Fractured deciduous canine

RE: Fractured deciduous canine

Anthony Todd — Sat, 19 Jan 2019 13:01:54 GMT

[quote user="Neil Wheadon"] in fact dinovets just snap them off,[/quote]

Don't know where that came from, not me. I only ever snapped off those big difficult molars at the back! ]JOKE]

Have you tapped it with the finger end of artery forceps to determine pain?

If there is, you can probably remove it gently, without elevating [or what ever the term is now]. Don't want to be too extensive or you could damage the permanent canine.

Not sure it's worth a GA unless there is obvious discomfit.

If it's solid and not too painful I'd leave it.

RE: Fractured deciduous canine

bevs2251 — Fri, 18 Jan 2019 03:27:48 GMT

A veterinary dentist years go advised us to remove retained/deciduous canines by a flap procedure, so I've done it this way ever since (usually at time of desexing so under same GA). Have broken off many retained canines in my time prior to doing flaps, never been an issue as far as I know so presumably the rest of the root resorbed. Flap has to be sutured closed, of course, adding extra time, but we always quote extra for each tooth + the cost of surgical material.

Watched a YouTube retained canine extraction - the vet ended up breaking the tooth while trying to extract it by digging out, no flap, left as is ! Would not have posted that on YouTube as it is the exact opposite of what one should do !!

RE: Fractured deciduous canine

Evelyn Barbour-Hill — Thu, 17 Jan 2019 17:00:56 GMT

Sometimes in a child a broken milk tooth can form a "pulp granuloma" which is generally not painful. I suspect in Roland Junior's case though the pulp necrosed and the dentist decided to rely on monitoring. I don't know, I wasn't there.

RE: Fractured deciduous canine

Rob Davis — Thu, 17 Jan 2019 16:49:20 GMT

[quote user="roland bulkyn-rackowe"]I believe he had pulp exposure, it was fractured near the gum margin (which then receded). He had a very sad face when they probed it and asked if it hurt, the open surface was red and looked bloody.[/quote]

That sounds like pulp exposure! Did they perform a pulpectomy or pulp capping? I'm really surprised if they left it alone and did nothing, but I guess if it was non-painful that would be ok. As Evelyn pointed out, he can let you know if does become painful at some point.

RE: Fractured deciduous canine

Roland Bulkyn-Rackowe — Thu, 17 Jan 2019 16:38:34 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="roland bulkyn-rackowe"]

Is it very different in humans? My son snapped a deciduous tooth 3 years ago, it was examined by the emergency dentist who advised to leave it but see the regular dentist in a week. By that time it was non painful. He should be shedding it in another year or so.

[/quote]

Of course I don't know what your son's tooth was like, but if it had a pulp exposure it would stop hurting when the pulp died. It will start hurting again if there is periapical infection. In fact pulp exposures in deciduous teeth in children can cause problems, quite big ones, and they are treated in various ways, including endodontics, when necessary.

Two very obvious differences in humans. One is that for a very good reason making a gap (that's not going to be filled rapidly by a permanent successor) is a very bad thing to do. The other is that a human tooth is going to be monitored closely by its owner!

[/quote]

I believe he had pulp exposure, it was fractured near the gum margin (which then receded). He had a very sad face when they probed it and asked if it hurt, the open surface was red and looked bloody.

RE: Fractured deciduous canine

Rob Davis — Thu, 17 Jan 2019 15:25:08 GMT

[quote user="emma o'connor"]

I've been following this thread with interest as this has happened in my owner labrador pup. I only noticed the fractured deciduous canine when she was around 16 weeks old because she attempted to mouth on my arm and it felt a bit sharp! I took the approach to monitor and she is now 21 weeks old with a half erupted permanent canine and the broken deciduous fragment is loose but not fallen out yet. She is eating fine (yes i know she's a lab!!!) but i regularly check for any pain around the tooth or redness and swelling and so far no signs of any problems. I intend to continue monitoring and if the fragment hasn't fallen out by the time the permanent canine is fully erupted I will remove it.

[/quote]

I don't think this is unreasonable at 16 weeks. I would probably have extracted it in my own puppy, but I don't think you've done the wrong thing!

RE: Fractured deciduous canine

Rob Davis — Thu, 17 Jan 2019 15:23:21 GMT

[quote user="roland bulkyn-rackowe"]Is it very different in humans?[/quote]

The enamel is much thicker in human teeth making uncomplicated fractures (i.e. fractures without pulp exposure) more likely. I suspect your son didn't have exposed pulp, otherwise I would expect endodontic treatment would have been advised.

It would be almost impossible to fracture a canine deciduous canine (!) at 12 weeks without exposing pulp, hence the different advice.

RE: Fractured deciduous canine

Evelyn Barbour-Hill — Wed, 16 Jan 2019 16:51:21 GMT

[quote user="roland bulkyn-rackowe"]

[/quote]

RE: Fractured deciduous canine

emma o'connor — Wed, 16 Jan 2019 12:42:42 GMT

RE: Fractured deciduous canine

Roland Bulkyn-Rackowe — Wed, 16 Jan 2019 11:11:22 GMT

RE: Fractured deciduous canine

Evelyn Barbour-Hill — Tue, 15 Jan 2019 21:57:01 GMT

[quote user="David Mills"]Do you think people should be "scared" after attending cpd?[/quote]

They might be, if they weren't that interested in the subject in the first place.

Or of course if the CPD were bad.

RE: Fractured deciduous canine

David Mills — Tue, 15 Jan 2019 21:37:26 GMT

[quote user="Evelyn Barbour-Hill"]I can't see the analogy, myself. [/quote]

Do you think people should be "scared" after attending cpd?

Are we a results or process based profession?

RE: Fractured deciduous canine

Evelyn Barbour-Hill — Tue, 15 Jan 2019 18:10:16 GMT

[quote user="David Mills"]Leave it well alone.[/quote]

Why?

True, if you know you aren't any good at extracting deciduous teeth, or you are just scared of it, you could monitor and hope that the tooth will be naturally shed before there's any obvious trouble with it.

"Leave well alone". But it isn't well, is it? It's broken and there are consequences.

[quote user="David Mills"]cruciate CPD sometimes. I've been on the latter a few times where the take home message was don't dare touch anything over 30kg without a TPLO. No mention of TTA, MMP, or anything else. [/quote]

I can't see the analogy, myself.

[quote user="Neil Wheadon"]I think that David and I are in effect asking the same thing[/quote]

No, Neil, I think you are moving on to a wider question about deciduous canine teeth in general as opposed to a broken one.

[quote user="Neil Wheadon"]I am convinced that many temporary canines are not removed in total yet we see no issues with them, in fact dinovets just snap them off, they are removed too fast after a neuter especially if 4 are present. [/quote]

I've no doubt this is true. There's an awful lot of incompetent dentistry still going on. If you are going to extract these teeth at a neutering, find out how to do it and allow sufficient time to do it.

The resorptive process goes on so in the long run it doesn't matter, but as I said I have seen reactions and adverse effects around snapped-off deciduous canine roots left behind. This is going to be especially likely if you do it with a broken deciduous canine that already has a necrotic pulp.

[quote user="Rob Davis"]it is easy to get away with poor dentistry[/quote]

And there's a lot of it about.

RE: Fractured deciduous canine

Rob Davis — Tue, 15 Jan 2019 09:50:13 GMT

[quote user="Neil Wheadon"]

I think that David and I are in effect asking the same thing

I am convinced that many temporary canines are not removed in total yet we see no issues with them, in fact dinovets just snap them off, they are removed too fast after a neuter especially if 4 are present.

In adult teeth, yes roots cause pain, but do temporary teeth long term or do the roots continue to cause an issue or are they resorbed? The resorption is surely easy to ascertain, more vets are taking digital X-Rays, are they being seen?

Neil

[/quote]

I'm sure that you are right and root fragments are sometimes left behind following deciduous extractions. If the tooth is vital at the time of attempted extraction (i.e. if there is live pulp within it) then I would expect there to be more pain immediately post-op than if the tooth has been completely extracted. It is quite possible (?likely) that these remaining remnants will commonly be reabsorbed over a period of time and essentially sort themselves out, but to me that isn't an excuse for not trying to do the job properly in the first place.

Even with good technique, roots will occasionally fracture during extractions. I will extract those fragments if I can, but there are occasions when I decide that retrieving the root is more likely to cause problems than leaving it. The owner will be informed that I have made a decision to leave the root remnant and will be warned that it could cause problems requiring extraction in the future.

Tooth resorption in cats will often "sort itself out" if left long enough, but I hope none of us think it's right to leave that without treatment.

I think the problem is that it is easy to get away with poor dentistry because our patients hide oral pain so well.

RE: Fractured deciduous canine

Neil Wheadon — Tue, 15 Jan 2019 08:50:17 GMT

I think that David and I are in effect asking the same thing

Neil

RE: Fractured deciduous canine

Rob Davis — Tue, 15 Jan 2019 08:44:42 GMT

[quote user="David Mills"]

Leave it well alone.

I do feel that dental CPD is a bit like going on cruciate CPD sometimes. I've been on the latter a few times where the take home message was don't dare touch anything over 30kg without a TPLO. No mention of TTA, MMP, or anything else.

[/quote]

Are you suggesting it would be wrong to remove it? Both Evelyn and I have suggested that we would extract, but monitoring is not necessarily wrong at this age. What would your advice be if this was an adult tooth?

RE: Fractured deciduous canine

David Mills — Tue, 15 Jan 2019 00:52:45 GMT

Leave it well alone.

RE: Fractured deciduous canine

Evelyn Barbour-Hill — Tue, 15 Jan 2019 00:37:33 GMT

[quote user="ebedford"] So you wouldn't use a drill at all for the bone in an open extraction?[/quote]

No.

RE: Fractured deciduous canine

ebedford — Mon, 14 Jan 2019 23:54:31 GMT

Thank you, that's very helpful. Definitely is an awkward age! So you wouldn't use a drill at all for the bone in an open extraction?

RE: Fractured deciduous canine

Evelyn Barbour-Hill — Mon, 14 Jan 2019 22:42:57 GMT

If the pup is three months old, you are rather betwixt and between. A little younger and I'd say definitely extract. A little older and there's no point because the thing is going to be shed soon anyway. So with this one, if you really don't fancy extraction you can afford to just monitor.

I would extract it because it may be painful and it may develop periapical infection (not necessarily an abscess). If it's gone black inside it won't be painful until it develops periapical infection. I recall one that wasn't even known about until there was a hugely swollen lymph node in the neck.

We've had a thread on extracting deciduous incisors before. It's not super-difficult as long as you use correct technique and are patient.

If you haven't got a fine Fahrenkrug elevator and a thin sharp luxator, or you haven't much experience, do it via a flap. The quantity of bone you need to remove is very small: just flick the lateral shell of bone away from the tooth with a thin instrument. When you get good at it, you can extract the thing "closed" if you like .

Several rules: 1) make sure you are familiar with the size and shape of the tooth and where the root lies; 2) don't use forceps, don't even have any forceps anywhere remotely within reach; 3) be patient, very patient.

(When you get as good as me you are allowed to use forceps after an initial loosening )

When you do it properly the risk of damaging the permanent successor is slight.

[quote user="Neil Wheadon"]The thought I can't get away from is 'Has anyone actually seen an issue with a mouth where half the temp canine is left in?' [/quote]

Yes. Though it resolves soon enough as the natural resorption proceeds. The main issue is that if you leave half the tooth in you've wasted your time and might as well not have bothered. Still, I guess it's achieved the cosmetic effect desired.

[quote user="ebedford"]since it isn't bothering the dog at the moment[/quote]

Oh, the times one hears that. It's not a good excuse. You know that.

RE: Fractured deciduous canine

Neil Wheadon — Mon, 14 Jan 2019 19:56:17 GMT

I watched a CPD video the other day on deciduous canines (and as with all dental CPD, it scares the life out you, avoid that, do that etc) and the pressing point seemed to be that the roots were very long and that levering on the erupting canine with a very wide pulp cavity would court disaster.

However in the other world I live in, temporary canines are pretty common, yet they are removed pretty quickly, though how complete I don't know.

The thought I can't get away from is 'Has anyone actually seen an issue with a mouth where half the temp canine is left in?'

Neil

RE: Fractured deciduous canine

ebedford — Mon, 14 Jan 2019 19:39:09 GMT

Thanks, that's very helpful. Is the damage caused to the adult tooth by an abscess worse than the damage to the tooth caused by extracting and removing bone for an open extraction?

I do often remove retained deciduous teeth from 6 months old, never with open extraction actually... Is it more difficult to do it without causing damage in a 3 month old tooth without an erupted adult tooth?

RE: Fractured deciduous canine

Rob Davis — Mon, 14 Jan 2019 17:28:49 GMT

Personally I would extract. There will be exposure of pulp which will be painful even if that is not evident. I have seen these abscessate fairly quickly which can then cause damage to the unerupted adult teeth.

These extractions can be tricky - at 3 months the teeth are still fairly fragile with relatively thin dentine and you are right to be concerned about damaging the unerupted adult teeth. I always do open extractions and avoid instrumentation on the lingual/palatal aspect with anything other than a very fine periotome. I would radiograph if possible so you know what you are trying to remove, the roots are surprisingly long and tend to be orientated more caudally than most people expect.

I do not believe there is a particular risk in anaesthetising a 3 month old puppy. I frequently extract deciduous teeth at this age or younger, though more commonly because of malocclusion rather than fracture.