Are there options for treatment other than extraction?
YES. It is often possible to save a fractured tooth with a root canal treatment (RCT). This procedure involves cleaning out the diseased pulp and filling the tooth. In some cases, particularly fracture of the lower canine (fang) teeth, it might be considered the treatment of choice. These teeth have a very large root which occupies the majority of the jaw one in this region and extraction can in some cases result in jaw fracture. A root canal treatment is a specialist procedure which requires referral to a veterinary dental specialist.
It is very common for dogs and cats to break teeth. Dogs often damage their teeth whilst chewing on hard objects, catching sticks or when playing with other dogs. Cats frequently fracture their canine (fang) teeth when they jump or fall from a height. Road traffic accidents are another common cause. As vets we are often asked if it is necessary to treat a fractured tooth. The answer is almost always YES.
How do I know if the pulp is exposed or not?
The exposed inflamed pulp can usually be seen as a red or black spot in the middle of the broken tooth. This can sometimes be very small (especially in cats) and difficult to see. Sometimes it is only possible to detect by examining and probing under a general anaesthetic.
What happens when a tooth breaks?
In most cases when a tooth is fractured the soft pulp in the middle of the tooth becomes exposed. The pulp contains blood vessels and thousands of nerve fibres. A freshly fractured tooth will therefore bleed and usually be excruciatingly painful. The pulp becomes inflamed and develops pulpitis. The tooth at this stage becomes less painful than following initial fracture however bouts of throbbing toothache and sensitivity are likely to be experienced. Pulpitis and its’ associated pain can persist for months to years.
The tooth will eventually die and bacteria within the tooth may leak out and cause an abscess at the tooth root. The pet will be in more noticeable pain if this occurs but it may take years to reach this point.
What are the signs of toothache in pet dogs and cats?
The signs can be subtle and often go unnoticed. Most pets will carry on eating and behave relatively normally. When watched carefully however some pets may be grumpy, possibly have become head shy, spend more time sleeping (cats in particular) or be avoiding harder food especially on the affected side. Following treatment owners frequently report that their pet is much happier despite not noticing an obvious change in their behaviour beforehand.
What if the pulp is not exposed?
In most instances this type of fracture is not a problem as the tooth is usually able to self-repair from within. However, bacteria can occasionally enter the tooth through tiny tubules in the exposed dentine and lead to pulpitis and the same consequences as described above. It is rarely possible to be certain if this is the case on conscious examination alone and further assessment by x-ray might need to be considered.
What is the treatment for a fractured tooth?
Extraction will usually be recommended. There is no tooth in a pet’s mouth that is essential and they are much better off without a painful infected tooth than with it. In most cases a surgical extraction will be required. This involves lifting a flap of gum and removing a small amount of bone to expose the underlying root(s). The entire tooth can then be removed with minimal risk of complication.