the following items should be avoided:. Natural Bones. Nylon Bones.
Cow Hooves. Ice Cubes. Sticks. Cages (if your pet chews on them). Rocks. Other hard treats or toys Finally, the purposeful 'clipping' of teeth should be avoided as this process causes pain and can contribute to infection or damage to the unerupted, developing adult teeth.