Fractured lower canine

RE: Fractured lower canine

Gillian Mostyn — Wed, 16 Dec 2020 16:25:59 GMT

To be absolutely fair to Alex, I don't think he was in clinic so it was the receptionists telling me there would be a delay till Feb.

RE: Fractured lower canine

Gillian Mostyn — Wed, 16 Dec 2020 16:23:38 GMT

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29549/fractured-lower-canine/227266#227266"] If it's the "top third" of the tooth broken off without much splintering or any longitudinal cracks, and the fracture line is nowhere near the gum line,[/quote]

It was a very friendly and boisterous 2 year old lab with a sore mouth - I couldn't be sure of anything. I have warned them, though, that it will need dental rads and a full assessment under GA before a decision can be made about the tooth.

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29549/fractured-lower-canine/227266#227266"]Of course the tooth is best preserved. [/quote]

Anecdotally, I rarely see practices offer referral for dental issues - they don't seem to consider it an option? Like you say, extraction (or benign neglect) seems to be the only options. (Yes, I know that it isn't always benign to leave them...)

RE: Fractured lower canine

Norman Johnston — Wed, 16 Dec 2020 16:22:48 GMT

I did reply earlier but it must have got lost. This is an emergency and referral services have an obligation to see them in a timely manner. The RCVS made this clear some years back when challenged about 24 hour care for specialist clinics. I'm not suggesting we see fractured canines at 3am but as soon as physically possible is required.
Our receptionists knew that fractured teeth, fractured jaws, severe oral pain etc needed seen ASAP - no questions asked. If the day was full you moved something less pressing out or added it and worked harder that day!
If any one of us broke a tooth today, when would YOU like it dealt with?
I also take the point about pulp inflammation and pulp necrosis. What often is forgotten about is that the fractured tooth will be often have a razor sharp surface which will lacerate the tongue or overlying mucosa.
Well done Colin for seeing the case so soon and Evelyn for offering. Proper vets

RE: Fractured lower canine

Gillian Mostyn — Wed, 16 Dec 2020 16:18:04 GMT

I had assumed that Norman. Thank-you.

RE: Fractured lower canine

Norman Johnston — Wed, 16 Dec 2020 16:11:18 GMT

David retired in 2019 I think. He is on the retired list of EVDC diplomates

RE: Fractured lower canine

Rob Davis — Wed, 16 Dec 2020 16:00:17 GMT

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29549/fractured-lower-canine/227266#227266"] I still see people recommending extraction – is that what's taught at some veterinary schools? Extraction is absolutely the "if all else fails" last resort.[/quote]

I know we've been here before, Evelyn, but extraction is still much better than doing nothing, which sadly is still a common occurrence. There are not many vets who are able to offer endodontic treatment and not everybody is in a position to afford even if it is available.

RE: Fractured lower canine

Evelyn Barbour-Hill — Wed, 16 Dec 2020 15:45:40 GMT

Thanks to motorways and the A55, I'm easy to reach from Manchester...

Colin will do a good job.

Of course the tooth is best preserved. I still see people recommending extraction – is that what's taught at some veterinary schools? Extraction is absolutely the "if all else fails" last resort.

When the pulp necroses the tooth will stop hurting. I don't mean that as a reason for delay!

Even though it's a youngish dog, I would not, these days, attempt any sort of vital pulpectomy and pulp capping in such a case, unless maybe I saw the dog immediately after the incident. The chances of success are not anywhere near enough to 100%. This dog needs a "full root canal". If it's the "top third" of the tooth broken off without much splintering or any longitudinal cracks, and the fracture line is nowhere near the gum line, the procedure is straightforward and the prognosis should be excellent.

RE: Fractured lower canine

Gillian Mostyn — Wed, 16 Dec 2020 13:47:43 GMT

I used to refer to David Crossley but I don't know where or if if he's working now. I've now arranged referral to Colin so the owner is very happy - as am I. I don't know how I didn't know about him before! Thanks so much!

RE: Fractured lower canine

Rob Davis — Wed, 16 Dec 2020 10:02:35 GMT

Or David Crossley?

RE: Fractured lower canine

Rob Davis — Wed, 16 Dec 2020 10:00:09 GMT

How about Colin Baxter?

RE: Fractured lower canine

Gillian Mostyn — Wed, 16 Dec 2020 09:46:46 GMT

Tried Alex first - busy till Feb... Thanks for the advice though - much appreciated.

RE: Fractured lower canine

Rob Davis — Wed, 16 Dec 2020 09:42:34 GMT

[quote userid="2457" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29549/fractured-lower-canine"]- am I right in thinking this tooth is best preserved if it is possible?[/quote]

Yes - extraction will be much more traumatic and the tooth is functionally and structurally important so best to keep if possible.

[quote userid="2457" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29549/fractured-lower-canine"]-is this something that is best done urgently?[/quote]

The tooth will be painful in the initially stages while the pulp is still vital (if you have ever had exposed pulp you will be aware of this!). Once exposed the pulp is moribund unless treated in the first 24 hours or so. It is possible in the first few hours to perform vital pulp therapy and try to keep the tooth alive, but the success rate falls dramatically once the pulp has been exposed for more than 24 hours. Pulp necrosis may take a few weeks and there is likely to be some degree of discomfort during this time but probably gradually reducing after the initial insult. Once the pulp has died there will probably be no pain for a period until periapical disease develops at some point down the line.

The root canal treatment itself will be easier and in theory less likely to fail if done sooner as there will be less requirement for canal disinfection.

The reality is that the majority of fractured teeth in my experience are not detected by owners in this acute phase, but rather are picked up by vets during routine examinations, so most are already necrotic by the time they are treated.

[quote userid="2457" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29549/fractured-lower-canine"]are there any dental referral practices fairly local to me (Manchester area) that would be able to see this patient? I suspect the owners would be happy to travel if necessary though.[/quote]

Alex Smithson is up your way. I suspect Suffolk is a little too far to travel...