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Dental fracture
Introduction
- Fracture of tooth may expose pulp which can become inflammed and infected leading to pain and likely eventual periapical abscessation.
- Cause: traumatic.
- Signs: painful (variable expression).
- Treatment: endodontics, 'root canal therapy' (to save tooth), extraction.
Presenting signs
Signs are often subtle and commonly evident only retrospectively after treatment!
- Mouth pain - variable and may not be expressed.
- Behavior change (aggressive, less interactive).
- Sleeping pattern change (may be increase or decrease, possible lethargy).
- Hypersalivation.
- Facial swelling.
- Difficulty/altered pattern of eating.
Acute presentation
- Bleeding from mouth.
- Oral pain.
Age predisposition
- Younger animals have thin tooth wall thus likely raised risk.
Public health considerations
- Avoid touching the area re potential pain and resultant aggression.
Cost considerations
- Extractions usually cheaper BUT possible complications may alter this (root remnants, jaw fracture).
- Endodontics (root canal therapy) - also requires post-operative radiographic monitoring.
Special risks
- Lower (mandibular) canine extraction Dental extraction : jaw fracture Jaw: fracture.
- Upper (maxillary) canine extraction: iatrogenic oronasal fistula (ONF) formation Oronasal fistula .
- Root fragment retention Dental trauma: root fracture.
- Endodontics is a referral discipline.
- Damage to adjacent dentition (especially in young animals - permanent dentition).
Pathogenesis
Etiology
- Trauma, eg jumping, fights, RTA.
- Trauma when eating/chewing, eg bones.
- Trauma to weakened crowns, eg secondary to 'FORLS' (feline odontoclastic resorptive lesions/'neck' lesions) Odontoclastic tooth resorption (resorptive lesions).
Predisposing factors
General
- Young animals (immature dentition).
- Playing/roaming habits.
- Diet.
- FORLs Odontoclastic tooth resorption (resorptive lesions).
Specific
- RTA.
- Cage biting.
- Chewing hard objects (including bones).
- Fights.
- High-rise injury.
- FORLs.
Pathophysiology
- Exposure of pulp due to fracture → inflammation and infection of pulp ('pulpitis') → necrosis of pulp → periapical pathology (abscessation/granulation tissue/cyst). Tooth discoloration Dental trauma: tooth discoloration, from pulp necrosis, may occur.
- Pulp may still become inflammed (with potential pathology as above) even if not fully exposed as thin dentine is poorly protective.
Timecourse
- Immediate onset re discomfort and pulp compromise.
- Weeks to years re periapical pathology.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Bennett J W, Kapatkin A S, Marretta S M (1994) Dental composite for the fixation of mandibular fractures and luxations in 11 cats and 6 dogs. Vet Surg 23 (3), 190-194 PubMed.
- Davidson J R & Bauer M S (1992) Fractures of the mandible and maxilla. Vet Clin North Am Small Anim Pract 22 (1), 109-119 PubMed.
Other sources of information
- BSAVA Manual of Small Animal Dentistry. Crossley & Penman, BSAVA.
- Veterinary Dentistry for the General Practitioner. (2004) Gorrel C, Saunders.