{"id":1329,"date":"2013-03-01T16:52:03","date_gmt":"2013-03-01T16:52:03","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1329"},"modified":"2022-10-06T13:43:46","modified_gmt":"2022-10-06T13:43:46","slug":"dental-diagnosis-canine-tooth-fracture","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/dentistry\/dental-diagnosis-canine-tooth-fracture\/","title":{"rendered":"Canine Tooth Fracture"},"content":{"rendered":"

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Tooth fractures are very common in dogs. The most commonly fractured teeth are the canines and carnassials (maxillary fourth premolars and mandibular first molars).<\/span><\/p>\n

Fractures are further characterized as complicated<\/em> or uncomplicated<\/em>. Complicated crown fractures have direct pulp (nerve) exposure, whereas uncomplicated crown fractures have direct dentin but no pulp exposure.<\/span>1<\/sup><\/span><\/p>\n

Both types of tooth fractures require therapy; however, treatment differs depending on the physical and radiographic appearance.<\/span><\/p>\n

QUESTION<\/b><\/span>
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Based on the clinical evidence, what type of fracture is shown in Figure 1?<\/b><\/span><\/h3>\n
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Figure 1<\/p><\/div>\n

ANSWER<\/b><\/span><\/h2>\n

This patient has an uncomplicated crown fracture,1 which is very common in large-breed dogs. These types of fractures occur when a piece of the crown is broken, exposing the dentin but not the pulp.<\/span><\/p>\n

The radiograph (Figure 2<\/b>) reveals that this tooth is nonvital and infected, both of which are evidenced by the periapical rarefaction surrounding all 3 roots (red arrows).<\/span>2<\/sup><\/span> Additional radiographic signs of endodontic disease include a wider endodontic space (or on occasion, narrower) and internal or external resorption.<\/span>2<\/sup><\/span><\/p>\n

\"Figure<\/a>

Figure 2<\/p><\/div>\n

Figures courtesy vetdentalrad.com (Importance of Dental Radiology client educational poster)<\/i><\/span><\/p>\n

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QUESTION & ANSWER<\/b><\/h2>\n

What therapeutic measures should be pursued\u2014keep an eye on the fracture, extract the tooth, or perform a restoration or root canal?<\/b><\/span><\/h3>\n

Hopefully your answer was not “keep an eye on the fracture.” Despite the fact that veterinary patients rarely show clinical signs, uncomplicated crown fractures can be very painful.<\/span>3<\/sup><\/span><\/p>\n

Role of Dentinal Tubules<\/b><\/span><\/h3>\n

Dentinal tubules surround the tooth, running from the root canal to the enamel. Each tubule contains an odontoblastic process\u2014basically a nerve supply that is limited to sensory function. There are approximately 50,000 dentinal tubules per mm2<\/sup> coronal dentin, which is about twice the number found in human teeth.<\/span>4,5<\/sup><\/span><\/p>\n

When enamel is lost, the dentin is exposed; therefore, a 1-cm area of enamel loss in a canine tooth exposes 3 to 4 million<\/em> odontoblasts. This exposure leads to quicker dentinal fluid flow out through the dentinal tubules via the capillary effect. The increase in flow deforms the A-delta fibers and C-fibers, which is perceived by the patient as pain.<\/span>3<\/sup><\/span><\/p>\n

Factors, such as heat, cold, and desiccation, change the flow rate, cause the nerves to fire, and result in pain (sensitivity).<\/span>6<\/sup><\/span> Sensitivity is actually a sign of low-grade pulp inflammation called pulpitis<\/em>.<\/span><\/p>\n

Bacterial Infiltration<\/b><\/h3>\n

Loss of enamel also allows bacteria to potentially ingress into the root canal system.<\/span>3,7<\/sup><\/span> In some cases, these bacteria can result in endodontic infection and subsequent abscessation, which can occasionally manifest clinically as a swelling or draining tract, but is generally subclinical and, therefore, undiagnosed. The only way to definitively diagnose this infection is via dental radiographs.<\/span><\/p>\n

Therapeutic Measures<\/b><\/span>1,7,8<\/sup><\/span><\/h3>\n

There are 2 options for nonvital and infected teeth: root canal therapy or extraction.<\/span><\/p>\n