Treatment Plan for a Fractured Tooth Depends on Timeline of Fracture

When a veterinarian or pet owner calls regarding treating a fractured tooth with pulp exposure, the first question to be asked is ‘when do you think this happened?’.  The timeline of a tooth fracture is ESSENTIAL in establishing a treatment plan.  If a tooth fracture occurs within a 48 hr. window, a VITAL PULPOTOMY can be performed to save the tooth.  This procedure allows the tooth to continue internal maturation (laying down more dentin while the pulp cavity gets narrower).  Success rate of a vital pulpotomy within 48 hrs is over 90%.    Recheck dental radiographs are needed every 6 months for 2 years, then annually to monitor tooth maturation.

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Tooth fracture with pulp exposure within 48 hrs. of presentation

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Visible crown fracture with pulp exposure

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Always assess (x-ray) the entire tooth to make sure no root fracture or apical disease noted.

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After vital pulp therapy and restoration

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The crown height was reduced slightly to remove the oblique crown tip. This will help prevent further tooth fracture.

If the tooth is fractured greater than 48 hrs prior to exam by a dentist, the chances for tooth vitality (survival) diminishes considerably.   With many instances, standard root canal therapy (PULPECTOMY) is recommended instead of the above mentioned vital pulpotomy.   Extraction is also a treatment option but one must truly consider the wisdom of extracting a tooth that the pet can use the rest of his/her life.  That’s the beauty of a root canal therapy.

If a veterinarian is presented with a fresh tooth fracture with pulp exposure, 5 things must be done immediately (provided the client cannot see the Veterinary Dentist that day or it is later in the afternoon)

  1. Start the patient on oral antibiotics (Clindamycin or Amoxicillin/Clavulanate)
  2. Start the patient on an NSAID therapy provided the pet can tolerate the drug
  3. Prescribe an oral rinse such as Chlorhexidine 0.12% (CET Oral Hygiene Rinse) to be used on the affected tooth twice daily
  4. Draw for a pre-anesthetic panel if blood work has not been performed within a short time frame
  5. See a Veterinary Dentist immediately

Follow this protocol and you will have a very good chance to save a very important tooth.

Barden Greenfield, DVM, FAVD, DAVDC     Your Pet Dentist of Memphis, Nashville, and Little Rock

 

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