Broken or Fractured Teeth and Treatment Options
Routine visits to your veterinarian are very important, and an oral exam can identify issues such as broken teeth, oral tumors, periodontal disease, stomatitis, and other problems that pose a much more serious health risk. In fact, approximately 80% of our canine friends suffer from periodontal issues by age 5! Two Types of Dog Teeth Fractures Fractures that crack or chip the enamel exposing dentin, but do not expose the pulp canal, are termed uncomplicated fractures (Figure 1). When the enamel and dentin are broken, exposing the pulp canal, the fracture is a complicated fracture (Figure 2).
Pets with broken or fractured teeth are an extremely common presentation for veterinarians. We see at least one case daily, and several weekly. The large premolar and molar teeth are typically injured from chewing hard objects. The canine (fang) and incisor teeth are frequently fractured from trauma. In cats, it is particularly common to see fractured upper canine teeth. For cats in general, the canine teeth are most likely to fracture from facial trauma, while fractures from chewing objects is uncommon.
Teeth are fractured from chewing hard objects (see the first three photos below), from major trauma, and from less obvious trauma such as, pets fighting or playing. The extent of the fracture helps to determine a rational treatment plan. The extent of the fracture may be obvious, with vital (live) pulp exposure, or it may be more subtle. The non-vital (dead) exposed pulp is often not as apparent as calculus (tartar), which may cover up the fracture site. Additionally, the non-vital tooth may have the pulp chamber exposed without the bright pink or red pulp tissue visible. The extent of a tooth fracture may only involve the outer enamel, or it may involve deeper structures, such as the dentin or pulp (nerve and blood supply).
It is important to establish an accurate diagnosis prior to deciding on the best treatment for fractured teeth. Dental radiographs with periodontal probing allow for accurate diagnosis and optimal treatment plans.
Misconceptions and misunderstandings in veterinary dentistry are common. Some veterinarians are unfamiliar with modern dentistry and treatment options for teeth. Many pets benefit by saving teeth rather than extracting every tooth with problems. There are benefits in extracting teeth, as well as saving them.
We feel very strongly about providing thorough dental and oral surgery consultations. This allows for informed decision making.
Do fractured teeth hurt?
Fractured teeth hurt!
The anatomy, physiology and nervous system of our companion animals is incredibly similiar to our own. It is only logical to assume animals experience pain from fractured teeth. The degree of pain is related to the extent and duration of the fracture. If the pulp is exposed from an injury, such as being hit from a baseball bat or golf club, there is immediate and excruciating pain. Many times we fail to notice our pets have had fractured teeth.
As the tooth becomes infected through the fracture site, it may die and become non-painful. If the infection spreads to the alveolar bone supporting the tooth, pain often returns. The bone and local soft tissues may become infected and eventually abscess. The abscess may result in an intraoral swelling (inside the mouth), or an extraoral facial swelling (outside the mouth), and eventually become a draining tract. Swollen faces are tremendously painful in our experience with patients. We also notice that the pain is reduced when the abscess 'bursts' and drains. These draining tracts may form intraorally or extraorally.
Treatment of fractured teeth eliminates the pain. Treatment also eliminates the swellings and draining tracts that sometimes develop.
Our experience has consistently been that pet owners are very surprised on how dramatic the improvement in their pets' behaviors are, abruptly after treatment has been provided. Many of these owners did not realize how painful their pets were until after we provided treatment.
What treatment options are available for fractured teeth?
Option 1: Extraction
Removing teeth is one treatment option, and it is the only option if the veterinarian does not have appropriate equipment, instruments, training, experience and interest in providing advanced dental care. There are times when extraction is the best treatment option, however there are times when extraction involves unnecessary risks for the patient. Risks associated with tooth extraction include: additional fractured teeth, fractured jaws, excessive bleeding and infection. At times, an extraction procedure may fail, and a tooth remnant is left in the alveolus, or end up in a sinus or other vital structure. The benefit of an extraction can be a rapid elimination of the problem.
We provide treatment options with disclosure of risks and the anticipated prognosis. These dental consultations allow for informed decision making for the pet owner.
Option 2: Endodontic Therapy (root canal therapy or vital pulpotomy therapy)
Root canal therapy and vital pulpotomy with pulp capping, are two treatment options for fractured teeth. The family veterinarian typically does not offer these services because of their focus on more common needs for companion animals. They have made decisions to invest wisely in technology that allows them to offer optimal general care for your pets. It is not fair to expect the family veterinarian to invest time, effort and money in services of lower demand. The quality of endodontic service is compromised when the operator only gets the opportunity to do 10 or 12 root canal treatments a year. Equipment, training and experience makes a huge difference in providing successful services. You can count on them to save your pet's life, and refer your pet to us for endodontic therapy.
Endodontic procedures require: specialized training, equipment, instrumentation and clinical case experience. Not every upper fourth premolar tooth has the same root canal anatomy or orientation. Not all teeth have the same number of roots or anatomy. Young pets tend to have very wide canals. If they are too young, root canal therapy may be contraindicated. In those cases, vital pulp therapy may be appropriate. With the wide variation in patients (180# Great Dane to the 1.4# tea cup Yorkie) we see, there is a demand for a wide assortment of equipment and instruments. Not all endodontic procedures are performed using the same technique or materials. The high volume of cases we see improves our efficiency, patient safety, and the overall success rate.
We have experienced a very high rate of success in providing endodontic therapy. It has been a great pleasure to resolve dental problems and save teeth. It is particularly rewarding to see the satisfaction clients enjoy from these services.
Our dental consultations are designed to answer your questions, and to provide the information needed to make treatment decisions.
More Clinical images
Broken dog teeth are common, according to the American Veterinary Dental Association. Dogs can break their teeth by chewing or being hit with something like a ball or a rock. If your dog has broken.
- You should consider, though, that antlers and other excessively hard chews are a common cause of broken teeth in dogs. Broken teeth are extremely painful and can lead to abscesses and infections.
- Broken teeth are unfortunately a common problem with dogs. Aggressive chewing on hard objects (rocks, fencing, etc.) or on hard treats (cow hooves, bones and hard nylon toys) are the primary cause. To prevent broken teeth and destructive chewing, dental experts recommend regular exercise and special doc-approved toys to distract them from the.
Dog Dental Care
Cat's Dental Chart
Puppy Missing Teeth
Broken Pet Teeth
Broken (fractured) teeth are a very common occurrence in dogs and cats. Pet teeth can break due to trauma (hit by a car, ball, or rock) or due to chewing on hard objects. Any pet tooth can break, however some teeth are more commonly fractured than others, such as the canine (fang) teeth in the dog and the cat, and the upper fourth premolar (large tooth on the upper jaw in the back of the mouth) in dogs.
There are two categories of broken pet teeth: those that directly involve the root canal (termed complicated crown fractures) and those that do not extend deep enough to expose the root canal, but rather only expose the layer beneath the enamel which is called dentin (uncomplicated crown fractures). Both of these types of tooth fracture require therapy, but the treatment can be very different.
Pet teeth with direct root canal exposure are excruciatingly painful to a dog or cat. Unfortunately, only very rarely will animals show discomfort, as they are evolutionarily conditioned to mask pain fairly well, preferring to suffer in silence. This allows owners (and veterinarians) to ignore the problem, as “it doesn’t seem to bother the pet”. But we now know that these animals are suffering with consequences both locally in the mouth as well as systemically throughout the body. This means that in today’s current age of veterinary medicine, it is no longer appropriate or acceptable to ignore broken teeth in our patients. We have had numerous clients who have told us that their pet is not bothered by its broken tooth when it is discovered, that later tell us joyfully that their pet is acting “5 years younger” just two weeks after the problem is fixed.
The reason that a broken pet tooth with direct pulp exposure presents a problem is that after the tooth is fractured, bacteria from the mouth gain access to the root canal and infect the tooth. Eventually, the tooth will die and become a bacterial haven. The bacteria then leak out through the bottom of the tooth, and infect the bone in that area. Eventually, the bacteria cause bone destruction around the tips of the tooth root. Next, the blood vessels in the area pick up the bacteria and spread it to other areas of the body, including the liver & kidneys which filter the blood, and potentially to the heart valves, which damage these vital organs. In fact, infected teeth (and periodontal disease) can so greatly affect the rest of the body and its vital organs that we have had numerous patients with elevated liver and kidney enzymes found on the pre-op blood which then improve or return to normal levels within two weeks of the dental procedure.
Occasionally, the infection at the root tips will get so bad that an abscess will break out through the skin and appear as a wound on the face, often below the eye. This most commonly occurs with a fracture of the upper fourth premolar in dogs, and it is known as a carnasial tooth root abscess. It can also happen secondary to an infected canine as well as most other teeth. In cats, an abscess will usually be due to a fractured canine tooth, but due to the shortness/shape of the nose, this wound will open below the eye as well. Antibiotics will usually resolve the problem for a while, but invariably the problem will continue to reoccur if the offending tooth is not appropriately dealt with.
Treatment Options for Broken Pet Teeth
There are three options for treatment of a fractured tooth with direct pulp expsure, and ignoring it is NOT one of them. This problem can only be solved with either root canal therapy, vital pulp therapy, or extraction.
The first and best option to treat fractured tooth that is otherwise healthy is root canal therapy.
This procedure removes the infected root canal tissue (called the pulp), medicants to help prevent future bacterial contamination. This is most commonly done for canines in dogs and cats, and the upper fourth premolars and lower first molars in dogs. However, any tooth can be saved in this manner. The advantages of root canal therapy over extraction of the tooth include:
- Saving the tooth
- Preserving the strength in the jaw
- Avoiding surgical pain
- Especially for large teeth
- Decreases risk of surgical complications
Learn more about root canal therapy.
Vital pulp therapy (VPT) is only recommended in pets under 18 months of age. This is because the teeth are generally not mature enough for root canal therapy until that age. Once the teeth are mature, root canal therapy has a much better prognosis. However, if VPT is to be performed, it should be done as soon as possible
The final option is extraction of the offending tooth. Choosing this treatment option may depend on the tooth involved, degree of fracture, and any other disease issues. Extraction is the least ideal option for the most “strategic” (i.e. useful) teeth which include the canine (fang) tooth, as well as the upper fourth premolar and lower first molar teeth in dogs this is the last option. There are several reasons we prefer to extracting these teeth if possible.
Puppy Canine Teeth Broken Tooth
- These are very large teeth with very large roots in animal patients. The root of the canine tooth is twice as long and wider than the crown (the part you can see). Extraction of these teeth requires more invasive oral surgery, i.e. they are not simple extractions.
- The patient loses the function of the tooth, which can be very important for chewing in some cases.
- Orthodontic problems can occur as a result of losing of the tooth.
Puppy Canine Tooth Broke
We try to avoid extraction in cases of otherwise healthy teeth.
Uncomplicated crown fractures are approached with different treatment options. These are also a very common finding on oral exam, particularly in large breed dogs. The most common teeth involved are the carnassials (maxillary fourth premolar and mandibular first molar) as they are the primary chewing teeth. However, any and all teeth can be fractured. These fractures almost always result in exposure of the underlying tooth structure called dentin. This will uncover dentinal tubules which contain what amounts to nerves and creates significant pain for the patient. This is similar to us having a sensitive tooth from a deep cavity. In addition, some of these teeth will die either due to the trauma, inflammation, or direct pulpal invasion via the dentinal tubules. For these reasons, it is recommended that these teeth be radiographed to ensure vitality. If the teeth are dead (evidenced by bone loss at the tips of the teeth) the teeth need to be root canalled or extracted. If the teeth appear to still be alive, the application of a bonded sealant is recommended to decrease sensitivity, block off the pathway for infection, and smooth the tooth to decrease periodontal disease.