Sunday , 20 August 2017

New Hope for Fractured Teeth

By Dr. Ed Mapes, Stonebridge Animal Hospital

Cracked and broken teeth are a common occurrence in dogs and cats. The fractures can be very superficial, not extending deeper than the enamel layer, but often extend into deeper dental tissues, including dentin and the pulp (nerve) chamber. 

These fractures are often painful and lead to bacterial gum infection that become even more troublesome. The infections deteriorate dental roots, and can spread to other body tissues through the blood stream. Fractured teeth with exposed pulp tissue cannot heal on their own, becoming a source of chronic pain, loss of appetite, and spread of infection that leads to loss of body condition. 

These teeth must receive endodontic treatment to be saved, or be extracted. More superficial fractures involving only enamel and dentin, without extending overtly into the pulp cavity, should be treated too because exposed dentin is associated with pathology from two different pathways; nerve stimulation and bacterial migration. These teeth do have the capacity to heal, by depositing a reparative dentin material that attempts to seal the tooth. This is seen as a brown color within the tooth. During this healing attempt, however, bacteria do enter the tooth and can eventually erode into the pulp cavity and doom the tooth.

Teeth that are freshly fractured with no evidence of internal infection or bony erosion can be treated with a relatively inexpensive procedure to apply bonded sealants that preserve the tooth. This treatment immediately seals exposed dentinal tubules, helps to prevent infection, decreases pain, and speeds up the healing response. These veterinary bonded sealants are similar to those placed on children’s teeth, and probably provide around 3-12 months of protection.

Figure 1 on the left illustrates a fractured canine tooth.  You can clearly see the exposed dentin and pulp; this tooth is very painful and an open conduit for infection.  The same tooth, as seen to the right, has had the roughened edges ground down to be very smooth.  Bonded sealant has been applied and air dried, leaving a tough protective layer that seals the tooth while and gives it time to heal.

                      Figure 1  fractured tooth                          Figure 2  treated and sealed tooth 

This tooth cannot heal on its own, and extraction has customarily been the recommended treatment by veterinarians. Application of bonded sealants (known as “glazing“) provides an opportunity to protect the tooth and give it more time to heal naturally. A few months after placement of bonded sealants, the tooth will have either healed itself internally or become non-vital and will require extraction or a root canal procedure. Therefore, all teeth treated with sealants should be re-radiographed in 6-12 months to ensure no pathology associated with death of the tooth or infection is developing. This treatment is generally only done once to each fracture site, and is most useful on fresh fractures. Since the age of a fracture is difficult to determine, it is wise to treat all fractures one time. Aggressive chewers that enjoy gnawing on rocks, fences, and other strange objects, are most prone to tooth fractures and can destroy the sealant in no time. Modification of this behavior is essential to long term success against broken teeth.

Construction is under way at our new Stonebridge Animal Hospital. We will soon begin moving equipment into the facility, begin training of our employees, and prepare for the grand opening in very early July. We will be able to perform advanced procedures like that discussed here to provide our patients with the best options in veterinary care.

With the zoning issues behind us, we are so happy to announce the address at last:

Stonebridge Animal Hospital
5913 Virginia Parkway
Suite 100
McKinney, Texas 75071

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