Treatment
Dental terms and definitions
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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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