Root Canal Therapy
Dogs and cats break teeth. It's a part of life. What to do with the broken tooth is a part of my life as a veterinarian. Depending on the type of fracture, therapy may or may not include root canal therapy or extraction. An uncomplicated fracture is one in which the pulp within the root canal is not exposed to the mouth. These can be bonded and rechecked at the physical exam and yearly cleaning. If the pulp is exposed we call that a complicated fracture; there are only two things you can do. I can also tell what you shouldn't do with it. Don't wait and see what happens. Your dog or cat will not tell you when it hurts and you'll never know if it is infected just by looking at it from time to time. Here's a hint though: it does hurt and it's already infected.
The complicated fractured tooth either needs to be extracted or it needs root canal therapy. If the tooth is a highly strategic tooth - this includes mandibular canines and carnassial teeth in dogs or any of the four canine teeth in cats - AND the tooth is a good candidate for root canal therapy then I will recommend root canal therapy over extraction.
A root canal for a dog? That must cost thousands! It's not cheap, and it's not the option everyone is going to choose- any more than anyone really needs a top-of-the-line laptop or a car that does zero to sixty in less than five seconds. But for some people, saving a tooth or maintaining the strategic integrity of the mouth is worth a few extra dollars. I recently performed a root canal I'd like to share with you. In this dog's case the root canal itself - not including all of the other work done - came to around $450.00. Not cheap, but reasonably priced. Extracting that same tooth would have cost around $350.00 and comes with the risk of fracturing the jaw (a low risk in my hands but it is still a risk), undermines the structural ingerity of the jaw and takes about two weks to heal. I would consider mitigating those risks well worth the investment.
We start with a tooth that has been fractured. In this case it is a mandibular canine tooth.
I can get my explorer into that canal; we need to either extract or treat it with root canal therapy. We can't leave it. We also need to take an x-ray. Without x-rays there is no way to properly perform a root canal.
We're ready to formulate our plan and approach. The first thing we do is find a good working depth with a hand held file. Then we use a rotary driven file to remove all of the soft tissue and a little bit of the dentin lining the pulp canal. During this step we are constantly changing file sizes and flushing our the canal. Here's a shot of a file we are working in, we aren't quite there as far as working depth goes.
You can see the darker gray line extending beyond the end of the white file. This means there is still more root canal to file out. Eventually we did reach our working depth and completed the filing. Then we irrigate and sterilize the canal. After the canal is properly dried we place an inert substance within the canal to fill it and prevent debris from filling the canal. There are several steps, that end with us filling the hole at the top with a restorative material. The final x ray is to be sure everything looks the way we want it to.
We then took a picture of the tooth from the outside to show the resoration.
I hope you can think of root canal as an available means to deal with a fractured tooth. While it does carry a slightly higher cost than extraction, if done correctly, it carries less risk, causes less pain, requires no healing time and maintains the integrity of the mouth.
Feel free to give me a call or shoot me an email if you want more information or think your pet may have fractured a tooth.
802 773 4771 (8 am to 6 pm Monday through Friday)
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