Fractured teeth The two main types of crown fracture seen in veterinary medicine are complicated and uncomplicated. Both types require therapy; however treatment for each is often different. All teeth with direct pulp exposure (complicated crown fractures) should be treated with endodontic or exodontic therapy; ignoring them is NOT an option. Prior to tooth necrosis, the viable nerve is excruciatingly painful. Following tooth death, the root canal system will act as a bacterial super-highway creating not only local infection, but also a bacteraemia which has been linked to more serious systemic diseases. The owners of these patients will be reluctant to pursue therapy as "It does not seem to bother the dog". Fractured and/or infected teeth do bother the pet and they will act better following therapy. Veterinary patients are known for being stoic, and therefore lack of outward signs of oral pain should not be misinterpreted as a benign state. Therefore, you must be a patient advocate and recommend therapy. Furthermore, for large teeth such as canines and molars, root canal therapy is a much better option than extraction. This is because it is not only a much less painful procedure, it also maintains the function of the tooth. Uncomplicated crown fractures are also a very common finding on oral exam, particularly in large breed dogs. These fractures will result in direct dentinal exposure. The exposed dentinal tubules will create significant pain for the patient. The currently accepted means by which this sensitivity is created is via the theory of fluid dynamics. In addition, some of these teeth will become non-vital due to the traumatic incident, pulpal inflammation, or direct pulpal invasion via the dentinal tubules. For these reasons, it is recommended that these teeth be radiographed to ensure vitality. If the teeth are non-vital (evidenced by periapical rarefaction or a widened root canal) endodontic or exodontic therapy is required. If the teeth appear vital, the application of a bonded composite is recommended to decrease sensitivity (please see the article on composite bonding later in the issue for further information). Brook A. Niemiec DVM Diplomate, American veterinary Dental College Fellow, Academy of Veterinary Dentistry Southern California Veterinary Dental Specialties Las Vegas Veterinary Dental Specialties San Diego Veterinary Dental Training Center Veterinary Dental Telemedicine

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