ISSN 2398-2977      

Teeth: fracture

pequis

Introduction

  • Cause: trauma (external, iatrogenic, bit-related); idiopathic; secondary to caries.
  • Signs: head shaking, halitosis, draining sinuses, nasal discharge, swelling, quidding.
  • Diagnosis: radiography.
  • Treatment: conservative, surgical.
  • Prognosis: good.

Pathogenesis

Etiology

  • Trauma:
    • External, eg kick.
    • Bit-related.
    • Iatrogenic - dental, or surgical procedures.
  • Idiopathic - hypothetically due to enamel, dentine or cement defects.
  • Secondary to caries   Teeth: caries - infundibular cement  .

Pathophysiology

  • Incidence somewhere between 0.71 and 3.5%.
  • Fracture   →   exposure of pulp cavity   →   impaction of feed and plant material   →   infection and dental decay   →   pain, swelling, dysphagia, halitosis   →   abnormal wear   Teeth: abnormal wear  .

Mandibular cheek teeth

  • External trauma   →   loosening or fractures involving the pulp cavity of the cheek teeth +/- mandibular fractures   Mandible / maxilla: fracture  .
  • Misuse of the bit:
    • Loss of canine and first cheek tooth.
    • Mandibular osteitis and interdental sequestration to involve the alveolus of the first cheek tooth   →   apical infection.
  • Dental procedures:
    • Dental shears (now obsolete): mistaken normal curvature of caudal mandibular occlusal surface for overgrowth   →   oblique cut across crown   →   exposure of pulp;
    • Inappropriate shears   →   fracture and secondary dento-alveolar infection; surgical procedures   →   accidental fracture during retropulsion of adjacent cheek tooth.
    • Aggressive technique   →   dental fracture   →   pharyngeal/mandibular cellulitis.
  • Surgical procedures:
    • Mistaken identity of cheek tooth for repulsion   →   damage to healthy tooth - more common in maxillary than mandibular cheek teeth.
    • Misplacement of extraction forceps resulting in fracture of adjacent tooth during oral extraction.
    • Misplacement of molar spreaders, ie not in interproximal space.

Maxillary cheek teeth

  • External trauma   →   fracture +/- maxillary, malar fracture   Mandible / maxilla: fracture  .
  • Iatrogenic   →   damage to apices and reserve crowns during surgical repulsion of adjacent teeth.
  • Extension of infundibular caries into dentine, coalescence of rostral and caudal infundibula   →    saggital fracture.
  • Buccal slab fractures fairly common, primary or secondary to non-vital pulp exposure of buccal pulp.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Tremaine H & Pearce C (2012) A modern approach to equine dentistry 4. Routine treatments. In Pract 34 (6), 330-347 VetMedResource.
  • Tremaine H & Casey M (2012) A modern approach to equine dentistry 2. Identifying lesions. In Pract 34 (2), 78-89 VetMedResource.
  • Cook W R (2011) Damage by the bit to the equine interdental space and second lower premolar. Equine Vet Educ 23 (7), 355-360 VetMedResource.
  • Dacre I, Kempson S & Dixon P M (2007) Equine idiopathic cheek teeth fractures. Part 1: Pathological studies on 35 fractured cheek teeth. Equine Vet J 39 (4), 310-318 PubMed.
  • Dixon P M, Barakzai S Z, Collins N M & Yates J (2007) Equine idiopathic cheek teeth fractures. Part 3: A hospital-based survey of 68 referred horses (1999--2005). Equine Vet J 39 (4), 327-332 PubMed.
  • Taylor L & Dixon P M (2007) Equine idiopathic cheek teeth fractures. Part 2: A practice-based survey of 147 affected horses in Britain and Ireland. Equine Vet J 39 (4), 322-326 PubMed.
  • Dixon P M et al (2000) Equine dental disease Part 3 - a long-term study of 400 cases - disorders of wear, traumatic damage and idiopathic fractures, tumours and miscellaneous disorders of the cheek teeth. Equine Vet J 32, 9-18 PubMed.
  • Lane J G, Gibbs C, Meynink S E, Steele F C (1987) Radiographic examination of the facial, nasal and paranasal sinus regions of the horse - I. Indications and procedures in 235 cases. Equine Vet J 19 (5), 466-473 PubMed.

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