Why do teeth break and fracture?
It should come as no surprise that, just like us, dogs and cats can fracture or break their teeth. In fact, when you think about all the crazy things some animals chew, it is surprising they don’t fracture their teeth more often. You may already know that pets can break their teeth when chewing on hard objects such as crates, bones, rocks or metal, but not everyone realizes many dogs fracture their teeth when chewing on hard treats like cattle hooves. In addition, any facial trauma, for example, a fall or being hit by a car can fracture teeth.
Signs your pet may have a fractured tooth
- Reacting or flinching when the mouth or tooth is touched
- Trouble eating
- Abnormal chewing (like chewing only on one side of the mouth)
- Refusing to eat hard food or hard treats
- Bloody saliva
- Facial swelling
- Unusually irritable temperament
It is important to realize that while these are some of the most common signs and symptoms seen in animals with fractured teeth, often there are no signs at all. Even though an animal may have a painful tooth fracture, they may hide the pain and continue to eat normally.
Diagnosing a tooth fracture
If your pet breaks a tooth, the best thing to do is take him to your veterinarian as soon as possible. Your veterinarian will do a complete examination to determine the severity and extent of damage sustained by the affected tooth. Your vet will determine if the fracture involves the pulp cavity (the center of the tooth containing living cells and the nerve) or the tooth roots. She will likely recommend oral x-rays (radiographs) to check the tooth below the gum line and see if the pulp cavity is affected.
Treatment of a tooth fracture
Treatment depends on the extent of the damage and which part of the tooth is involved. Not all broken teeth require treatment. Ultimately, whether treatment is needed or not depends on which part of the tooth is damaged. When the pulp cavity is not affected your veterinarian may need to merely file the rough or sharp edges of the chipped tooth down or, if it is not sharp, they may recommend just monitoring the tooth.
More complicated tooth fractures involving the pulp cavity require endodontic treatment; this involves a root canal or extraction. Root canals save the tooth and are less invasive and traumatic than extractions. Doing nothing is not a viable option as this type of tooth fracture can be quite painful and lead to complications. After all, if you broke your tooth you would immediately see your dentist for treatment; a fractured tooth is very painful. Well, the same holds true for your pet. Ultimately, the goal of treatment is to maintain a vital tooth and—at a minimum—alleviate pain and prevent infection and other complications.
Complications of a tooth fracture
Left untreated, complicated tooth fractures can lead to a number of different problems. Tooth fractures involving the pulp cavity can allow bacteria present in the mouth to get into the pulp canal and lead to an infection or abscess. This in turn can lead to infections around the tooth root (periapical tooth infections), bone loss, the development of an abnormal connection between the oral cavity and nasal cavity (oronasal fistula), chronic sinus infections, or mandibular fractures if the lower teeth are involved.
If you think your pet has a broken, chipped or damaged tooth, be sure to have your veterinarian take a look at your pet’s mouth as soon as possible. Also, don’t forget to bring your pet in for regular check-ups. I have personally discovered many animals with dental problems during a routine examination. Lastly, I encourage pet owners to get into the habit of brushing their pet’s teeth and checking their pet’s mouth regularly in order to identify problems early. And of course, watch what your pet is chewing on and stay away from hard objects that may damage teeth. For more information about dental disease or caring for your pet’s teeth speak with your veterinarian.
If you have any questions or concerns, you should always visit or call your veterinarian -- they are your best resource to ensure the health and well-being of your pets.
Thursday, January 7, 2021
Broken Teeth in Dogs and Cats - pets
Broken teeth are one of the most common dental problems seen. In dogs, fractured teeth commonly occur after chewing on an inappropriately hard item, after forceful trauma (such as a baseball bat or golf club accidents), or when a pet gets in a fight with another animal housemate. In puppies, broken teeth are sometimes seen when teeth are intentionally "clipped". In cats, fractured teeth are most often seen after hit-by-car trauma.
Fractured teeth hurt and become infected. The tooth is comprised of three main layers: the outer enamel, the middle dentin, and the inner pulp. The pulp contains living tissue made up of arteries, veins, lymphatics, connective tissues, and nerves. This is where the sensory pain receptors are located. The pulp, when exposed, may appear pink or black (as seen above).
Sensitivity occurs when teeth have enamel or dentinal damage. If the inner pulp is exposed, it is painful, and infection will develop. Even the cleanest mouth has bacteria. Once pulp is exposed, bacteria take advantage of the opportunity and invade the tooth. With time, bacteria spread to surrounding tissues this progression of infection can lead to tooth root abscesses, draining tracts, and weakening of the jaw bone. Depending on where the infection is located, other nearby structures could be affected - e.g. facial swelling, eye problems, chronic nasal discharge, etc.
It is important to note that most pets never show overt signs of pain or discomfort. Pets tend to show more subtle signs. Animals will sometimes avoid chewing on the same side as a fractured tooth and increased plaque and calculus at the affected tooth results. Other pets may be seen pawing at their face, be reluctant to play with toys, or may stop eating hard food and treats. Flinching, drooling, vocalization, change in temperament, inattention, reduced sense of smell, or inexplicable circling to the affected side may also be seen. In people, fractured teeth are painful, yet dogs and cats are unreliable in displaying obvious signs of oral pain.
Diagnosis and Treatment
Detailed examination and dental radiography (x-rays) are required when assessing and deciding the proper treatment for fractured teeth like the one seen to the right.
- Fractured teeth with no pulp exposure and no radiographic changes can often be treated with a dentinal sealant and/or composite restoration. It is important to note that teeth treated with sealants or composites may still get infected, so follow up recheck radiographs are obligatory.
- If pulp exposure is present in a fractured tooth of a pet under 2 years of age who fractured it within the last 48 hours, vital pulp therapy could be considered.
- If pulp exposure is present in a fractured tooth, root canal therapy or extraction should be performed as soon as possible. Root canal therapy is ideal because the tooth can be saved and no extensive surgery is necessary. It must be assumed that these fractured teeth are painful, even if the pet is not showing obvious signs. Infection can spread at any time. When a fractured tooth with pulp exposure is noted, treatment should be performed as soon as possible. A watch and see approach is never advised.
- If the tooth that is fractured is a deciduous (baby) tooth, it should be extracted as soon as possible with extreme care to avoid damage to the developing adult tooth. Waiting for the damaged deciduous tooth to exfoliate on its own is risky because infection could spread to the unerupted developing adult tooth.
To help prevent tooth fracture, the chewing of safe items should be encouraged and the following items should be avoided:
- Natural Bones
- Nylon Bones
- Cow Hooves
- Ice Cubes
- Cages (if your pet chews on them)
- Other hard treats or toys
Finally, the purposeful "clipping" of teeth should be avoided as this process causes pain and can contribute to infection or damage to the unerupted, developing adult teeth.
Do’s & Don’ts of Treating Dog Tooth Fractures
Bonded sealants should not be performed in complicated crown fractures or teeth with near exposure of the pulp, as you will trap bacteria inside the tooth, leading to endodontic infection and death of the tooth. If a tooth with an uncomplicated crown fracture is found to be non-vital or infected inside, then it should be treated with r
Figure 4. Picture of a fractured canine tooth with pulp exposure.
oot canal therapy or extraction. You can never tell what treatment is appropriate unless you utilize dental radiographs. In many cases, restoration of normal anatomy with composite restorative materials is also indicated, which can serve to restore full function and strength.
The amount of visible damage to the tooth is often a poor predictor of whether or not the pulp has been compromised. Some large fractures may result in no pulp pathology and some small fractures result in pulp necrosis that lead to an abscess. Fractured and worn teeth require careful clinical and radiographic evaluation to determine what treatment, if any, is indicated. Bonded sealants or composite restoration of a tooth does not ensure that the tooth will not abscess! Follow-up radiographs should be obtained in 6-12 months and periodically thereafter to verify that treated teeth remain healthy.
- Radiograph all fractured, discolored or worn teeth.
- Offer root canal treatment as an alternative to extraction for complicated crown fractures or uncomplicated fractures in which the tooth has become non-vital or endodontically infected.
- Chart and note all tooth injuries on the patient’s dental chart.
- Recheck all treated teeth regularly with dental radiographs.
- Assume if tooth fracture “looks minor” that no injury or infection of the pulp has occurred. Always obtain dental radiographs.
- Perform bonded sealants or restorative treatment without obtaining quality dental radiographs first.
- Perform bonded sealants or other restorative treatment without advising recheck dental radiographs in 6 months.
- Perform bonded sealants on teeth with exposed pulp (complicated crown fractures).
Take-Home Message: Improper diagnostics and dental restorative treatment may doom the pet to continued pain and infection because symptoms of dental pain in dogs and cats are not noted in most cases. The radiographic signs of teeth that are non-vital or endodontically infected can be very subtle or non-existent, taking years to develop in some cases. Abscessed teeth rarely swell up or have any associated drainage.
A dog with an improperly treated fractured limb will continue to limp and show obvious signs of the ineffective treatment. A dog with an improperly treated fractured tooth that is non-vital or has abscessed rarely show signs of pain. They continue to eat, drink and play, but live with chronic subclinical pain and infection. This will be illustrated dramatically in next month’s case report.
Facts Every Pet Owner Should Know About Fractured Teeth
Did you know your pet can fracture their teeth? Dental health plays an essential role in your companion’s overall well-being, and a fractured tooth could lead to a variety of problems. Here are four facts you should know about fractured teeth in pets.
#1: Pets can break their teeth in a variety of ways
Dogs most often damage their large upper premolar, or carnassial tooth, as well as their back molars when they chew on objects that are too hard. Dogs can also fracture teeth if they chew on wire kennels or experience blunt trauma, including getting hit by a car or simply attempting to catch a frisbee or fetch a stick.
Cats suffering from feline odontoclastic resorptive lesions (FORLs) have damaged, weak teeth that are more susceptible to fracture. Trauma can also cause a cat to break teeth when she jumps down from a high object and her front legs absorb the shock from the landing, causing her head to lower and hit the ground.
#2: A swollen lump under your pet’s eye may indicate a fractured tooth
While pets may show signs of pain when the tooth breaks, there are other signs pet owners may notice:
- Diminished appetite
- Chewing on one side of the mouth
- Having a swollen lump under the eye, which can indicate an oral abscess
#3: Treatment for a pet’s fractured tooth will depend on the type of fracture and the animal’s age
If your pet fractures a tooth, we’ll obtain X-rays to determine how far the break extends down the tooth and whether the roots or jawbone are affected. Depending on the severity of the fracture and your pet’s age, treatment may include:
- Resin bonding
- Root canal
- Vital pulpotomy therapy with pulp capping
#4: Most fractured teeth can be prevented
Other than the fractures caused by FORLs in cats, most tooth fractures in pets can be prevented by:
- Avoiding toys and treats that are too hard for you to bend, like animal antlers, bones, and even synthetic bones
- Ensuring your pet has a veterinary oral exam at least once per year
- Limiting games of fetch with hard items
Think your pet might have a fractured tooth? Call our office.
What if my dog or cat has a broken tooth?
If you can see that your pet's tooth is actively bleeding, this means that the pulp has been exposed. The pulp is where the blood supply and nerves are located, making is a painful condition, but depending on the individual pet they may or may not show signs of being bothered by this.
If you notice a distinct black dot on the crown of a fractured tooth it may have been pulp exposed in the past and now the pulp could be dead.
Taking a wait and see approach to pulp exposed pet teeth is not recommended. It could mean that your pet is dealing with a chronic infection and painful condition and you are sometimes unaware, as pets do not tend to stop eating or show obvious signs of a problem until the problem become quite serious. Pets usually have quite a strong food drive and do not want to show signs of illness, so do not be mistaken into thinking your pet has no pain from the fracture. Your pet feels a similar level of pain to what you would if your tooth was broken and exposed, so it is important to seek immediate treatment for them.
If you see the break actually happen or know when the break occurred a vital pulp therapy may be an option to treat the tooth, but there is a very short window for this treatment to be effective, so you should immediately contact a veterinary dentist.
Root canal therapies or extractions are the two treatment options for teeth with old fractures and pulp exposure. Once the pulp is exposed it is a matter of time before the tooth will become infected, then the tooth will die and eventually a painful abscess with develop around the root.