Dr. Woody Dudley, DVM
Are tooth fractures painful?
Yes. However, in most cases, there are no obvious symptoms. Our pets cannot tell us when the tooth hurts or is uncomfortable. The pain may come and go depending on when they bite down or when the affected tooth touches something warm or cold. Symptoms can include bleeding from the mouth, chewing in an odd manner, lethargy.
When the enamel layer of the tooth is fractured the dentin is exposed. The tooth becomes sensitive and painful. The dentin is the white layer of the crown below the enamel. Teeth are alive; they are nourished by vessels and nerves. The dentin has many microscopic tubes or tubules that contain fluid and nerves.
Pulp exposure is extremely painful. Sometimes enough of the tooth is removed due to a tooth fracture that the central part of the tooth called the pulp is open and visible. Nerves and blood vessels are found in the pulp. In appearance, it may look like an open hole in the middle of the tooth with bleeding or staining.
Tooth fractures are commonly seen in dogs and cats. In cats, they are frequently seen on the fang teeth (canine teeth). In dogs, fractures can be seen on any of their teeth. Some specialists believe up to 40% of large breed dogs have crown fractures.
The tooth fractures we can see are called Crown Fractures. The crown is the enamel-coated tooth portion above the gums that is visible. Enamel is the very hard outer layer of the crown. The crown of the tooth is the contact point for chewing, touching, and feeling food and other objects.
Can a fractured tooth become infected inside the tooth?
Crown fractures can lead to an infection and death of the tooth if untreated. This is called endodontic disease. Bacteria in the mouth and food can enter the fractured crown either through the dentin tubules or the pulp of the tooth. The infection can spread through and outside the apex of the tooth below the gum line causing an apical abscess.
Dental X-rays are very helpful in detecting whether or not there is an infection within the tooth and determine treatment. With dental X-rays, we can see the darker central pulp canal, the very white outer enamel layer, and the middle dentin layer. The root is the portion of the tooth below the enamel layer inside the gums.
What causes tooth fractures?
Chewing on hard objects such as antlers, bones, metal (chain link fences), and even rocks can cause crown fractures. Our pets love to chew. In their enthusiasm, they can chew with a large amount of force and cause a tooth fracture.
We recommend using chew toys that can be bent slightly to avoid crown fractures. With that said, we also recommend avoiding antlers, bones, and hard objects.
What is the recommended treatment for crown fractures?
Superficial crown fractures without pulp exposure or endodontic disease should receive a restoration (bonded sealant) to reduce sensitivity and help prevent future disease and infection inside the tooth. A restoration is similar to filling a cavity in a human tooth. The idea is to provide a hard, smooth, protective layer to the surface of the crown fracture to protect the tooth in the way the enamel does.
Deeper crown fractures with pulp exposure and endodontic disease (disease within the tooth determined by dental X-rays and probing) need more aggressive treatment. These are called Complicated Crown Fractures. If the tooth was fractured for over 48 hours, treatment options include extraction or a root canal. With extraction, the tooth, the pain, and the infection are permanently removed. A root canal is a great way to save the tooth; although, the sensation in the tooth will be lost. The structural integrity of the tooth is preserved with a root canal; sometimes the missing portion of the tooth will need to be fitted and replaced with a laboratory-created crown. Root Canals and Crowns are usually done by board-certified Dental Specialists. Extractions can be done by trained General Practice Veterinarians with dental X-rays and charting at their disposal and specialized equipment including dental instruments and high-speed drills.
The American Animal Hospital Association Guidelines recommend preventative dentistry cleaning and dental x-rays every year starting at 1 year of age. Tooth fractures will be detected during a preventative cleaning. We urge pet owners to make an appointment if the pet shows any symptoms or mouth issues are noticed on the visual examination of the teeth.