Wednesday, January 29, 2020

CERTIFED ORAL PAIN FREE~Demystifying Root Canal Strategies-Number #47

Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
P- 1-800-838-3368
F- 203-877-8301
Number 47 Jan 2020

       X-ray showing a Completed Root Canal in a Canine Tooth After Debridement and Obturation

Image result for Picture of an endo file in a dog's canine tooth

Root Canal Strategies

demystifying endodontic myths

Root canals preserve the function of the tooth. They involve little to no discomfort to your pet, and are less traumatic than extraction which involves incising soft tissue and removal of bone. 

The main objectives of root canal treatment:

  • The Cleaning and Shaping of the complete pulp space
  • Obturating the canal to assure a bacterial tight seal
  • Placement of a perfect coronal restoration
  • Pre- and post digital oral x-rays
  • Follow up Endodontic X-rays in 12 months under general inhalation anesthesia
  • Antibiotic are indicated when fever or malaise are present; if there is a spreading infection; or cellulitis is present
  • Unsupported use of antibiotics contributes to the development of antibiotic-resistant bacteria
  • The choice to use antibiotics is based on a sound diagnosis and clear clinical indicators
  • General Practitioners should only perform root canal therapy by their skill; comfort level; and endodontic training with continuing education
  • Referral to an Animal Dentist is recommended in cases which are outside of the LDVM's comfort level or with lack of experience

Myths v. Truth in Root Canal Care

The root canal has become a recognized standard of care in veterinary dentistry and should always be conisdered prior to exodontia [tooth removal].  It allows patients to retain teeth that were once untreatable.

Technological advancements have contributed to the improved performance of root canal treatment.

Root canal success is not centered only on new devices and technology advancement alone.  It is based on knowledge and application of basic mechanical and biological standards.

Medical and dental history of the patient along with Comprehensive Oral Radiology Evaluation and Treatment [CORET] are the keys to endodontic treatment success. 

In some instances, endodontic disease does not show up radiographically.  It must be emphasized that hard tissues are visible with dental x-ray; soft tissues such as the pulp are not visible. 

In the dog and cat, a patient with irreversible pulpitis may have normal dental x-rays while the pet advocate describes what they consider a patient in pain at home.

As the pulp disease advances and inflammation progresses, bone resorption on x-ray becomes evident and a radiolucent area may develop periapically.

Some Oral Pain Signs in Pets that may be indicators for Endodontic Treatment:
Not eating as usual
Avoiding dry food
Flipping food to the back of the mouth and not chewing
Changes in mood or activity
Teeth grinding
Avoiding toys
Sleeping more
Conversely-hyperactivity is now being noted
Avoiding treets
Eating canned but not dry food 

After the Root Canal-Crown or Cap?
Once a root canal is completed, the tooth needs to be restored.  There are many excellent restorative materials available in animal dentistry that are being used in human dentistry. It must be emphasized in humans or animals no composite-resin restoration is considered permanent.  

All dogs have very strong chewing force and can dislodge the most perfectly placed restoration.  If the patient dislodges the restoration, it must be immediatley replaced.  

If the dislodgment is more than twice a full jacket crown or cap is always the best alternative to prevent further visits to the animal dentist.

The discussion of crowns or caps being utilized is based on the evaluation of the tooth structure by the animal dentist performing the root canal with a detailed consultation with the pet advocate.  

There are enamel colored ceramic caps; porcelain fused to metal caps; Inceram caps, and titanium alloy caps.....all available for restorative care by animal dentists after root canal therapy.

A crown or cap is designed to help minimize the risk of fracture recurrence in any patient! 

Guard dogs; police dogs; and military dogs should absolutely receive a crown in order to protect their precious and strategic dental structures after root canal therapy! 

Working dogs, hunting dogs, and large and giant breed dogs that are particularly hard on their teeth should also be considered for crown/cap restorative care. 

The indicators for a crown or cap are based on each individual pet; damage to the affected tooth; the pet’s behavior regarding oral play; rough chewing habits; and how the fracture originally occurred. 

The decision for a cap or crown is a joint decison based on patient chew history; separation anxiety problems; and/or pet advocate input.  

Board Certified Animal Behaviorists should be consulted in dogs that have aggressive separation anxiety to avoid or prevent damage to other dentition. 

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