August 2009
Dr Gerhard Steenkamp

You inspect the following 2 patients:

1 A 25 year –old elephant bull, which has fractured its tusk 5 months earlier.  The owner describes that the bull was fighting with another bull, when the tusk broke.  There was a little bit of bleeding immediately after it happened but the animal seemed fine since.  Recently it looked as if puss was starting to drain from the fracture site (crack)

2 A 3 year-old Bulterrier that was involved in a fight.  You inspect the mouth and see 2 fractured teeth (201. 103).

a What do these teeth have in common?
b How do these teeth differ?
c What treatment is required in both cases?

Memo

a If blood is visible on the tooth or the fractured piece of tooth (tusk) it means the pulp was exposed.  The exposed pulp will become infected, and therefore require treatment before infection sets in. Please be aware that both forms of teeth have a dense nerve innervation and all previous report that elephant tusks do NOT have nerves was proven wrong!  The presence of nerves in teeth means extreme pain when exposed and treatment as soon as possible is therefore crucial in both cases.

b Elephant tusks are continuously growing teeth, called elodont teeth.  Germinal layers at the base of the tusk carry on with dentin (ivory) production throughout the life of the tusk.  The pulp is conical towards the incisal/coronal aspect and very often extends beyond the lip margin.  Pulp volume increase throughout the life of bulls, but reaches a plato in cows around 30 years of age.  Although the pulps in elephant are much bigger compared to that of a dog, it will struggle to overcome infection, but may take much longer to die.
 Dog teeth are called brachyodont (meaning teeth with a short crown:root ratio) and therefore the teeth are of a set size and will not continuously grow throughout the life of the tooth.  The pulp is small and decreases in size as the tooth matures.  It therefore has a limited ability to respond to trauma and infection.

c In elephants the tusk needs amputation and the pulp cleaned until healthy pulp is reached before closing the tusk again.  If too much pulp has been destroyed, extraction of the affected tusk is advocated.  No complete root canal therapy is possible on elodont teeth.

In dogs a similar procedure (called a partial pulpectomy or vital pulpotomy) can be done within the first 24 hours after trauma.  Thereafter a complete root canal therapy is advocated.