Managing fractured and worn teeth (Proceedings) - Veterinary Healthcare


Managing fractured and worn teeth (Proceedings)


A variety of dental lesions can occur as a result of chronic wear or acute trauma including severe dental attrition, fractured teeth, subluxated teeth, avulsed teeth and jaw fractures. The management of these lesions and injuries can be a diagnostic and therapeutic challenge. Proper management of these lesions and injuries can be a rewarding part of veterinary practice.

Dental Wear

Dental wear can be divided into two categories, attrition and abrasion. Dental attrition is the gradual and regular loss of tooth substance resulting from normal mastication. Excessive wear caused by malocclusion resulting in tooth-to-tooth contact is called pathologic attrition. Dental abrasion is the mechanical wear of teeth caused by mechanical wear other than by normal mastication or tooth-to-tooth contact such as wear caused by chewing rocks, cage bars, or wire. In cases of dental attrition the pulp responds to rapid wear by laying down tertiary or reparative dentin, which is visible as a dark brown spot on the affected tooth. The dark brown spot is solid and cannot be entered with a dental explorer. No therapy is usually required in these cases. Occasionally, very rapid dental attrition can result in pulpal exposure. These cases require endodontic therapy or extraction.

Cage-biter syndrome, a form of dental abrasion, can be seen in dogs who chronically chew on their cage bars. The unique pattern of dental wear associated with cage-biter syndrome includes dental wear on the distal aspect of the canine teeth. Dogs affected by severe wear on the distal aspect of their canine teeth may be affected with dentinal hypersensitivity, endodontic disease, and crown weakening resulting in dental fractures. Dental radiographs should be taken of teeth affected with cage-biter syndrome to help rule out the presence of endodontic disease. If endodontic disease is present affected teeth should be endodontically treated or extracted. Full or three-quarter prosthetic crowns can be placed on teeth affected with cage-biter syndrome. A three-quarter prosthetic crown is preferred in teeth that are not endodontically treated so that if endodontic treatment is required at a later date the ideal access site can be easily created without damaging the prosthetic crown.

Fractured Teeth

Fractured teeth usually result from external trauma. In cats, the tooth most frequently fractured because of trauma is the canine tooth. Fractured canine teeth in cats often result in pulpal exposure because of the extension of the pulp canal into the coronal tip of the canine tooth in felines. Pulpal exposure is confirmed if a fine dental explorer penetrates into the canal. The teeth most frequently fractured in the dog are the canine teeth, incisors, and the maxillary fourth premolars, however, any tooth may be fractured. Following pulpal exposure the following sequence of events may occur:

• Pulpal exposure → Bacterial pulpitis → Pulp necrosis → Apical granuloma → Periapical abscess → Acute alveolar periodontitis → Osteomyelitis → Sepsis

Radiographic evidence of chronic endodontic disease or pulpal necrosis include:

• Periapical lysis

• Apical lysis

• Large asymmetrical endodontic systems when compared to contralateral teeth

• Radiographic loss of tooth structure to the pulp chamber

• Secondary destruction of periodontal structures

• Gutta-percha point placed in draining tract pointing to apex of affected tooth

Fractured teeth should be endodontically treated or extracted. In cases of endodontically treated posterior teeth such as the upper fourth premolar or the lower first molar recommendations should be made to place a full crown on the treated tooth to help prevent refracturing of the tooth since nonvital teeth are more brittle than vital teeth and posterior teeth sustain tremendous amounts of force during mastication.

Several different endodontic procedures may be utilized to treat endodontically diseased teeth these techniques include: vital pulpotomy, conventional and surgical endodontic therapy. Whenever pulp disease is present it is important to decide which type of endodontic therapy is most appropriate based on the patient's age, time of exposure, and the gross anatomic features and vitality of the tooth. The most common and most successful type of endodontic therapy is conventional or nonsurgical endodontic therapy. Occasionally vital pulpotomy with direct pulp capping is recommended and rarely surgical or nonconventional root canal therapy is indicated.


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