Snapped canines - do they hurt?

RE: Snapped canines - do they hurt?

Evelyn Barbour-Hill — Wed, 26 Jul 2017 12:08:37 GMT

[quote user="Martin Atkinson"]When 99% of us are going to extract this tooth, a root canal filling is radical. [/quote]

[quote user="Martin Atkinson"]Most clients would not pay anyway[/quote]

RE: Snapped canines - do they hurt?

Martin Atkinson — Wed, 26 Jul 2017 12:00:01 GMT

[quote user="Evelyn Barbour-Hill"]Radical treatment? "Radical" is an excellent choice of word though it may have been unintentional![/quote]Fully intentional. Dictionary definition: Radical - relating to the basic/fundamental nature of something'. When 99% of us are going to extract this tooth, a root canal filling is radical. Most clients would not pay anyway when the vast majority of pets won't miss the tooth and that's even if we've decided it needs treatment.

[quote user="Evelyn Barbour-Hill"]Risk of GA? Minute.[/quote]Still the number one reason clients give for being reluctant to have any routine dental work done, albeit it could be that's just their excuse for being tightwads not wanting to pay for it.

RE: Snapped canines - do they hurt?

Evelyn Barbour-Hill — Wed, 26 Jul 2017 11:48:20 GMT

[quote user="Rob Davis"]

[quote user="Martin Atkinson"]Genuine question though: how do you differentiate between just exposure of dentine and necrotic pulp in these cases as they both appear as a dark plug.[/quote]

Feel with a sharp explorer - reparative dentine in cases of abrasion will be totally smooth, with exposed pulp the tip of the explorer will enter the pulp chamber.

[/quote]

And, with a little experience, they look different.

Nobody said that every fractured canine is inevitably painful. What we are pointing out is that it is likely to cause lowgrade chronic pain and in any case is unhealthy (pain is not the only criterion determining the desirability of treatment).

Risk of GA? Minute, especially when the depth of anaesthesia necessary will be a good deal less than that required for extraction.

Radical treatment? "Radical" is an excellent choice of word though it may have been unintentional!. Root canal treatment does indeed involve the root, the inside of it anyway, but it's hardly "radical" in the modern metaphorical sense – I'd reserve "radical" for extraction (or exodontia, as Yanks with delusions of grandeur will term it ).

RE: Snapped canines - do they hurt?

Anthony Todd — Wed, 26 Jul 2017 11:14:40 GMT

[quote user="Braden Collins"]

Last year when riding my bike, I was hit by a car and had multiple teeth broken. It hurts, and I think I'd need a lot of convincing to believe it doesn't hurt in dogs as well.

[/quote]

Surprisingly illogical from a poster whose views I have always respected...

Of course it hurts at the time independent of subsequent treatment.....

Most of the animals I saw were not presented at the time.

I only posted my experience as I can inevitably envisage animals' being put down because of dire warnings of severe chronic pain if the root canal is unfilled and the animal is, sadly, "uninsured" which, it appears, is now a diagnostic and therapeutic consideration.

RE: Snapped canines - do they hurt?

Braden Collins — Wed, 26 Jul 2017 10:33:26 GMT

Last year when riding my bike, I was hit by a car and had multiple teeth broken. It hurts, and I think I'd need a lot of convincing to believe it doesn't hurt in dogs as well.

RE: Snapped canines - do they hurt?

Rob Davis — Wed, 26 Jul 2017 10:17:49 GMT

[quote user="Martin Atkinson"][quote user="Rob Davis"]Sigh......[/quote]Sigh back. You are falling into the trap of being a dental specialist therefore every dental problem is critical and requires dental surgery. Specialists sometimes have tunnel vision and miss the bigger picture.[/quote]

I am not a dental specialist, I am very much a GP vet who has decided to educate myself about dentistry as my previous training was minimal. For the first few years of my career I had very little understanding of dental pathology and treatment. Without wishing to sound critical, this is still the position of the majority of vets. It is not a reflection on the vets themselves, but an unfortunate and predictable result of the lack of importance place on dentistry by the veterinary schools.

I do not believe that every dental problem is critical etc. I believe that every dental problem should be properly assessed and treated (or not) appropriately. I believe that exposed pulp should not be left untreated. This is based on a considerable amount of reading on the subject over several years, on repeatedly finding periapical changes on radiographs in animals with long term necrotic pulp and no visible signs of discomfort, on frequently seeing a change in demeanour in these animals post treatment when their owners were unaware beforehand that there was a problem.

There are many dental abnormalities which I am happy to leave untreated, exposed pulp is not one of them.

[quote user="Martin Atkinson"]PS Thank you for your advice on my question.[/quote]

Glad to be of assistance

RE: Snapped canines - do they hurt?

Martin Atkinson — Wed, 26 Jul 2017 09:28:32 GMT

[quote user="Rob Davis"]Sigh......[/quote]Sigh back. You are falling into the trap of being a dental specialist therefore every dental problem is critical and requires dental surgery. Specialists sometimes have tunnel vision and miss the bigger picture.

PS Thank you for your advice on my question.

RE: Snapped canines - do they hurt?

Rob Davis — Wed, 26 Jul 2017 09:16:53 GMT

[quote user="Martin Atkinson"]Back to the OP, I think it is over reacting, anthropomorphic and generalising to say that every fracture canine is inevitably painful and needs radical treatment. These teeth are something we come across very frequently and although we cannot ask our patients I would say that only in the minority of cases is there any discernible discomfort. There has to be a balance struck between leaving an apparently painless fractured tooth and the cost, risk of a GA and radical dentistry.[/quote]

Sigh......

[quote user="Martin Atkinson"]Genuine question though: how do you differentiate between just exposure of dentine and necrotic pulp in these cases as they both appear as a dark plug.[/quote]

Feel with a sharp explorer - reparative dentine in cases of abrasion will be totally smooth, with exposed pulp the tip of the explorer will enter the pulp chamber. Occasionally (especially in cats) the pulp chamber will be very narrow close to the tip and it may be difficult to ascertain whether or not there has been pulp exposure. A parallel radiograph of the crown can be useful in these situations, though if the fracture is very close to the pulp then pulp necrosis is more likely due to bacteria travelling through the dentine tubules which are wider and more numerous closer to the pulp.

RE: Snapped canines - do they hurt?

Martin Atkinson — Wed, 26 Jul 2017 09:11:28 GMT

A quick anecdote to Anthony's post on the police dog. I used to work with RAF police dogs which were trained as attack dogs designed to inflict serious injury not just to retrain a villain. a razor sharp canine would have been an attribute to them. However I recall being anaesthetist to an RAF dentist who put a gold crown on a dog's fracture canine at great cost to the public purse and was then PTS 6 months later because it has hip dysplasia!

Back to the OP, I think it is over reacting, anthropomorphic and generalising to say that every fracture canine is inevitably painful and needs radical treatment. These teeth are something we come across very frequently and although we cannot ask our patients I would say that only in the minority of cases is there any discernible discomfort. There has to be a balance struck between leaving an apparently painless fractured tooth and the cost, risk of a GA and radical dentistry.

Genuine question though: how do you differentiate between just exposure of dentine and necrotic pulp in these cases as they both appear as a dark plug.

RE: Snapped canines - do they hurt?

Rob Davis — Wed, 26 Jul 2017 08:46:47 GMT

As Evelyn has said, initially there will be acute pain from a fractured tooth with exposed pulp. The pulp will fairly quickly necroses, at which point there will not be any pain as the nerve is dead. The open pulp chamber, however, will act as a conduit through which oral bacteria will travel, exiting via the apical delta into the surrounding bone. With time this will result in periodical disease (granuloma, cyst, abscess etc) which will very likely result in pain. This pain is likely to be a chronic, lower grade pain to which the dog will acclimatise and will be very difficult to detect. Endodontic treatment at an early stage will, if successful, prevent the ingress of bacteria and the ensuing periapical pathology.

Leaving teeth with exposed pulp is not acceptable.

RE: Snapped canines - do they hurt?

Anthony Todd — Tue, 25 Jul 2017 23:04:21 GMT

[quote user="Evelyn Barbour-Hill"]Well, if they had had endodontic treatment done when first injured, that would not have happened and they would still have the tooth.[/quote]

I was talking about the stump, at or near gum level which often, when left alone, seemed to cause the dog no harm or discomfit in many or most cases, possibly surprisingly.

Of course if you root fill them all you'll never know.

RE: Snapped canines - do they hurt?

Evelyn Barbour-Hill — Tue, 25 Jul 2017 18:09:25 GMT

Well, Anthony, the police have their broken canines fixed these days, to ensure that these valuable dogs can continue to do their work.

And police dogs nowadays are not required to be "notorious", nor are they intended to do serious damage, be it with a razor sharp smashed tooth and quite possibly goaded by pain, or by any other means. Not in the UK anyway.

[quote user="Anthony Todd"]Some seemed to develop signs of infection or discomfit but not many, in which case the entire stump was removed.[/quote]

Well, if they had had endodontic treatment done when first injured, that would not have happened and they would still have the tooth.

RE: Snapped canines - do they hurt?

Anthony Todd — Tue, 25 Jul 2017 17:41:33 GMT

Sorry, I find all this hard to understand, speaking of dogs mainly.

I must have seen many canines snapped off at various levels and only a few ever seemed painful.

I looked after a notorious police alsatian with a diagonal canine fracture which was revered by the force for the damage it did with the razor sharp half canine.

Some seemed to develop signs of infection or discomfit but not many, in which case the entire stump was removed.

Of course some will say "ah but they just didn't show any pain even though they had it".

They sure show it with carnassials.....

RE: Snapped canines - do they hurt?

Rob Davis — Tue, 25 Jul 2017 17:01:03 GMT

[quote user="Evelyn Barbour-Hill"]Accesia in Sweden, no question[/quote]

I would second Accesia - the facilities and courses are excellent.

[quote user="Evelyn Barbour-Hill"]But, as I have banged on about before, I don't think you should just "learn to do a root canal" like a page in a recipe book. You need to understand fundamentals and you need to understand principle and practice, materials, restorative technique.[/quote]

As Evelyn says, endodontics is complicated. I have been on three week-long courses at Accesia and have completed a fair number of root canal procedures, but would still consider myself very much a novice. Cadaver work is really useful to practice techniques (I find foxes are great if you can find a local source), and you can't practice too much. Endo is very technique-sensitive and is fairly unforgiving if you make any technical errors. It is not something to undertake until you have had sufficient training, but if you're keen to learn then go for it. There are a large number of potential cases out there.

RE: Snapped canines - do they hurt?

Evelyn Barbour-Hill — Mon, 24 Jul 2017 17:35:14 GMT

[quote user="Stephanie Fursland"]Are there any (practical) courses teaching it that you would recommend?[/quote]

Accesia in Sweden, no question. But I don't think they have any basic endodontic courses before 2018, now.

Join BVDA and you'll hear quicker of any BVDA ones, not to mention getting reduced rates.

Or get someone to teach you privately.

But, as I have banged on about before, I don't think you should just "learn to do a root canal" like a page in a recipe book. You need to understand fundamentals and you need to understand principle and practice, materials, restorative technique.

RE: Snapped canines - do they hurt?

Stephanie Wellings — Mon, 24 Jul 2017 17:02:52 GMT

This is something I would really like to learn to do - have referred a couple recently so the demand is there (also trauma to teeth is often covered by insurance whereas periodontal disease isn't, so the cost is less of an issue).

Are there any (practical) courses teaching it that you would recommend?

RE: Snapped canines - do they hurt?

Evelyn Barbour-Hill — Mon, 24 Jul 2017 12:42:48 GMT

[quote user="Liz w"]how much equipment and training is needed to do root canal treatment?[/quote]

Apart from a quality airdriven dental unit; lots and lots of bits and pieces, a couple of small machines, various materials; and either a lot of training or some decent courses and a lot of experience; and plenty of reading (books and journals). If you wish to do it properly and to keep your options open as to technique to cope with the unexpected. Radiology is essential.

[quote user="Liz w"]Is it something that should be feasible in most practices?[/quote]

It should be but I doubt if it ever will be, because of the ways of working, layout of premises, lack of space, views on charging, lack of commitment and general attitude.

RE: Snapped canines - do they hurt?

Liz w — Mon, 24 Jul 2017 10:11:24 GMT

how much equipment and training is needed to do root canal treatment? Is it something that should be feasible in most practices?

RE: Snapped canines - do they hurt?

Evelyn Barbour-Hill — Sun, 23 Jul 2017 16:07:55 GMT

[quote user="Neil Wheadon"]So are these cats in chronic pain?[/quote]

Your dentist is correct. The tooth is painful until pulp necrosis is complete. After that, everything dead inside, the tooth itself is insensitive – obviously. Now the tooth has become a channel full of dead stuff, open to the environment, leading to an opening deep within the bone. Where the nerve endings are still very much alive. "Toxins" (a very broad term instantly understood by the lay public) and even live bacteria can leak in and out. Not a healthy situation, whether there's pain or not.

There's probably chronic pain, who can be sure? With chronic pain, one may not know it's there until it's been removed.

Root canal therapy is vastly, infinitely, preferable to extraction. No trauma for the cat, no "trauma" for the veterinary surgeon, and the cat gets to keep the tooth.

RE: Snapped canines - do they hurt?

Linda Filshie — Sun, 23 Jul 2017 15:02:11 GMT

I had a chronic abscess for many years (following a botched filling) missed until i changed dentists. It felt weird but not sore.