Dental Emergencies

Dental Emergency

Dental emergencies may not be life threatening, but require prompt treatment.

The main objectives is a dental emergency is to alleviate acute dental pain, and in some cases, to provide tooth saving treatments.

The thinking behind tooth saving treatments is based on the following:

“Save rather than extract” – is to maintain a functional bite.

Cosmetic appearances play no role in Veterinary Clinical decision making.

Trauma to Teeth: This can result in fracture of the enamel of the tooth or enamel and the dentin – gaining exposure of the pulp cavity, or it could be caused by a concussion type injury.

Many of these injuries cause acute pain which should be treated by a veterinary surgeon with the appropriate analgesia.

The acute pain is usually short in duration and can be controlled by analgesia then a plan for the treatment of the damaged tooth can be assessed and provided. Not all injuries are urgent to repair, but it is important you seek veterinary attention immediately in order for the correct pain relief to be administered and the correct decision for treatment to be made.

Different types of tooth fractures:

Uncomplicated Crown Fracture:

Fracture of the enamel only
Fracture of the enamel and dentin Not exposing pulp (some will require urgent treatment)

Complicated Crown Fractures:

Pulp exposure present (all cases should be treated – in young dogs there is an urgency)

Crown Root Fractures:

With or without exposure of pup (the fracture typically runs longitudinally or obliquely through the crown and root – prognosis is guarded in these cases, most require extraction urgently as the acute pain is usually extended.

Blunt Trauma: The tooth presents with an intrinsic purple, grey or beige discoloration which has resulted from a concussion type injury. Bleeding of the pulp tissue was caused by blunt trauma and the break down products of the red blood cells have entered the dentin, causing varying shades of discoloration on the degree of pain and discomfort the dog is showing. Again, seek veterinary attention early so that the correct decision can be made quickly.

Intrusion of Tooth: This is when a tooth can be pushed or partly pushed into the bone, or can be pushed into the nasal cavity.

Avulsion of Tooth:

Complete avulsion of a tooth – this is when the tooth has come out of its socket. Re-implantation depends on survival of the periodontal ligament cells and to achieve this avulsed tooth has to be re-implanted within 2 hours of the injury.

The tooth has to be kept in the correct medium during transport to the veterinary specialist dental hospital – this medium is usually milk or saliva. The tooth should only be handled by the crown to help the periodontal ligament cell’s survival.

In veterinary dentistry these opportunities are rare and more common in people in certain types of contact sport.

Lateral Luxation with Alveolar Fracture:

This is when the bone is fractured and the tooth is moved sideways. This is much more common injury in dogs.

This type of injury required urgent veterinary attention. The vet would stabilise the fracture which allows the periodontal ligament to heal.

A “figure of eight” canine–to-canine move with acrylic re-enforcement is a common method of treatment. The wire stays in place for 6 weeks and at the time of removal the affected tooth will require a root canal therapy.

Guidelines for fractured teeth with pulp exposure to be saved by vital pulp therapy

Up to 18 months of age, there is a window of up to 2 weeks from the time of the trauma to vital pulp treatment – the shorter the time, the more likelihood of a better outcome.

Over 18 months of age, the window for vital pulp treatment is 2 days from the time of trauma (or alternatively to be booked for full root canal therapy for which there is not so much urgency).

Has the trauma been witnessed? If not, is the owner confident to state an exact date of “when the tooth was last intact?” This will be easier to determine if the teeth are brushed daily.

Start antibiotics immediately – once overwhelming infection has been established the vital pulp therapy can no longer be successful.

Start analgesia immediately.

Acute tooth root abscess: This is a common infection condition with dogs presenting in acute pain if an abscess has not yet found a route of drainage.

There are 2 basic causes of this condition:

Endodontic Lesions – dead pulp often because of trauma, but can also occur due to spread of bacteria to the pulp cavity via the blood.

Periodontal lateral abscess – this is when a pocket of the periodontal becomes blocked at the gum margin.

Both these conditions are very painful and require veterinary attention immediately – analgesics will be given on first presentation and antibiotics can often alleviate presenting signs.

Treatments can be root canal therapy or extraction.