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==Introduction==
==Introduction==
Tooth fractures may affect the crown, the crown and the root or just the root.
[[File:Tooth root fracture.jpg|200px|right|thumb|Root fracture]]
[[File:Tooth root fracture 2.jpg|200px|right|thumb|Root fracture]]
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.
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.
==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 are the teeth that most commonly fracture.
'''Causes''' of fracture include: chewing on metal fences or gates, hard chew toys, stones, ice cubes, horse and cow hooves. Road traffic accidents and other trauma can also lead to fractures.
==Aetiology==
'''Causes''' of fracture include: chewing on metal fences or gates, hard chew toys, stones, ice cubes, horse and cow hooves.
A slab fracture of the [[Dental Formula - Dog|carnassial tooth]] usually results from dogs chewing, whilst trauma to the anterior teeth (canines and incisors) results from catching a hard object for eg. Stones/Frisbees. Trauma to the front teeth can also result from an anterior collision – with a stationary object or another dog.
External head trauma from road traffic accidents (RTAs) or external blows/kicks can also result in tooth fractures.
==Classification of tooth fractures==
:'''Class A1''' – involves the [[Tooth - Anatomy & Physiology#Enamel|enamel]] only
:'''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
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.
'''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 explorer tip with the animal 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 [[Enamle 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.
'''Radiography''' should be performed regularly to check for periapical inflammation or bone disorders.
'''Radiography''' should be performed regularly to check for periapical inflammation or bone disorders.
==Prevention==
Chewing hard objects should be avoided. Stones, bones and certain toys are harder than the tooth substance and can result in fracture of the tooth.
{{Learning
{{Learning
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis00709.asp Dental fracture]<br>[https://www.vetstream.com/felis/Content/Disease/dis60698.asp Dental trauma: root fracture]
|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''
{{Lisa Milella reviewed
|date = 14 August 2014}}
{{review}}
{{Waltham}}
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[[Category:Dental Diseases - Dog]]
[[Category:Dental Diseases - Dog]]
[[Category:Dental Diseases - Cat]]
[[Category:Dental Diseases - Cat]]
[[Category:Expert Review]]
[[Category:Lisa Milella reviewed]]
[[Category:Endodontic Conditions]]
[[Category:Traumatic Dental Conditions]]
[[Category:Waltham reviewed]]