CERTIFED ORAL PAIN FREE-TREATING PULPITIS-Number #49




Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
P- 1-800-838-3368
F- 203-877-830l
E-Mail DonDeForge100@gmail.com
SilverSandsVeterinary.com
SilverSandsVeterinary.blogspot.com
Januar 2020-Number 49





CERTIFIED ORAL PAIN FREE~
TREATING PULPITIS IN THE DOG~
REVERSIBLE v IRREVERSIBLE PULPITIS~
REMOVAL OF PULPITIS PAIN~

Pulpitis by definition is inflammation of the tooth pulp. The pulp is the inner part of the tooth that consists of blood vessels, nerve endings, lymphatics, and connective tissues. In DOGS AND CATS, the most common reason for pulpitis is trauma to a tooth.  This is initiated by either blunt trauma or chewing on items that are too hard. 

Common Hard Chew Materials to be AVOIDED
Rawhides
Pig Ear
Cow Hoof
Antler
Bully Sticks
Baked Bones
Raw Bones
Butcher Bones
Hard Plastic Toys
Hard Rubber Toys
Chewing on rocks and sticks

Trauma Emergencies -Unavoidable

Baseball bats
Lacrosse sticks
Tennis rackets
Field Hockey sticks
Hockey sticks
Automobile Accidents
Jumping out of windows of home or cars
Runnning into walls
Jumping off decks
Forceful door closures with direct hit to the face
Rough play with children-tug toys or catching hard toys


The dog or cat with pulpitis can present to the LDVM with a myriad of tooth colors:
Pink
Red
Red Blue 
Gray
Dark Blue gray
Yellow Red
Purple
Brown

 The color change is a result of hemorrhage and the bursting of red blood cells within the tooth. Because the pulp is enclosed within a hard rigid chamber...... any inflammation can rapidly increase inner pressure and restrict blood flow.   


The breakdown products of Hemoglobin from lysed Red Blood Cells diffuse from the pulp into dentinal tubules to just beneath the enamel.  

This is what causes the tooth to become discolored.  Reversible Pulpitis is seen most frequently as a red to pinked area on the coronal tooth surface or beyond.  Irreversible pulpitis can change from pink to one of the colars above as pulp necrosis continues.

Pulpitis a Painful Condition:
Swelling within an enclosd structure results in damage to other soft tissues within the area.  It is postulated, based on the human model, that nerve fibers within the pulp may transmit sharp pain.  Once pulp necrosis continues within the tooth, the pain may lessen until a periapical abscess at the root apex occurs................. causing even greater pain!

Treat Early and Treat Aggressively

Pets with oral pain exist each day with "bad pain"!  This means that the pet you love is feeling pain but goes on with their life thinking there is no life other than living in pain.  

This is the exact reason to consult an animal dentist early on and not wait until a periapical abscess occurs leading to further pain. 

The Pulpitis Hunt:
Reversible v Irreversible

Usually pulpitis can be determined visually. If the tooth appears intrinsically discolored (a color change from within, not on the exterior), then pulpitis has occurred. 

Comprehensive Oral Radiology Evaluation and Treatment [CORET] must be initiated to help assess the tooth status.

One animal dentist reports that in 42% of discolored teeth.............. dental x-rays appear pathology free.  Apical changes are not present.  The assumption is that dental x-ray changes come long after pulp inflammation and necrosis.

Forming a Partnership with your Animal Dentist:

Reversible Pulpitis:
There is mixed data on which teeth will respond to medical treatment for acute pulpitis.  It is this author's opinion that age is not as nearly important as early recognition of the problem. When the tooth that was normal yesterday is pink or light red today........call your LDVM or Animal Dentist immediately.  Many of these patients when placed on systemic antibiotics; anti-inflammatory medicine; and analgesics will return to normal in 90 days.  Others will not as the pathology continues to progress.

Patients undergoing therapy for reversible pulpitis should have baseline dental x-rays with repeat x-rays in 6-12 and 18 months.

Irreversible Pulpitis:

Unfortunately, most of the  pulpitis cases are irreversible!
In these patients, endontic treatment-i.e.-Root Canal Therapy is indicated.  If dental x-rays show that Root Canal Treatment is possible the pet owner should be given this option.

Extracting teeth that do not need extraction is invasive surgery and only should be advised if the client refuses referral to an animal dentist for endodontics.

Not treaing Irreversible Pulptiis leads to periapical bone loss; root resorption; and fistulous tracts. Pain is associated with the progression of this process.


Questions?
Contact Dr. Don DeForge
Fellow of the Academy of Veterinary Dentistry
DonDeForge100@gmail.com

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