Mestre pelo Departamento de Cirurgia da FMVZ-USP; Sócia-Proprietária do ODONTOVET, Centro Odontológico Veterinário, Butantã, São Paulo, SP, Brasil
An emergency is a sudden occurrence that requires immediate action. The urgent situation can be classified in two situations: emergency for the tooth or emergency for well-being of the patient.
Any time the endodontic system of a tooth is exposed, inflamed, infected or injured whether in a primary or permanent, or mature or immature tooth, it required appropriate treatment. While extraction is always an option for removing the potential source of chronic infection, in young permanent teeth the alternative selected depends principally on viability of the pulp, attempts to keep it vital if possible, and the extend of root maturation. The location and stage of progression of dental disease can be important in treatment planning and prognosis. Immature teeth with pulpal exposure are treated according to the severity and origin of the exposure. Treatment is designed to produce additional growth to extend that maturation is possible. Therefore, time spent between trauma with broken crown and pulp exposure and endodontic treatment (pulp capping or vital pulpotomy) must be as short as possible to secure vitality of a permanent immature. Time plays a key role in these cases. A common misconception is that vital pulpotomy can be performed only in cases of recent (within a few hours) pulpal exposure or coronal fracture. The younger the tooth (and wider the root canal), the longer is the period when vital pulpotomy is a feasible procedure. An open pulp cavity allows bacteria to enter the pulpal tissue, resulting in pulpal inflammation and pathology. The goal of vital pulpotomy is to remove the inflamed pulp and after hemorrhage is controlled, calcium hydroxide is placed on the pulp (pulp capping) to promote a dentinal bridge formation and closure. Vital pulpotomy must be performed as a sterile procedure. Antibiotics therapy should be used: a high blood concentration of ampicillin prevent contamination of pulp tissues during the procedure. While keeping the pulp viable for the life of the tooth is the ideal objective in performing a vital pulpotomy and pulp capping, it should be noted that a certain percentage of teeth treated in this manner will ultimately fail requiring an addition endodontic therapy or extraction.
Another condition that requires immediate action is the tooth avulsion or luxation. Avulsion by definition is the separation of the tooth from its alveolus. Implantation of the avulsed tooth is the return to is alveolus and this should be done as soon as possible, with adequate splinting for 4 to 6 weeks. While the treatment is not performed, the tooth should be kept moist in milk or saline. Complications of reimplantation include internal and eternal resorption, ankylosis. Luxation is described as the dislocation of a tooth out of is alveolus without being totally avulsed from the mouth. Luxation includes extrusive, intrusive and laterally luxated teeth. The principle of treatment is the same as for avulsed teeth, except the prognosis usually is better with luxated teeth because less periodontal tissue damage. In both situations, a root canal treatment with calcium hydroxide obturation is performed no sooner than 2 weeks and a convention root canal procedure is performed several months later.
In advanced periodontal disease, when teeth are loose, they can luxate, notably upper molars, and interfere with the occlusion. In those cases, the animal is not able to close the mouth and present discomfort. If not possible to do a periodontal treatment, at least, the teeth evolved should be extracted.
Jaw fractures are common in dogs and cats. They results from external trauma (typically automobile accidents, falling from height, backward kick and others injuries) or from periodontitis or neoplasia predisposing the animal to pathologic fractures. Most fractures in dogs affect the mandibular body. In the cats, the most common site is of fracture is the symphyseal area. Maxillary fractures are less common. After emergency treatment of airway obstruction and hemorrhage, the priorities for management of mandibular and maxillary fractures are, first, to restore animal's ability to use the tongue and close its jaws sufficiently for swallowing to occur. Second: to restore the ability to completely close its jaws in a comfortable position, and third to restore normal occlusion.
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