Silent dental disasters: Tooth fractures and dead teeth
Dental disease involves a wide variety of problems including periodontal disease, genetic malocclusions, cancer, fractures, concussive trauma leading to dead teeth, endodontic disease, tooth resorption and many other maladies. There is no shortage of things that can wrong in the oral cavity.
Two common conditions that we often note on an oral exam are fractured teeth and discolored teeth. These are serious dental conditions with significant impact on a pet’s quality of life. Interestingly, most pets show no signs of pain, despite the level of discomfort that is occurring. However, most owners will see a noticeable improvement in the pet’s demeanor, activity and behavior AFTER the dental condition is addressed thus providing evidence that pets do hide signs of pain in most cases of dental disease.
Fractured teeth occur due to many factors-including trauma, cage chewing, chew toy mishaps, dog fights, hit by car incidents and tooth resorption among others. They are classified as either complicated or uncomplicated. Complicated fractures involve pulp exposure (see photo to left) and are often painful and very prone to bacterial infection as the pulp chamber is exposed to the oral cavity. These teeth require either tooth extraction OR root canal therapy. Doing nothing and monitoring will lead to continued pain and infection for the pet and is not recommended. Dental radiographs are important in planning appropriate treatment in these patients.
Case #1
This patient fractured his tooth on a hard chew object. This is a typical slab fracture of the upper fourth premolar-also known as the carnassial tooth. (Figure 2). This is one of the most common fractures we see. On the x-ray, there is a crown fracture, a root fracture and pulp exposure. (Figure 3) This tooth was extracted.
Case #2
The cracked molar (complicated fracture) on the patient to the left was unnoticed by the owner as it far back in the mouth. (This was a very painful tooth that required extraction.)
Case #3
This patient fractured a number of incisors off long ago. It was noted on oral exam to be missing several incisors. On the x-ray to the right, the roots were noted to be buried below the gum line and are in need of extraction to avoid pulp necrosis and pain.
Uncomplicated fractures are fractures of the enamel of the tooth that exposes dentin but NOT the pulp chamber. These can still lead to pain and infection over time since dentin is a highly porous surface. These teeth may in some cases be protected with a dental sealant to cover those dentin tubules. All uncomplicated fractures should be monitored with regular intra-oral dental radiographs and regular oral exams to be sure they have not become a complicated fracture or developed apical (tooth root) disease, which occurs in many cases over time.
Discolored teeth occur for many reasons but the most common is due to trauma. Dogs especially can be very hard on their teeth as they are chasing balls and toys, colliding with other dogs and chewing on a wide variety of objects. Teeth that are gray, pink, beige, purple, tan or other “non-white” colors are almost always (90% of cases) non-vital, dead teeth. They should never be ignored. They are highly prone to developing disease of the pulp chamber, causing a low-grade painful problem that often goes untreated for years, since most owners think “everything is fine.” Intra-oral radiographs are very important to determine the degree of disease present and plan treatment. In most cases, extraction or root canal therapy is required.
The first premolar in the x-ray (far right tooth) has a widened pulp chamber compared to the teeth to the left of it. This is a dead tooth and was discolored on exam. This tooth died a long time ago and has left this patient in chronic undetected pain.
Dental disease is widespread in our pets and is easily missed since most pets will not show obvious signs of pain while eating, chewing or playing. Regular home care as well as routine oral exams will detect many problems, but annual comprehensive oral health assessment and treatment procedures (COHATs) and full mouth radiographs may detect additional significant disease that, when treated, will enhance your pet’s quality of life significantly.
For more information regarding treatment of fractured or discolored teeth, the following links from veterinary dentists have good information regarding these conditions:
http://www.mypetsdentist.com/site/view/113063_DiscoloredPetTeeth.pml