Imagine examining a dog or cat’s mouth, and you spot a fractured tooth. The pet seems to be eating fine, with no apparent discomfort. Should you keep your findings silent, share your thoughts, recommend extraction, or refer for vital pulp or root canal therapy? Let’s dive deeper into the world of fractured teeth in our patients.

Our patients experience dental misfortunes from accidents, fights, chewing on hard toys, antlers, and falls. Sometimes these incidents can lead to fractures in their teeth. The maxillary and mandibular canines are usually the teeth that are most prone to fracture, followed by incisors and the maxillary fourth premolars.

Cats and dogs have different tooth structures. In cats, the pulp chamber extends within millimeters under the crown tip, whereas there’s usually considerable protective dentin beneath the enamel in mature dogs. When trauma exposes the pulp, oral bacteria invade, causing infections that often spread to the surrounding tissues and bone.

To get a better picture, intraoral dental radiographs come in handy; they help identify pulpal and periapical issues and can evaluate the width of the root canal compared with the contralateral tooth (assuming it’s still vital). A nonvital tooth might have a wider root canal, indicating past pulp damage and necrosis (

The presentation regarding teeth with endodontic pathology (issues inside
the tooth) can vary. Concussive trauma can lead to pulpitis in some cases, with no obvious fracture present. Internal bleeding of the pulp is often noticeable as a discolored tooth (

). Sometimes you’ll see a fractured crown without pulp exposure (uncomplicated crown fracture), whereas other times, the pulp might be exposed (complicated fracture). In advanced scenarios, you might even spot fistulous tracts below the gumline (

Most pets with fractured teeth do not display signs of discomfort, even though they’re experiencing pain like humans. Cats, especially, are experts at hiding their pain. However, signs like occasionally chewing on one side, drooling excessively, or avoiding hard food or treats are present. (

The treatment dilemma: To save or extract?

What should you do when faced with a fractured tooth that exposes the pulp? (

 Removing the damaged tooth entirely, which stops the pain but may affect oral function.

 This approach aims to save the tooth and restore its function, and it includes root canal therapy and vital pulp therapy.

Figure 5: Fractured right maxillary fourth premolar affected with advanced periodontal disease, extraction indicated.

Several factors come into play when deciding between extraction and endodontic therapy.

 If the fracture is limited to enamel or involves dentin in a mature dog, without exposing the pulp, no further therapy is often needed if probing and intraoral radiographs do not show evidence of periodontal disease. Action is necessary for an uncomplicated crown fracture if the animal is young (with a large pulp chamber and root canal) and when the pulp is exposed (complicated crown fracture).

 Tooth support is vital for successful endodontic treatment. The prognosis may be unfavorable if there’s moderate to advanced periodontal disease. In those cases, extraction is the treatment of choice (

 Although any tooth can be treated endodontically, certain teeth are more critical for oral function, including canines and maxillary fourth premolars. Saving these is a priority (

 Recent veterinary literature reports that root canal therapy carries a high (94%) long-term success rate. Ensure your pet caregivers understand the prognosis, costs, and follow-up care involved in endodontic therapy.

 If you’re uncomfortable with advanced endodontic procedures or if the client refuses them (referral), extraction may be the only option for pulp-exposed teeth.

Vital pulp therapy: A lifesaver for some teeth

Vital pulp therapy includes partial coronal pulpectomy, direct pulp capping, and restoration. This approach works well for teeth that have experienced acute (less than 48 hours) pulp exposure; it can save the tooth’s function without the need of root canal therapy. (

The patient’s age and the fracture’s timing can also impact treatment choice. Young patients with open root apices may benefit from procedures like vital pulp therapy, whereas older patients with closed root apices can undergo standard root canal therapy.

Fractured teeth in our pets are common and demand careful attention. Whether it’s tooth extraction or endodontic therapy, your decision should consider the severity of damage, periapical and periodontal changes, the tooth’s function, the owner’s expectations, and your expertise. Intraoral dental radiographs are essential in making informed decisions. Managing fractured teeth relieves pain and ensures your furry patients’ long-term oral health and happiness.

Kuntsi-Vaattovaara H, Verstraete FJ, Kass PH. Results of root canal treatment in dogs: 127 cases (1995-2000). 

. 2002;220(6):775-780. doi:10.2460/ javma.2002.220.775

, received his undergraduate training at the University of Florida and his doctorate in veterinary medicine from Auburn University. After completing an internship at the Animal Medical Center in New York, New York, he returned to Florida, where he practices companion animal medicine surgery and dentistry at All Pets Dental in Weston. He has been certified by the American Board of Veterinary Practitioners (canine and feline) since 1986 and the American Veterinary Dental College (AVDC) since 1990. He was president of the AVDC from 2012 to 2014 and currently president of the Foundation for Veterinary Dentistry.

Articles

What happens when your patient breaks a tooth?

F is for fractured teeth

11. Drug for the acute onset of canine pancreatitis is launched on the US market

By Kristen Coppock Crossley, MA, Associate Editorial Director

An update in veterinary pharmacy reveals the first drug conditionally approved by the FDA to treat acute canine pancreatitis; fuzapladib sodium for injection (Panoquell-CA1; Ceva) is now available in the United States.

We have compiled a countdown of our top 15 content in 2023, here is number 11

Holiday Karaoke with dvm360

Join Adam Christman, DVM, MBA, and Julia Miller, DVM, DACVD, and the adorable Kuma in a heartwarming holiday karaoke session that's sure to fill your season with joy. The gang belt out a spirited rendition of holiday classic  "Rockin' Around the Christmas Tree" before bringing the house down with a duet of Mariah Carey's "All I Want for Christmas Is You."  Happy holidays from dvm360®!

Videos

With a special guest appearance from Mariah Carey

Holiday karaoke extravaganza with Julia Miller and Adam Christman

Learn about the latest advances in dermatology

Treating the itchy pet with Julia Miller

In this segment of dvm360 Live!™, Julia Miller, DVM, DACVD, leads a discussion on dermatology, covering everything from corticosteroids to take-home topical therapies clients can use at home. Advocating the principle of "first do no harm," Miller reviews the latest products and technologies aiming to make a difference in veterinary dermatology.

Below is a partial transcript. See the full video above for more.

: "One of the big things is people say, 'I get my spray bottle out, my dog runs away.' Nobody likes that, you know? But if there's a treat that they really love...give them a special treat when they're getting their treatments, and that way, it kind of is a good and bad together, and they might actually be a little bit more compliant for it."

Julia Miller, DVM, DACVD, discusses patient-tailored topical treatments for managing canine itch

The multimodal approach to the itchy pet: treating from a "whole-animal" perspective

The latest headlines in veterinary medicine

The human-animal bond, veterinary scholarships, and more

This episode of dvm360 Live!™ features Julia Miller, DVM, DACVD, who shares her expertise and experience in handling dermatology cases. Adam Christman, DVM, MBA, and chief veterinary officer of dvm360®, delivers the latest vet med headlines. Here are the news stories discussed in this segment. See the above video for more:

Veterinary students awarded $530,000 in scholarships from The Foundation for the Horse

: The 29 recipients were recognized during the American Association of Equine Practitioners' annual convention in San Diego, California.

New study finds reduced loneliness in older adults living with fostered cats

: The study conducted at the University of Georgia links improvements in older adults’ mental health and fostering shelter cats

Plus, meet Julia Miller, DVM, DACVD, who joins the set to talk dermatology in this episode of dvm360 Live!™

The human-animal bond, veterinary scholarships, and more headlines

Have you heard the term house officer at a veterinary clinic and was curious about what it meant? Or if you have heard of it and were curious to learn more about it? To help get a better understanding of house officers, Leslie Bauer, DVM, DABVP, director of house officer training programs for Thrive Pet Healthcare and ER Academy national director joins this episode of the podcast to answer all your house officer questions.

"Thrive Pet Healthcare's ER Academy is a one-year program that guides new graduates from commencement to competence on the emergency room floor. The program provides structured mentorship, where mentees engage in primary cases with a senior veterinarian, focusing on case management, client communication, and navigating the challenges and triumphs on the floor. Emergency surgery is actively encouraged at each Thrive location, recognizing its significance in skill development. The program is offered at five Thrive locations," Bauer told 

Throughout the episode, host Adam Christman, DVM, MBA, and Bauer review more about Thrive Health Petcare's training programs, the future of their house officer training, and more to help listeners get a better understanding of house officers in and out of the Thrive Health Petcare network. 

"Mentees follow a schedule alongside their mentors, engaging in weekly didactic learning to attain VECCS core competencies. They adhere to capped work hours and undergo quarterly evaluations. Each veterinarian in the program undergoes evaluation, and a plan is devised to foster their growth, progressively reducing oversight while increasing their caseload. Thrive is pleased to embark on its seventh year of this program," she concluded.

Below is a partial transcript. Listen to the podcast above for more.

[House officer] is a term that we borrowed from human medicine, like a lot of our other things. And it refers to basically, veterinarians who are licensed veterinarians that are undergoing advanced training programs. And so technically, it came from a resident physician that was seeing patients but had an attending physician. And so the house was actually the hospital. And so that's where it originally came from. In veterinary medicine, we used it to refer to interns and residents. 

Podcasts

Learn more about the role of a house officer, and the pressures they face