Enamel loss exposing the underlyinmg dentine which is sensitive
to touch, chemicals, osmotic pressure etc.

Tooth Damage

External damage!

When there is loss of enamel from the tooth surface the underlying sensitive dentine is exposed. In dogs and cats the enamel is very thin, so even minor enamel damage can be a serious and painful problem. In this situation surface sealing or restoration is needed. When dentine exposure is gradual, as with most forms of tooth wear, its exposure is not so serious. The dental pulp can detect changes in teh outer layers of the tooth and providing it has not been previously damaged it seals off the surface layers of dentine and produces new dentine below areas of irritation so reducing sensitivity.

Wear on the palatal surface of the upper canine tooth
caused by a maloccluded lower canine tooth. The pulp has been exposed.

However, tooth wear from prolonged contact with opposing teeth (i.e. when there is a malocclusion present) or with abrassive substances (such as stones and the grit impregnated felt of tennis balls) wear can exceed the pulp's capacity for sealing and production of new dentine. Sensitive dentine is then exposed, with the possibility of the pulp becoming exposed, infected and dying; the result of which is periapical disease and root abscessation. If the pulp has been exposed, whatever the cause, then either endodontic treatment or extraction is indicated.

Loosening of teeth !

It is not uncommon for teeth to be broken or loosened in accidents or fights. These teeth need treatment. Loosened teeth can often be saved by splinting them back into position. The periodontal ligament will then heal providing it has not been totally destroyed or become badly contaminated. Even teeth that have only been slightly loosened are likely to have lost their blood supply, so endodontic treatment is required to prevent problems due to the death of the pulp.

Pink, brown or grey discoloration of a tooth is usually due to
loss of blood supply and death of the pulp. This worn tooth has been endodontically treated.

The knocked out tooth!

If an otherwise healthy tooth is knocked out, as sometimes happens in accidents, it may be possible to save the tooth if the delicate root surface is not too badly contaminated or damaged. Reimplantation, splinting and root treatment may save the tooth if performed soon after dislodgement.

Avulsion and intrusion of a dog's upper canine tooth into the nose.
The the socket wall is fractured and the gingiva torn.

Handling avulsed teeth:

• Only handle the dislodged tooth by the shiny crown surface. Do not touch the root.

If it is your own or a child's tooth and the tooth is not damaged or contaminated then the best action is to re-insert it into its socket (if this proves difficult or painful then the tooth should be kept in the side of the person's mouth away from other teeth, so it is bathed in saliva) and go to see a dentist ASAP

• If the tooth is badly contaminated, rinse it briefly in sterile saline or luke warm water
  
• Place the tooth in a small container of:: a. specially formulated tooth storage solution if available (stocked by some pharmacies and sports centres) or b. cool low fat milk
  
• Obtain professional assistance as soon as possible

Even if a tooth is moderately contaminated it may be possible for it to be cleaned sufficiently for reimplantation, but the success rate is much lower than for minimally contaminated teeth.

Once reimplanted, the tooth usually needs to be splinted into position so that it can re-attach itself. The blood supply to the dental pulp is severed by the injury and the pulp dies, becoming an ideal site for bacteria to grow. Antibiotics are indicated at the time of re-implantation to control periodontal infection, but they do not penetrate into the dead pulp and infection builds up there. This is dealt with by endodontic treatment, removing the pulp and replacing it with inert filling material. This is normally done 1-2 weeks after re-implantation and splinting, allowing time to assess whetehr there is early failure of reimplantation. Unnecessary delay beyond this stage increases the risk of failure.

Unless the vet has had special training in advanced dental techniques, he/she will need to refer the case to a specialist veterinary dentist for appropriate splinting, endodontic assessment and root treatment.

The tooth has been correctly replaced in the socket
and splinted using dental acrylic

The shorter the period the tooth has been out of its socket, and the less degree of contamination and damage to the periodontal tissues on its surface, the greater the chance of the tooth healing back in position. Because there is a risk of root infection or resorption, all re-implanted teeth need to be checked radiographically at intervals after the initial treatment.

If your veterinary practice do not know who to refer specialist dental work to, in the UK they can refer to the Royal College of Veterinary Surgeons register of specialists.

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