The enamel in dogs and cats are thinner than in humans. In cats 0,1 mm to 0,03 and in dogs 0,1 mm to 0,6 mm, whereas human enamel has a thickness up to 2,0 to 4,0 mm. This means that even very small uncomplicated dental fractures cause exposure of the underlying dentine in cats and dogs.
Exposed dentine will, due the open tubules, cause pulpal pain following change in the fluid of the tubules. Dogs and cats rarely show any symptoms, when they suffer from exposed dentine.
The pulp - the dentinoblasts will try to close the exposed tubules by producing reparative dentine. Depending on the severity of the exposure, pulpitis will arise. The pulpitis can be reversible or irreversible.
Exposed dentine with less than 2 mm to the pulpal chamber can cause pulpitis. This is the case in most uncomplicated dental fractures.
The trauma that causes the fracture can also itself provoke a pulpitis and in the cases where the pulps capability to restore itself is challenged, the ongoing irritation from the exposed dentine can be the factor that leads the pulpitis to be irreversible.
In the acute phase, recently after a fracture, the evaluation of the pulpitis is not possible on x-rays. But the x-ray is needed as a baseline evaluation for comparison with follow-up x-rays later.
Depending on the age of the animal and the severity of the fracture, I recommend a follow-up radiograph of the fractured tooth in 6 months. Shorter in younger animals and more severe fractures.
The anatomy of the fractured tooth is compromised, so the tooth will always be more fragile than initially following a fracture. The missing enamel will cause the dog to be more sensitive to abrasion/attrition in the future.
Treatment aim towards sealing the exposed dentinal tubules. Before sealing, the fracture site is thoroughly cleaned. Acid etching of maximum 5 seconds on the exposed dentine and thorough rinse with water (10–15 seconds). After the preparation, a restoration is applied to the fracture site. In sites, where wear and chewing forces are small, a build up with composite can be performed. On the coronal part of canines and carnassials, a composite filling will not last. In these cases, only a very thin (flowable) composite is applied or a bonding with an adhesive containing filler particles. This will add some wear resistance to the restauration.
For better resistance to wear and new fractures, a prosthetic crown can be placed on the crown. Prosthetic treatment is more expensive, and therefore, less frequently chosen as a treatment in our clinic.
If we see a fracture very close to the pulp (and the fracture is fresh, <48 hours), I prefer to do a partial pulpectomy with MTA, since I find the prognosis better with this treatment.