Near Pulp Exposure

Fractures occur relatively frequently in our pets. Fractures may be superficial and involve only the enamel. Other fractures will involve the dentin only or exposure the pulp.

When a fracture occurs within 1-2 mm of the pulp it is referred to as a near pulpal exposure. It is visible as a light pink discoloration of the tooth as seen in top photo. An explorer is used to confirm that the pulp is not exposed. The explorer tip will not enter the tooth. The thin layer of dentin that is still covering the pulp is a hard substrate and will feel rough but uniform.

This is a painful condition initially. The dentin is a porous tissue that is sensitive to temperature and pressure changes. Bacteria in the oral cavity or irritants may cause a pulpal infection or inflammation. Without treatment many of these teeth will become non- vital and require root canal therapy or extraction.

Therapy for any tooth fracture requires radiographic evaluation of the tooth and its root structure. A tooth with a near pulp exposure should have an indirect pulp cap procedure.

The tooth is initially cleaned and polished with a non-fluoride pumice. A layer of calcium hydroxide is initially placed over the pink area, and allowed to set. This will serve to protect the sensitive pulp, and allow placement of a hard resilient composite restoration . Next an acid is used to prepare the surface of the tooth for a bonding agent. The bonding agent will serve as a strong foundation to which a durable composite restoration is placed. The restoration is durable but in time will wear due to the shearing forces applied in our canine patients.

Our goal is to seal and protect the pulp from infection and allow the body to produce repairative dentin layer on the inside of the tooth over the next few months to years.

Follow up therapy requires sedation and radiographs in one year.