Apr 30, 2018
Broken or Fractured Teeth and
Treatment Options
Pets with broken or fractured teeth are an extremely
common presentation for veterinarians. We see at least one
case daily, and several weekly. The large premolar and molar
teeth are typically injured from chewing hard objects. The
canine (fang) and incisor teeth are frequently fractured from
trauma. In cats, it is particularly common to see fractured
upper canine teeth. For cats in general, the canine teeth are
most likely to fracture from facial trauma, while fractures from
chewing objects is uncommon.
Teeth are fractured from chewing hard objects (see the first
three photos below), from major trauma, and from less obvious
trauma such as, pets fighting or playing. The extent of the
fracture helps to determine a rational treatment plan. The
extent of the fracture may be obvious, with vital (live) pulp
exposure, or it may be more subtle. The non-vital (dead)
exposed pulp is often not as apparent as calculus (tartar),
which may cover up the fracture site. Additionally, the
non-vital tooth may have the pulp chamber exposed without the
bright pink or red pulp tissue visible. The extent of
a tooth fracture may only involve the outer enamel, or it may
involve deeper structures, such as the dentin or pulp (nerve and
blood supply).
It is important to establish an accurate diagnosis prior to
deciding on the best treatment for fractured teeth. Dental radiographs with
periodontal probing allow for accurate diagnosis and optimal
treatment plans.
Misconceptions and misunderstandings in veterinary
dentistry are common. Some veterinarians are unfamiliar
with modern dentistry and treatment options for teeth. Many
pets benefit by saving teeth rather than extracting every tooth
with problems. There are benefits in extracting teeth, as
well as saving them.
We feel very strongly about providing thorough dental and oral
surgery consultations. This allows for
informed decision making.
Vital (live) tooth with recent tooth fracture. This dog
refused treats. Complicated Crown Fracture.
Another pet with the same tooth fractured. Owner reports
normal
eating and drinking habits, but not playful. Complicated Crown
Fracture.
Complicated Crown Fracture.
This is a non-vital fractured tooth. It was completely
covered by calculus. The
owner insisted the pet was "pain free" and without behavior changes
until after
root canal therapy was performed. The owner was shocked to see
a dramatic improvement in behavior after treatment.
Do fractured teeth hurt?
Fractured teeth hurt!
The anatomy, physiology and nervous system of our
companion animals is incredibly similiar to our own. It is
only logical to assume animals experience pain from fractured
teeth. The degree of pain is related to the extent and
duration of the fracture. If the pulp is exposed from an
injury, such as being hit from a baseball bat or golf club, there
is immediate and excruciating pain. Many times we fail to
notice our pets have had fractured teeth.
As the tooth becomes infected through the fracture site, it may die
and become non-painful. If the infection spreads to the
alveolar bone supporting the tooth, pain often returns. The
bone and local soft tissues may become infected and eventually
abscess. The abscess may result in an intraoral swelling
(inside the mouth), or an extraoral facial swelling (outside the
mouth), and eventually become a draining tract. Swollen
faces are tremendously painful in our experience with
patients. We also notice that the pain is reduced
when the abscess "bursts" and drains. These
draining tracts may form intraorally or extraorally.
Treatment of fractured teeth eliminates the pain. Treatment
also eliminates the swellings and draining tracts that sometimes
develop.
Our experience has consistently been that pet owners are very
surprised on how dramatic the improvement in their pets' behaviors
are, abruptly after treatment has been provided. Many of
these owners did not realize how painful their pets were until
after we provided treatment.
What treatment options are available for fractured
teeth?
Option 1: Extraction
Removing teeth is one treatment option, and it is the
only option if the veterinarian does not have appropriate
equipment, instruments, training, experience and interest in
providing advanced dental care. There are times
when extraction is the best treatment
option, however there are times when extraction involves
unnecessary risks for the patient. Risks associated with
tooth extraction include: additional fractured teeth, fractured jaws, excessive bleeding and
infection. At times, an extraction procedure may
fail, and a tooth remnant is left in the alveolus, or end
up in a sinus or other vital structure. The benefit of an
extraction can be a rapid elimination of the problem.
We provide treatment options with disclosure of risks and the
anticipated prognosis. These dental consultations allow for informed
decision making for the pet owner.
Option 2: Endodontic Therapy (root
canal therapy or vital
pulpotomy therapy)
Root canal therapy and vital pulpotomy with pulp
capping, are two treatment options for fractured teeth. The
family veterinarian typically does not offer these services because
of their focus on more common needs for companion
animals. They have made decisions to invest wisely in
technology that allows them to offer optimal general care for your
pets. It is not fair to expect the family
veterinarian to invest time, effort and money in services of
lower demand. The quality of endodontic service is
compromised when the operator only gets the opportunity to
do 10 or 12 root canal treatments a year. Equipment,
training and experience makes a huge difference in providing
successful services. You can count on them to save your pet's
life, and refer your pet to us for endodontic therapy.
Endodontic procedures require: specialized training, equipment,
instrumentation and clinical case experience. Not every upper
fourth premolar tooth has the same root canal anatomy or
orientation. Not all teeth have the same number of roots or
anatomy. Young pets tend to have very wide canals. If
they are too young, root canal therapy may be
contraindicated. In those cases, vital pulp therapy may be
appropriate. With the wide variation in patients
(180# Great Dane to the 1.4# tea cup Yorkie) we see,
there is a demand for a wide assortment of equipment and
instruments. Not all endodontic procedures are performed
using the same technique or materials. The high volume of
cases we see improves our efficiency, patient safety, and the
overall success rate.