We, as veterinary dental specialists, are often approached by the panicked pet parent inquiring what they can or should do because their dog (or cat) fractured a tooth. On the flip side, we are frequently asked “Why should we treat that broken tooth? My dog seems happy and is eating.”
It is a scientific fact that dogs feel the same pain sensation as humans. The difference between dogs/cats and humans is how pain is expressed between the species. When the wimpiest creature on the face of the earth, the human male, fractures the tooth you can clearly tell. We human males, scream, cry, complain, want our mommies, and run to the doctor as fast as we can. Dogs, on the other hand, do not. Remember that dogs do feel the pain just as humans do, but they are more reserved about their expression of their pain.
Dogs and cats just don’t complain much. Our four-legged family rarely quit eating because of a fractured tooth. They rarely quit eating for any oral problem. A couple of years ago this author treated over 150 maxillofacial trauma patients (face and/or jaw fractures) in one year and by far the majority of those were still eating at presentation. Most of the time with dogs and cats, the will to live overrides pain, so they eat.
Dogs are also packs animals. If a pack member exhibits pain, a perceived weakness, that pack member loses social rank and is often isolated. Pack animals really dislike being isolated. In addition, it typically takes the entire pack to find groceries (hunt effectively), therefore the fear of going hungry is also a factor in not showing pain. In summary, think about how you would feel if you had a fractured tooth or abscessed tooth due to an untreated broken tooth – your doggie or kitty feels exactly the same. Cats are notorious for just maintaining the status quo even when in pain. It is cruel not to alleviate that pain to the best of our abilities.
Tooth fractures are very common in dogs. In a study of 621 dogs and cats, it was found that 26.2% had tooth fractures. The most common tooth to fracture is the canine (fang) tooth. The second most common tooth to fracture is the maxillary (upper) fourth premolar. The maxillary fourth premolar and the mandibular (lower jaw) first molar are known as the carnassial teeth. The carnassial teeth perform by far most of the chewing. Collectively, the canine teeth and the carnassial teeth are known as “strategic teeth” as they provide most of the form and function of the mouth. We veterinary dental specialists will jump through hoops to save these vitally important strategic teeth.
The high incidence of fractured canine teeth may be explained by understanding that the dog’s prehensile organ (a.k.a. hands) is their mouth. One could consider the canine teeth as the “fingers” of the dog’s hands. When extreme stress is placed on canine teeth, they do not bend…they break. Fractures of the carnassial teeth are most commonly caused by chewing on hard objects. Common causes of carnassial teeth fractures seen at Carefree Dentistry & Oral Surgery for Animals are nylon chew bones, antlers, hooves, bully sticks, and marrow bones. Dogs love to chew on these objects, however, when they really get into it and bite down hard, they frequently break teeth. Of course, there are other causes of fractures such as maxillofacial (face and jaw) trauma (hit by a car, kicked by a camel, etc.). It has been reported that nearly 70% of patients with maxillofacial trauma will have fractured teeth.
Severely fractured teeth mean that the tooth is fractured sufficiently enough to expose the pulp tissue. This is termed a complicated crown fracture. The pulp is in the hollow center of the tooth. “Pulp” is a term that is used to describe the vein, or artery within the tooth. It is interesting that of all tooth fractures, complicated crown fractures are the most common. A fresh complicated crown fracture is extremely painful. The tooth always becomes non-vital (dies). When the pulp tissue dies, the pain usually goes away…until it abscesses, then OUCH!!
Strategic tooth with an extremely painful complicated crown fracture. The red spot(s) is the pulp tissue. OUCH!!
When our doggies or kitties have a complicated crown fracture, there are only three treatment options. They are as follows:
1. Do nothing: If nothing is done, most likely the pet will continue to suffer. Often painful abscesses will form. Abscesses slowly poison the body. Not good.
2. Extraction: Sadly, on occasion due to concurrent disease of the supporting structures of the tooth (periodontal disease), or the severity of the fracture, the tooth must be extracted. Extraction of a strategic tooth is particularly detrimental to the function and/or form of the pet. (Recall that strategic teeth are the four canine (fang) teeth and the four chewing teeth). For example, if a maxillary (upper) fourth premolar, which is a strategic tooth, must be extracted, then that pet will not chew on the extraction side, thereby suffering the loss of the cleaning effects of chewing on that side, hence more plaque, calculus, and periodontal disease. The other side will compensate by doing most of the chewing, leading to excessive wear. Complications associated with extractions of teeth by inexperienced operators do frequently occur. For example, the author has repaired dozens of mandibular (lower jaw) fractures due to the extraction of a mandibular canine tooth. The mandibular canine tooth comprises two-thirds of the cross-sectional diameter of the mandible, therefore it is sometimes easily fractured during extraction. In the hands of a board certified veterinary dental specialist, complications of extractions are uncommon. Note: The author has never fractured a mandible during extraction.
3. Root canal therapy: Root canal therapy of a strategic tooth is much less invasive than extraction. It has a much shorter recovery time as compared to extraction. The cost of root canal therapy is very similar to extraction and the complication rates are equivalent (not common). The success rate and/or no evidence of failure for root canal therapy is 96% in canine teeth. Root canal therapy consists of three basic steps: To clean the pulp canal, to sterilize the pulp canal, and finally to fill (obturate) it.
Because performing a root canal requires specialized training and lots of practice, it falls under the auspices of a board-certified veterinary dentist.
Frequently, a “crown” or “cap” will be placed on the tooth to provide further protection. Crowns make the tooth stronger than the original tooth, enhance the success rate of root canal therapy, and in most cases, extend the life of the pet. Plus, crowns look really cool.
The good news is that if your doggie or kitty suffers a fractured tooth, we can help.
Kipp J. Wingo, DVM
Diplomate, American Veterinary College of Dentistry
Carefree Dentistry & Oral Surgery for Animals
AnimalDentalAZ.com
[1]Jason W. Soukup, DVM; Scott Hetzel, MS; Annie Paul; Classification and Epidemiology of Traumatic Dentoalveolar Injuries in Dogs and Cats: 959 Injuries in 660 Patient Visits (2004-2012), J VET DENT Vol. 32 No. 1 Spring 2015
[1] Soukup JW, Mulherin BL, Snyder CJ. Prevalence and nature of dentoalveolar injuries among patients with maxillofacial fractures. J Small Anim Pract 2013; 54:9-14.
[1] Bonner SE, Reiter AM, Lewis JR. Orofacial manifestations of high-rise syndrome in cats: a retrospective study of 84 cases. J Vet Dent 2012; 29:10-18.
[1]Da Bin Lee, Boaz Arzi, Philip H Kass, Frank J M Verstraete; Radiographic outcome of root canal treatment in dogs: 281 teeth in 204 dogs (2001-2018); J Am Vet Med Assoc.
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