Fractured teeth are a common injury for animals. They can occur secondary to trauma, but most broken teeth result from chewing on hard objects or toys. Things such as Nylabones, bully sticks, hooves, and bones can be very damaging to dental tissue. When a tooth breaks, it needs treatment immediately. Even if the pulp is not overtly exposed, the tissue underneath the enamel, which is called dentin, will be exposed, and since there are nerves in this tissue, the tooth is painful and the pulp can easily become infected.
When the pulp is exposed, however, the pain is more intense. Surprisingly, most pets will show absolutely no signs of this discomfort, even though live nerves are exposed. Left untreated, the pulp becomes infected, which causes more pain, and eventually the tooth will abscess. At this point, the bone around the tooth can also become involved, and aside from additional pain, the bone can be destroyed. A fresh fracture(less than 48 hours old) can be treated with vital pulp therapy, which allows us to keep the tooth alive and allow it to continue developing. Beyond this time frame, however, root canal therapy will be indicated. While this type of treatment will leave a non-vital tooth, it does allow the pet to keep the tooth, which aids function and cosmetics.
Root Canal Treatment
For broken teeth with pulp exposure, root canal therapy is a viable alternative to extraction. This helps to preserve function of the tooth in addition to the cosmetic appearance and occlusion. Most often, the canine and carnassial teeth are treated, but any non-vital or fractured tooth can potentially be salvaged. Crowns are sometimes placed on these endodontically treated teeth, but are generally reserved for working dogs.
Vital Pulp Cap Therapy
Freshly fractured teeth are a true dental emergency, as they can be salvaged without the need for root canal therapy. A less invasive procedure known as a pulp cap can be performed if the fracture is less than 48 hours old. It involves removing only a portion of the pulp and then layering different restorative materials over the fracture. This allows the tooth to remain alive and continue to develop.
This is a procedure that can be performed on broken immature teeth that have not yet developed to the point where root canal therapy is possible. The purpose of apexification is to treat the teeth endodontically in order to aid the development to the point where root canal therapy is a viable option. In most cases, this type of therapy is done in dogs less than 10 months of age who have broken one of their permanent teeth.
Surgical Root Canal Treatment
Even severely abscessed teeth can sometimes be salvaged with this procedure, which is reserved for those teeth that have some degree to root resorption apparent on dental radiographs. This is usually secondary to chronic pulp exposure and infection/inflammation within the tooth.