Pediatric dentistry: An overview of common problems you'll see in practice - Veterinary Medicine
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Pediatric dentistry: An overview of common problems you'll see in practice
Can you readily identify persistent deciduous teeth, malocclusions, and unerupted teeth in puppies and kittens? If these and other oral conditions are caught early and properly treated, you can help start patients on the right path toward good lifelong dental health.


VETERINARY MEDICINE


Treatment


Dental terms and definitions
Deciduous tooth extraction can be difficult because of the considerable length and thin walls of deciduous teeth (Figure 3). Resorption and ankylosis of the persistent deciduous teeth can further complicate extraction. Consequently, deciduous tooth root fracture is common during extraction attempts. When fracture occurs, make every effort to remove the root apex as it may become infected or act as a foreign body, leading to marked inflammation.4 Clinical signs are rarely associated with deciduous tooth root fracture, but the patient will experience severe pain from the exposed nerve, which will then become a source of chronic bacterial infection following tooth necrosis. Since a retained root tip is sufficient to deflect the permanent tooth from its normal eruptive path, complete removal is even more critical in cases of interceptive orthodontics (see "Dental terms and definitions").4

Deciduous tooth extractions should be done carefully to avoid damaging the permanent tooth.2 Some veterinary dentists surgically extract these teeth to decrease the possibility of causing iatrogenic damage. Obtain a postoperative dental radiograph to confirm complete extraction of the deciduous tooth as well as to document the continued presence and proper condition of the permanent tooth.

FRACTURED DECIDUOUS TEETH

Any deciduous tooth can fracture, but fracture of the cuspids is by far the most common. The fracture is almost always traumatic in origin (e.g. caused by being hit by a ball, bat, or car; falling; or abnormal chewing behavior). Deciduous teeth are longer and have thinner walls than their permanent counterparts, so they are more prone to fracture.5 In addition, the relatively larger size of the pulp chamber ensures that almost any deciduous tooth fracture will result in pulp exposure.4

Diagnosis

On oral examination, a fractured deciduous tooth will be shorter than the contralateral tooth and the pulp will be evident. If the fracture is fresh, it will be pink and may be bleeding (Figure 4). Because of the large size of the endodontic system, pulp infection and abscessation occur quickly.5 If abscessation has occurred, the pulp will be dark-brown or black, and a draining tract may be present at or near the root apex (Figure 5). These abscesses drain directly onto the crown of the developing permanent tooth, which may result in damage such as enamel hypocalcification.5,6

Evaluate dental radiographs of the fractured tooth to ensure that it is a deciduous tooth and to determine deciduous root presence and integrity, as well as the proximity of the permanent tooth.5 Commonly, the roots will be undergoing resorption, making extraction challenging.

Treatment




Extracting the fractured tooth is the treatment of choice. Extraction will alleviate the pain and potential infection from the exposed dental pulp. If deciduous tooth extraction will result in the loss of a valued dental interlock, vital pulp therapy or root canal therapy may be performed.4 An additional benefit of endodontic therapy is the avoidance of scar formation, which could result in an impacted permanent tooth.


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Source: VETERINARY MEDICINE,
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