Why do we need to closely examine any fractured tooth?

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
1. Clarke DE (1995). Endodontics of dogs and cats: an alternative to extraction. Aus Vet J 72(10): 383–389.
2. de Paula-Silva FW, Santamaria M Jr, Leonardo MR, Consolaro A, da Silva LA (2009). Cone-beam computerized tomographic, radiographic, and histologic evaluation of periapical repair in dog`s post-endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 108(5): 769–805.
3. DuPont G (2010) Pathologies of the dental hard tissues. In: Small animal dental, oral & maxillofacial disease. BA Niemiec, Ed., CRC Press, Taylor & Francis Group, Boca Raton, pp. 127–157.
4. Fiani N, Arzi B (2010). Diagnostic imaging in veterinary dental practice. Endodontic disease. J Am Vet Med Assoc 236(1): 41–43.
5. Girard N, Southerden P, Hennet P (2006). Root canal treatment in dogs and cats. J Vet Dent 23(3):148-160.
6. Hale FA (2001). Localized intrinsic staining of teeth due to pulpitis and pulp necrosis in dogs. J Vet Dent 18(1): 14–20.
7. Harran-Ponce E, Holland R, Barreiro-Lois A, Lopez-Beceiro AM, Pereira-Espinel JL. Consequences of crown fractures with pulpal exposure: histopathological evaluation in dogs. Dent Traumatol 2002; 18(4): 196-205.
8. Kovačević M, Tamarut T, Jonjić N, Braut A, Kovačević M (2008). The transition from pulpitis to periapical periodontitis in dogs’ teeth. Aus Endod J 34(1): 12–18.
9. Kuntsi-Vaattovaara H, Verstraete FJ, Kass PH (2002). Results of root canal treatment in dogs: 127 cases (1995-2000). J Am Vet Med Assoc 220(6):775-780.
10. Lewis JR (2013).Therapeutic decision making and planning in veterinary dentistry and oral surgery. Vet Clin North Am Small Anim Pract 43(3):471-487.
11. Lin LM, Di Fiore PM, Lin J, Rosenberg PA (2006). Histological study of periradicular tissue responses to uninfected and infected devitalized pulps in dogs. J Endod 32(1):34-38.
12. Mathews K, Kronen PW, Lascelles D, et al.(2014). Guidelines for recognition, assessment and treatment of pain. J Small Anim Pract 55(6): 5–13.
13. Moradi S, Bidar M, Zarrabi MH, Talati A (2009). Dental pulp reaction to exposure at different time intervals in open apex canine teeth of cats. Iran Endod J 4(2):49-52.
14. Park K, et al. (2014). Determining the age of cats by pulp cavity/tooth width ratio using dental radiography. J Vet Sci 15(4):557-561.
15. Soukup JW, Hetzel S, Paul A (2015). Classification and epidemiology of traumatic dentoalveolar injuries in dogs and cats: 959 injuries in 660 patient visits (2004-2012). J Vet Dent 32(1): 6-14.
16. Soukup JW, Hetzel S, Paul A. Classification and epidemiology of traumatic dentoalveolar injuries in dogs and cats: 959 injuries in 660 patient visits (2004-2012). J Vet Dent 2015; 32(1): 6-14.
17. Soukup JW, Mulherin BL, Snyder CJ (2013). Prevalence and nature of dentoalveolar injuries among patients with maxillofacial fractures. J Small Anim Pract 54(1): 9–14.
18. Srečnik Š et al. (2016). Microbiological aspects of naturally occurring primary endodontic infections in dogs. Accepted manuscript J Vet Dent.