Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.
PRACTICAL DENTISTRY |
Figure 6. Dental radiograph of the maxillary left fourth premolar (208). This tooth has an uncomplicated crown fracture and endodontic infection, evidenced by the periapical rarefaction (red arrows).
Complicated Crown Fractures Complicated crown fractures are the most easily diag- nosed form of endodontic disease, requiring only an oral examination for diagnosis.
Avoid "Wait & See" While it may seem obvious that an exposed nerve hurts or a diseased tooth would be a source of infec- tion, this knowledge is not universal. It is a common misconception among clients and even some veteri- narians that these fractures don't hurt because the pet is eating normally. Many clients are told to "Just keep an eye on it" or "Since it doesn't bother him, wait until it abscesses." The fact is, once the nerve is exposed, the tooth cannot heal itself and requires therapy.
Subtle Clinical Signs Fractured and/or infected teeth affect animals by creating pain, infection, and even fatigue, but often these signs are subtle or hidden. In addition, signs of infection generally present gradually and are, there- fore, less noticeable. Because animals are typically more stoic than humans, lack of obvious signs of oral pain should not be misinterpreted as a benign state.
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Figure 7. A draining abscess on the left side of the face; this patient had been previously treated with antibiotics with minimal effect.
Veterinary dentists often see animals that continue to eat normally despite the presence of lesions that should be causing intense oral pain.
Bacterial Pathway After a broken tooth eventually dies and much of the associated pain subsides, the root canal system acts as a bacterial pathway, allowing both local infection and systematic bacterial spread through the bloodstream. Spreading bacteria can negatively affect numerous vital organs, including the heart, liver, kidney, lungs, and brain, leading to serious systemic disorders.14-17 All teeth with direct pulp/nerve exposure must be
treated with either root canal therapy or extrac- tion.12,18
Ignoring these teeth is not an option, as prior
to tooth death, the living nerve is excruciatingly painful, and subsequent infection follows. Most owners see a notable or even dramatic improvement in their pets' attitudes and energy levels after therapy is provided.
Uncomplicated Crown Fractures Uncomplicated crown fractures are also a very com- mon finding on oral examination,19
particularly in large-breed dogs. These fractures result in direct den- C
Figure 8. (A) Discolored and nonvital mandibular left canine (304) (blue arrow); note the color difference between it and the maxillary canine; (B) Discolored and nonvital mandibular right third molar (411) (yellow arrow); this tooth is no less infected or painful than the canines and demonstrates the importance of a complete oral examination; (C) Discolored and nonvital mandibular left canine (304)
January/February 2012 Today's Veterinary Practice 43
Proper Therapy for Endodontic Disease