Clinical Suite: Fixing the Fractured Tooth

Figure 1 (above) Typical appearance of a complicated crown fracture in the maxillary left 4th premolar

Fractured teeth (Figure 1) are common in dogs and cats^1,2 and may be a result of trauma or may be identified by a client who notices that a pet’s tooth suddenly looks different. In some cases, the patient may have difficulty eating or acutely develop facial swelling (Figure 2). It is critical that treatment be recommended for all fractured teeth (vs a watch-and-wait approach); many patients still eat and drink despite a fractured tooth, and because an abscess may not be obvious, periapical pathology can only be evaluated via dental radiographs (Figure 3). Facial swelling and draining tracts signal an abscessed tooth’s end stage, in which infection and discomfort have likely been present but were not clinically apparent.² Uncomplicated crown fractures with no pulp exposure should also be evaluated with radiographs; if there is no periapical pathology, dental sealants can protect exposed dentin tubules and prevent contamination and eventual pulp involvement.

Related Article: Cracking the Myths of Fractured Teeth

Related Article: Fractured Tooth Treatment at a Glance

• Treatment choice depends on fracture type, tooth maturity, chronicity, and client desire to preserve the tooth.
• Exodontic therapy involves fractured tooth removal via surgical extraction. Exodontics may be more appropriate if the tooth is a poor candidate for preservation or if the client cannot adhere to home-dental-care guidelines.
• Endodontic therapy pursues tooth preservation with vital pulp therapy or root canal therapy via referral to a dental specialist. Endodontic procedures require regular follow-up evaluation with dental radiographs and appropriate home dental care by the client. Although not required, crowns can be placed to further protect the tooth (a good option for working dogs or dogs with anxiety).

Related Article: Fractured Tooth: Team Workflow

• When a young patient (<12 months of age) acutely fractures a tooth, time is of the essence. At this age, the permanent teeth are usually not fully formed; the walls of the tooth are very thin, and the apex of the root is not closed (Figure 4).
• If untreated, any fracture or trauma can cause an immature tooth to become nonvital; if nonvital, these teeth should be extracted because of lack of function or predisposition to further fractures.
• To preserve immature teeth, treatment by vital pulp therapy (Figure 5) should be pursued within 48 hours of the tooth fracture.^3,4