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The Ugly Truth About Fractured Teeth

Posted 04.13.16 by Emily Lindsey

Are Fractured Teeth Really a Big Deal?

The short answer is: Yes! All fractured teeth run the risk of becoming non-vital (or dead) and infected. Though some tiny, very superficial fractures may never cause a problem, it is always best to have fractured teeth checked by a vet. Any disturbance to the enamel has the potential to cause a bigger problem.

Won’t I Know if My Dog Has a Bad Tooth?

The short answer, this time, is: No! Many pets are talented at hiding pain and discomfort. I have seen pets with severely fractured teeth and badly infected root abscesses acting like they didn’t have a care in the world.

One of my favorite bits of ‘veterinary crystal ball reading’ involves looking at an appointment on the schedule for “insect bite, swollen side of face,” and saying to an assistant, “It sound’s like a tooth abscess is coming in!” Once the problem is dealt with (more on that later!), owners often report that their pet is “acting like a puppy/kitten again!” a few days later. In other words, we don’t see how the pain is affecting them until we see how happy they act without it!

What Is the Vet Looking For Inside Spot’s Mouth?

First off, worn teeth are very different from fractured ones. If the surface of a tooth is perfectly flat and glassy, it likely has been worn down. This is called dental abrasion. Labradors who chew tennis balls are notorious for this! While we never want dental damage, the nice thing about this kind is that it happens very gradually so the tooth has a chance to adapt and defend itself from the inside out.

Discolored teeth, teeth that have a rough spot in the fracture center, or teeth that have a hole right down the middle of the pulp canal – these are cause for greater concern. The only real way to evaluate these teeth fully involves anesthesia with a full oral exam and dental x-rays. Severe cases (like that swollen face appointment I mentioned) need to be treated right off the bat even before anesthesia is scheduled.

How Do You Treat a Fractured Tooth?

This depends on the extent of the damage, the presence or absence of infection, which tooth is involved, and also, on cost. The most straightforward, permanent, and cost-effective way to deal with a fractured tooth is often to extract, or pull, it. Depending on the tooth, this may take a few minutes or up to an hour.

Not all teeth are created equal as far as function is concerned. Many dog and cat teeth are small and of minimal functional importance.  A few teeth, the ones I deem “the big important teeth,” get a little more consideration. The canines, or fang teeth, fall into this category, and so do the large molars and premolars in the back of the mouth. For these “big important teeth,” the option of endodontic treatment (like root canals) and/ or crown placement exists. Your veterinarian can refer you to a veterinary dentist for these services. Some teeth, however, are too far damaged to be candidates for such treatment.

Here are some fun examples:

Mao was a beautiful two-year-old tuxedo cat with wonderful owners. She was in for her regular annual exam when I noticed a broken upper right canine tooth. About half of the visible portion of the tooth, called the crown, was missing. There was also a central brown spot on the stump of the tooth. The gums looked normal. When I inquired about Mao’s eating, playing, and grooming habits, her owner responded that everything seemed fine. Mao was acting like a perfectly normal, crazy young cat. I explained to Mao’s mom that fractured teeth may seem okay, but often they are trouble waiting to happen. Mom agreed to treat Mao’s tooth, and thank goodness she did!

When we took x-rays, this is what we found:fractured teeth in catcat fractured teeth

First we saw the normal, left canine tooth. Its long, skinny root extended well into the bone of the skull. The picture of the right, fractured tooth told a different story. Where was the top of the root?

Most of that tooth root had been eaten away by infection! When I removed the tooth, the socket was full of puss, some of which began coming out of her nostril on that side.

The infection had dissolved the tissue between the tooth root and the nasal passages. This is called an oronasal fistula. By removing the tooth, treating with antibiotics, and closing the gums with stitches, we fixed the problem.

Another example of a badly fractured tooth involves Sam, a super sweet 8-year-old whippet. Sam had damaged the most commonly broken tooth in the doggy mouth: upper premolar four. This bad boy is the biggest tooth in the head. It has three roots, and it takes the majority of the force when dogs chew on things like toys, sticks, or bones. Because of that, a large piece of the tooth can sheer off completely or partially. I couldn’t tell how badly the tooth was damaged until Sam was under anesthesia, and we scaled off all the tartar. This is what we found:

fractured teeth dog

The tooth is fractured well into the pulp cavity, which contains the nerves and blood supply. A large piece is missing, and another large piece, being lifted here with an instrument, is no longer attached to the rest of the tooth. Undoubtedly this tooth was causing Sam some significant discomfort.

fractured teeth tph

Here is the after picture while I was in the midst of sewing the gums closed. (Side note, black gums are normal, not a sign of devitalized tissue or infection). A couple more stitches and Sam would be on the way to healing. After a couple of weeks, the stitches dissolve, and Sam just has a patch of smooth gums where the tooth had been to show for it —and a whole lot less discomfort!

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