Changes

{{OpenPagesTop}}

{{OpenPagesTop}}

==Introduction==

==Introduction==

Tooth fractures may affect the [[Enamel Organ#Crown|crown]], the crown and the [[Enamel Organ#Root|root]] or just the root.

Tooth fractures may affect the [[Tooth - Anatomy & Physiology#Crown|crown]], the crown and the [[Tooth - Anatomy & Physiology#Root|root]] or just the root.

Fractures are termed '''complicated''' if there is exposure of the pulp.

Fractures are termed '''complicated''' if there is exposure of the pulp.

==Signalment==

==Signalment==

All teeth are susceptible to fracture, but in the mature dog and cat, '''maxillary canines''' are most commonly broken, followed by the mandibular canine, the maxillary fourth premolars, and incisors. In the immature dog less than 6 months old, '''deciduous canine''' teeth commonly fracture.

All teeth are susceptible to fracture, but in the mature dog and cat, '''maxillary canines''' are most commonly broken, followed by the mandibular canine, the maxillary fourth premolars, and incisors. In the immature dog less than 6 months old, '''deciduous canine''' teeth are the teeth that most commonly fracture.

==Aetiology==

==Aetiology==

==Classification of tooth fractures==

==Classification of tooth fractures==

:'''Class A1''' – involves the [[Enamel Organ#Enamel|enamel]] only

:'''Class A1''' – involves the [[Tooth - Anatomy & Physiology#Enamel|enamel]] only

:'''Class A2a''' – involves the enamel and [[Enamel Organ#Dentin|dentine]] but has not exposed the [[Enamle Organ#Pulp|pulp chamber]]

:'''Class A2a''' – involves the enamel and [[Tooth - Anatomy & Physiology#Dentin|dentine]] but has not exposed the [[Tooth - Anatomy & Physiology#Pulp|pulp chamber]]

:'''Class A2b''' – involves the enamel and dentine but has also exposed the pulp cavity

:'''Class A2b''' – involves the enamel and dentine but has also exposed the pulp cavity

Fractures may also be classified as '''crown only''', '''crown-root fractures''' or '''root fracture'''.  

Fractures may also be classified as '''crown only''', '''crown-root fractures''' or '''root fracture'''.

==Crown Fractures==

==Crown Fractures==

Crown fractures are usually obvious visually.

Crown fractures are usually obvious visually.

<u>Enamel fracture</u>: if only the [[Enamel Organ#Enamel|enamel]] is fractured, this will appear as chips in the enamel surface.

<u>Enamel fracture</u>: if only the [[Tooth - Anatomy & Physiology#Enamel|enamel]] is fractured, this will appear as chips in the enamel surface.

The treatment of choice is to smooth any sharp edges with fine diamond burs or sanding disks in order to prevent trauma to the lips and tongue.  

The treatment of choice is to smooth any sharp edges with fine diamond burs or sanding disks in order to prevent trauma to the lips and tongue.  

[[Intra-Oral Radiography|'''Radiography''']] should be obtained to check for any apical root fractures and a follow-up radiograph should be performed within the year to check for periapical pathology.

[[Intra-Oral Radiography - Small Animal|'''Radiography''']] should be obtained to check for any apical root fractures and a follow-up radiograph should be performed within the year to check for periapical pathology.

<u>Enamel and [[Enamel Organ#Dentine|dentin]] fracture</u>: this provides a direct pathway for bacteria to the pulp via the dentinal tubules. [[Enamel Organ#Pulp|Pulp]] exposure should be evaluated for by probing with an [[Dental Explorer|explorer tip]] with the animal [[Oral Examination Under General Anaesthesia|under general anaesthesia]]. Radiographs should be taken to evaluate the root.

<u>Enamel and [[Tooth - Anatomy & Physiology#Dentine|dentin]] fracture</u>: this provides a direct pathway for bacteria to the pulp via the dentinal tubules. [[Tooth - Anatomy & Physiology#Pulp|Pulp]] exposure should be evaluated for by probing with an [[Dental Explorer|explorer tip]] with the animal [[Oral Examination Under General Anaesthesia|under general anaesthesia]]. Radiographs should be taken to evaluate the root.

*'''Indirect pulp capping''': covers exposed dentin with glass ionomer cement followed by crown restoration. Follow-up radiographs are taken at 6-monthly intervals.

*'''Indirect pulp capping''': covers exposed dentin with a crown restoration. Follow-up radiographs are taken at 6-monthly intervals.

*'''Direct pulp capping''': the dentin is removed and the pulp is covered with calcium hydroxide or glass ionomer cement, followed by crown restoration.  

*'''Direct pulp capping''': the dentin is removed and the pulp is covered with calcium hydroxide or mineral trioxide aggregate (MTA), followed by crown restoration.  

<u>Enamel and dentin fracture with pulp exposure</u>: if the pulp is exposed '''endodontic treatment''' must be performed or the tooth must be '''extracted'''. An untreated exposed pulp leads to necrosis of tissue in the direction of the [[Enamel Organ#Root|root]] apex.

<u>Enamel and dentin fracture with pulp exposure</u>: if the pulp is exposed [[Endodontic Treatment|'''endodontic treatment''']] must be performed or the tooth must be [[Exodontics|'''extracted''']]. An untreated exposed pulp leads to necrosis of tissue in the direction of the [[Tooth - Anatomy & Physiology#Root|root]] apex.

==Crown-Root Fracture==

==Crown-Root Fracture==

A crown-root fracture involves the enamel, dentine and [[Enamel Organ#Cementum|cementum]]. It can be further classified into complicated or uncomplicated.

A crown-root fracture involves the enamel, dentine and [[Tooth - Anatomy & Physiology#Cementum|cementum]]. It can be further classified into complicated or uncomplicated.

==Root Fracture==

==Root Fracture==

A root fracture involves dentin, cementum and pulp and is generally complicated.

A root fracture involves dentin, cementum and pulp and is generally complicated.

Some root fractures which are reasonably stable, horizontal and uncontaminated, may heal unaided with the pulp remaining vital. The [[Enamel Organ#Alveolar Bone|alveolus]] acts as a '''natural splint''' which maintains the segments of tooth in close proximity.

Some root fractures which are reasonably stable, horizontal and uncontaminated, may heal unaided with the pulp remaining vital. The [[Tooth - Anatomy & Physiology#Alveolar Bone|alveolus]] acts as a '''natural splint''' which maintains the segments of tooth in close proximity.

If the fracture is unstable, the coronal segment of the fracture should be removed and the apical segment either extracted or treated endodontically.

If the fracture is unstable, the coronal segment of the fracture should be removed and the apical segment either extracted or treated endodontically.

{{Learning

{{Learning

|flashcards = [[Veterinary Dentistry Q&A 06]]

|flashcards = [[Veterinary Dentistry Q&A 06]]

}}

}}

Wiggs, R. (1997) '''Veterinary Dentistry: principles and practice''' ''Wiley-Blackwell''

Wiggs, R. (1997) '''Veterinary Dentistry: principles and practice''' ''Wiley-Blackwell''

{{review}}

 

{{Waltham}}

{{OpenPages}}

{{OpenPages}}

[[Category:Dental Diseases - Dog]]

[[Category:Dental Diseases - Dog]]

[[Category:Dental Diseases - Cat]]

[[Category:Dental Diseases - Cat]]

[[Category:LisaM reviewing]]

[[Category:Lisa Milella reviewed]]

[[Category:Endodontic Conditions]]

[[Category:Endodontic Conditions]]

[[Category:Traumatic Dental Conditions]]

[[Category:Traumatic Dental Conditions]]