Tooth Fractures 101

Our pet's teeth are subject to fracture or trauma in daily play and forceful chewing. When the crown (visible part) of the tooth is fractured or worn down the pulp may become exposed to bacteria. The result is tooth death and infection extending to the apex (root tip).

The diagnosis can be made based on visible loss of tooth structure, abnormal crown shape, asymmetrical tartar, or red-black dot on the tooth. The canine teeth and upper 4th premolars are the most commonly fractured teeth. Let's review our tooth anatomy.

1. Fractures involving the enamel only should receive an X-ray to evaluate the root and have sharp enamel margins smoothed. X-rays should be repeated in 12 months to assess if the severity of the trauma could cause tooth death.

2. Fractures involving the enamel and dentin should have the same evaluation. Exposed dentin is painful, porous, and offers bacteria a route to the pulp. Thus the exposed dentin should be sealed with a restorative. In time the restoration will wear but with treatment the tooth will have time to mature and dentin tubules will seal internally.

3. Fractures involving the enamel, dentin and pulp require one of these treatments: Root canal, Extraction, Pulp caping. Let's Wait & See is not an option.

Root canal procedure allows the pet to retain the use of the tooth. It involves removing the diseased pulp tissue to remove the pain or infection.

We recommend it for the ten functionally important teeth: Canine teeth, upper 3rd incisors, & 4 carnassial teeth. Canine teeth grasp objects, lower canine teeth position the tongue and their roots comprise a large portion of the rostral mandible. Carnassial teeth (upper PM4 and lower M1) are important for chewing.

Extraction is an option for non-essential teeth and pets with poor periodontal health. Most extractions require a surgical (flap) approach and suturing of the gums with an absorbable suture. Intra-oral radiographs are helpful to evaluate for root fractures and the periodontal health of adjacent teeth. Extractions offer "one procedure" when client's commitment to oral health is not ideal.

Pulp capping or vital pulpotomy is a procedure that maintains tooth viability and allows root maturation. Consider the pet's age. In most instances this procedure is reserved for pets with immature teeth (< 18 mo). These teeth have an open root apex, maybe erupting, and maturing. Pulp capping cleans and seals the top 5-6 mm of the crown from bacteria and should be done within 48 hours of the fracture.