January 2005
Dr Gerhard Steemkamp

A 3 year-old Boerboel is presented with a fractured tooth after it was involved in a dog fight, 3 hours earlier.

A What is your diagnosis?

B Is treatment required?

C What treatment options are available?

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Memorandum

A Complicated crown or crown-root fracture, extending subgingivally.

B In this case the pulp is exposed (therefore complicated fracture). Exposed pulp will undergo pulpitis and pulpnecrosis, leading to periapical cyst, granuloma or abscess formation. In severe or longstanding cases osteomyelitis may develop around the apex. No tertiary dentin will seal the pulpcanal and if no treatment is started the consequences as mentioned above will follow.

C Treatment is aimed at:
Saving the tooth -If presented as in this case, within the first 24 hours a
partial Pulpectomy can be done.
Saving the tooth - Perform conventional root canal therapy if presented after
24 hours.
Placing of a steel crown after the tooth was appropriately treated is optional
and often only indicated in working dogs.
Extracting the tooth - preventing any of the complications as discussed
previous.
Pain relief - Non steroidal anti-inflammatory drugs like Carprofen.
Infection control - Appropriate antibiotics for the oral cavity should be used
for 5 - 7 days, like Amoxycillin or Amoxycillin/Clavulanic acid combination.

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