Dental fracture is the most common way in dogs and cats for bacteria to enter the dental pulp and cause infection (primary endodontic infection). Although defensive reaction occurs in the body (in the dental pulp and later in the periapical tissues), this cannot eliminate microbes that are well entrenched in the root canal and endodontic disease (pulp disease) develops.
Initially, extremely painful inflammation of the dental pulp (pulpitis) develops, but the infection subsequently spreads to involve the whole dental pulp with pulp death (necrosis) occurring in 2 to 3 months post dental pulp exposure in dogs and cats. Inflammation and infection also spread to involve periapical tissues (tissues around the tooth apex within the bone) resulting in so called apical periodontitis, when usually more dull, throbbing pain develops.
What do we recommend?
Detailed oral examination and dental radiographs are needed to evaluate the nature of the fracture and presence of endodontic disease – is the pulp open (complicated fracture) or not (uncomplicated fracture)? Is only the crown of the tooth involved or also the root? Are there any radiographic signs of endodontic disease present and if so, how severe? Based on the findings, we will suggest what to do.
In general, if the pulp is open, the tooth needs to be treated to remove infection and alleviate pain. Endodontic disease can be treated either by removal of the tooth (extraction) or by removal of the microbial ecosystem within the root canal (endodontic therapy). The treatment plan is made based on clinical and radiographic findings, general health of the dog and client’s request.
If the pulp is not open, we will still suggest dental radiographs. Namely, the tooth may become infected even if the pulp is not directly open, because dentinal tubules (canals within dentin that connect directly to the pulp) are large enough to allow bacteria to enter into the pulp. So, if any signs of endodontic disease are noted on radiographs, we will treat the tooth as if the pulp was open. If there are no radiographic signs of endodontic disease seen, we will recommend monitoring of the tooth with dental radiographs in 6 – 12 months as any tooth that sustained trauma may become non-vital over time. However, if we are highly suspicious of endodontic disease, but cannot confirm it with dental radiographs, we may also suggest radiographic re-check in earlier or advanced imaging, such as computed tomography (CT) or cone-beam CT (CBCT).
If you have noted any problems with your animal, please consult your veterinarian.
Selected references
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