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Bonded extract or not to extract?

Have you ever contacted the veterinary practice where you normally take you fur kid(s) and requested an appointment with their regular veterinarian only to be told he/she is away on a conference? Have you ever wondered exactly what this means? Well, at Chester Basin Animal Hospital, it means that the veterinarian has taken time away from practice to attend a course or a series of lectures where they are able to learn new skills in a particular area of practice, or to be kept up to date with the latest advances in every day practice.

For example, last fall Dr. Welland traveled to Minneapolis to attend the 2016 Veterinary Dental Forum. While there, she was enrolled in approximately 20 hours of lectures and 8 hours of hands on “wet labs”. At one of the hands on labs, she learned about bonded sealants and how to use these in practice.

Bonded sealants are used to treat small chips or fractures on teeth where there has been no direct exposure to the tooth pulp. This type of fracture is called an uncomplicated crown fracture. Although it may appear very minor, this type of fracture removes the enamel and exposes the underlying tooth structure known as dentin. Dentin is a layer of living tissue with tiny tubules (dentin tubules) that communicate with the nerve (root) of the tooth. Exposed dentin can lead to the following problems:

  1. Pain or sensitivity similar to the sensitivity humans feel with gum recession or deep cavities.

  2. Infection of the root canal system. When dentin is exposed bacteria can gain access to the dentin tubules that run from just beneath the enamel all the way down to the root canal.

  3. Periodontal disease. When a chip or fracture occurs, enamel is removed and the surface of the tooth becomes rougher, allowing plaque and tartar to accumulate more readily. This can contribute to a more rapid onset of periodontal disease.

Last week, Dr Welland performed her very first bonded sealant procedure. Kaluah, a 4 year old American Pit Bull Terrier suffered a fracture involving one of her upper incisor teeth. The tip of the incisor tooth had been chipped off. Fortunately, the fracture did not expose the root canal or pulp, and the tooth was found to be stable on x-ray with no evidence of periodontal disease. After discussion with the owner, it was decided to treat the tooth with a bonded sealant rather than extract it.

Following a complete oral health assessment and treatment (COHAT) where Kaluah’s teeth were cleaned and polished, a full mouth series of dental x-rays were taken, and a full assessment of the teeth and soft tissues of the mouth was conducted, Dr Welland set out to address the fractured tooth.

First, the tooth was smoothed and reshaped using fine sanding discs. Following this, the tooth was cleaned and dried. An acid etch was then applied to the tooth to help promote adherence of the other materials used. Then, a bonding agent was applied which filled the dentin tubules and blocked the pathway for infection. Lastly, the tooth was sealed with an unfilled resin (similar to clear nail polish) and light cured to allow it to harden.

Before and after treatment. The affected tooth is circled in each picture. IMAGE 1 shows the fractured tooth before treatment. Note the rough, jagged edges of the tooth in IMAGE 1. IMAGE 2 shows the tooth following treatment. Notice the more smooth appearance of the tooth surface. As well, the original shape of the tooth has been mostly restored.

By carrying out this procedure on Kaluah’s fractured tooth, she not only got to keep her tooth, but we also hope to have reduced any sensitivity she may have been feeling from the exposed dentin, blocked the pathway for future infection of the root canal, and smoothed the tooth thereby decreasing the chance of developing periodontal disease.

Without the special training Dr. Welland received at the Dental Forum, we would not have been able to perform this procedure, and the only option for treatment of Kaluah’s tooth would have been to extract it.

#tooth #oralpain #bondedsealant #animaldentistry

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