Fractured Teeth

There are only two options for an abscessed tooth or a fractured tooth with pulpal exposure: extraction or root canal treatment to save the function of the tooth. In the past, I could recommend that teeth treated within the first 24-48 hours could be saved with vital pulp therapy or pulp capping rather than root canal. However, presentations at the Veterinary Dental Forum in November 1998 showed that traumatically fractured teeth have a low success rate with pulp capping or vital pulp therapy alone (rather than root canal therapy). Therefore, we recommend that all traumatically fractured teeth be treated with root canal therapy (or extraction) rather than vital pulp therapy.

A swelling under the eye is almost always an indication of an abscessed upper carnassial tooth (upper 4th premolar). Dental X-rays will diagnose the abscess by showing bone loss at the apex (or apices) of the roots. An abscessed upper 1st or 2nd molar can also cause swellings under the eye. And an abscessed upper 1st, 2nd or 3rd premolar may cause swelling of the muzzle. Antibiotics will temporarily relieve the symptoms, but the tooth needs extraction or root canal to treat it definitively.

Abscessed upper canine teeth may present as swellings of the side of the muzzle; lower canine teeth may present with draining fistulae of the chin near the distal symphysis. This may take years since the mandibular bone is so dense. In the meantime, the animal is suffering pain and infection. Often a stoic animal may not show outward signs of oral pain but will show dramatic signs of improvement once the tooth is treated.

Fistulae of the buccal mucosa apical to the muco-gingival line suggest endodontal disease; fistulae coronal to the muco-gingival line suggest periodontal disease. Fistulae at the muco-gingival line suggest both endodontal and periodontal involvement. However, these outward signs occur only with a long-standing or chronic infection. The observant veterinarian will know treatment is necessary when pulpal exposure is evident.

The 5 most common causes of fractured teeth in dogs are bones (any kind of natural bone), cow hooves, rocks, hard nylon chew toys, and ice cubes. Please educate your clients! Rubber toys, edible toys, and rawhide are usually fine for the teeth. In general, all chew toys should be resilient. Pet owners should either be able to bend the toy with their hands or depress it with a thumbnail.