# Broken Deciduous Teeth, Part Deux



## [email protected] (Nov 18, 2013)

More than a year ago one of our members posted a question about his 11 week old puppy breaking a deciduous ("baby") tooth, and wondering what to do about it. There was some discussion on the topic, and then a post more than a year later to update everyone that the adult tooth did fine with no apparent damage from the broken deciduous tooth. Since that post is now quite old, and since many of us have already read it, I have started a new post on the subject.
Deciduous teeth commonly break, and once broken they have the potential to do real damage to the adult tooth as it erupts. As an owner, this (abnormal) process needs to be differentiated from the normal process of teeth shedding. One way to do this is to determine (if possible) how severe the trauma was that lead to the loss of the tooth. Teeth that clearly get broken or torn from the gums often weren't ready to shed. Heavy bleeding often indicates a tooth that wasn't ready to shed. Also, think about the normal shedding cycle of the teeth. If your dog looses a tooth at the expected time, you are likely seeing normal shedding. If the tooth is lost too early it may be a problem. And finally, how much of the root was left behind? Normal shedding should not leave a root that you can see, nor should it leave a fractured crown. Normal loss occurs beneath the gumline, preferably far down toward the tip of the root. 
So let's start with some basic anatomy and development:

1) The adult teeth often do not come in "underneath" the deciduous teeth, nor do they necessarily "push out" the deciduous tooth/root: 








There are two things that you should appreciate in this radiograph (x-ray). First, you can see the deciduous upper canine tooth (between the arrows) with the fully erupted canine tooth sitting adjacent to it. This is a very common arrangement of these two teeth, and this same arrangement often occurs with the other teeth. Thus if a deciduous tooth does not shed normally, there is a very good chance that it will stay put indefinitely. This is a moderate problem if the tooth is still healthy. (The problem with this arrangement is that it allows food and debris to become trapped between the deciduous and adult tooth.) It is a much bigger problem if the deciduous tooth breaks.
Second, you can see that the root of the deciduous tooth is resorbing and looks weak and abnormal. This is an expected change for the roots of these teeth, and it is part of what allows them to shed normally. If you ever see a deciduous tooth that has come out, you may notice that it doesn't have a normal root (usually the root will appear short, blunted, or fragmented). Typically as the deciduous teeth age their root(s) become weak and eventually the crown breaks away, leaving some small part of the resorbing root behind. This is normal! In this case the small, degenerate portion of the root will resorb over time.
The problem comes when a deciduous tooth breaks that was not ready to shed. In this case a substantial portion of healthy root is left behind. To quote Fraser Hale (a prominent veterinary dental specialist): "_A fractured primary tooth with exposed pulp quickly undergoes septic pulp necrosis and then it is a contaminated hollow tube embedded in the face and an open pathway for bacteria to get into the jaw. The notion that it is just a baby tooth and will fall out on its own is a fallacy because often the inflammation around these necrotic teeth seems to inhibit the normal root resorption that allows the tooth to exfoliate. So the contaminated primary tooth stays in place, not only as a conduit for infection, but also forcing the adult tooth to erupt into an undersirable location._"

2) Broken deciduous teeth can permanently damage the developing adult tooth:
























These first three photos show moderate damage to the enamel of the adult teeth, all caused by broken/infected deciduous teeth. The enamel is the very hard surface of the tooth and it protects the delicate (and porous) dentin beneath it. This sort of enamel damage is not only unsightly, it opens up a conduit for bacteria to enter the tooth and cause root infections. It also substantially weakens the tooth, increasing the risk of the adult teeth eventually breaking.
















This photo and accompanying radiograph shows an adult canine tooth that underwent severely abnormal development owing to a broken deciduous tooth. In both the photo and the radiograph you can see how severely abnormally shaped the adult tooth is, and how it is starting to undergo breakdown of the crown. The enamel is almost entirely missing, and the pulp chamber is dead and exposed. This adult tooth will have to be removed. In this case the infection from the broken deciduous tooth allowed bacteria to enter the developing root of the adult tooth, causing it to grow abnormally and then to die.








This is another photo of a canine tooth that underwent severely abnormal development owing to damage to the adjacent deciduous tooth. Note the very abnormal tip of the crown. This will eventually break, necessitating either a root canal or removal of the tooth. Note the broken/infected deciduous tooth still in place next to it!

3) Broken deciduous teeth really do infect.








In this photo the tip of the deciduous canine tooth had broken (hard to see from the photo, but broken at an angle near the tip), exposing the pulp chamber. The "bleb" that you can see to the upper right is a fistula (abscess hole) that is occurring because the infection is trying to escape through the gum. Notice that the tract of the infection is going right through where the adult tooth bud is developing.








In this photo the deciduous tooth has died but not shed normally. As is typical, it is closely apposed to the adult tooth. Notice that the deciduous tooth is broken (you can see the hole where the pulp is exposed), the tooth has turned brown (it is now "dead"), and there is marked inflammation of the surrounding gum tissue with some regression of the gums (they are pulling back away from the tooth). In this case the owner declined to let us remove the deciduous tooth and 18 months later we had to remove the adult tooth because it too was infected.

4) Broken teeth hurt. A lot! Often I hear people say, "it's only a baby tooth." Contrary to popular opinion, these teeth have nerves in them, just like all other teeth. When they break, they hurt. Eventually they will infect and the infection will kill the pulp (including both the nerve and the blood supply), but in the meanwhile the dog is in pain. And, even after the nerve dies it leaves behind infection/inflammation which is also a source of pain. The other thing to remember is that this pain goes on during a critical stage in the psychological development of the puppy. It is hard for me to believe that this chronic pain doesn't have an effect on the developing mind of the dog. A few weeks ago I saw a puppy with a broken tooth. Every time I tried to handle his mouth he flinched or jerked away. The owner interpreted this as bad behavior, but more likely it was a normal protective response!

5) The risk of damage to the adult tooth depends upon a lot of factors that are difficult to assess/control: a)how close the root of the deciduous tooth is to the root/root bud of the adult tooth, b) How developed the adult tooth is at the time that the deciduous tooth breaks, and c)how degenerate/resporptive the roots of the deciduous tooth are at the point that the crown breaks. (Remember that first radiograph? If the root of the deciduous tooth has nearly resorbed, there is a good chance that the process will continue normally with no change to the adult tooth. If not, the root of the deciduous tooth may persist and allow infection to set in.) 

To me this issue is the same as using a seatbelt. You can drive for a long time without using your belt and be fine. You can get in an accident without your seatbelt and still be fine. But, on average, you will live a lot longer if you always wear your seatbelt than you will if you don't. I'm sure that many of you have had dogs break their deciduous teeth and still be fine. I'm happy for you. (I'm not so happy for your puppy, who was in pain for weeks to months). But I see far too many of these cases where the decision not to address a small problem leads to a much bigger one later on. Back to our friend Dr. Hale: "..._So the short answer is that a fractured primary tooth needs to be extracted ASAP and monitoring it is not a medically acceptable option...the decision by the owner to monitor the fractured primary tooth was a poor choice and if I were faced with a client who wanted to take that path, I would have them sign an "against medical advice" document_..." 
I'm sure that there are a lot of people in wheelchairs who wish that they had worn their seatbelt. And every year I get to see a number of owners who ignored broken deciduous teeth and ended up with permanent damage to their dog's mouth. In this case I have yet to have an owner tell me that they thought their "wait and see" approach had been wise.


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## gingerkid (Jul 11, 2012)

Thank you very much for this informative post.


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## Kyndall54 (Apr 26, 2013)

What a great post! Thanks so much!


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## beth_ridge (Jun 23, 2015)

Great topic. 
So snapping a deciduous canine and having it removed as soon as noticed could still cause enamel on the adult canine to be present? Assuming that trauma has occured to the gum?


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## [email protected] (Nov 18, 2013)

I'm not sure that I understand your question. Enamel is always present on both the adult teeth and the deciduous teeth. Enamel is the hard, outer aspect of the tooth. It's formation has nothing to do with the gums, and gum trauma shouldn't affect enamel formation. 
Could you please clarify your question.


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## beth_ridge (Jun 23, 2015)

Sorry l meant damage to the enamel, like pitting? So this damage could only be caused from a broken deciduous tooth? I have a puppy at the moment that snapped their baby canine at 10wks. It was removed immediately and appears no infection was present. Anti-biotics was also provided. Now the adult canine is coming through the enamel is appearing to be damaged, like pitting. My vets off sider (main vet on leave) thinks the damage is caused thru the trauma to the cells of the growing canine? I'll try to get a pic. Ive never seen this before and am so disappointed as this pup was my show prospect


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## animalcraker (Nov 9, 2006)

What antibiotics was your pup put on? And what breed? Please post pics, depending on the severity and breed his potential show carrier may not be over.


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## beth_ridge (Jun 23, 2015)

Hmmm looking back through my bill, it doesnt seem my puppy was put on anti-biotics. For the 2nd tooth that my puppy broke that sustain infection  So annoyed at myself that l didnt notice. Staffordshire Bull Terrier. I'll try to upload a pic


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## beth_ridge (Jun 23, 2015)

Heres the tooth


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## beth_ridge (Jun 23, 2015)

Sorry cant work out how to add a photo


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## [email protected] (Nov 18, 2013)

If the only enamel damage present in the mouth is on an adult canine tooth, which replaced a damaged deciduous (baby) canine tooth, likely the problem was either trauma to the developing adult tooth bud, or infection that reached the developing tooth bud. If there are other areas of enamel pitting on other teeth, it is more likely that you dog has enamel dysplasia. I am not a show person, so I couldn't comment on whether either of these problems will affect your dog's show career. I also can't give you any idea how quickly infection could set in once a deciduous tooth breaks, but likely this could occur within a few days. As mentioned earlier in this thread, the deciduous tooth is basically a hollow tube, and once broken it creates a large conduit for bacteria to reach below the gumline.


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## animalcraker (Nov 9, 2006)

Too bad the picture isn't working :/ I'm not a Bully person, I show Afghan Hounds myself, but your pup may still have a viable show carrier. This is assuming he's a fine example of his breed, and correct in all other conformational aspects. 

From what I've seen Staffies are not a very competitive breed at least in my area. You can look up the Akc points schedule for your region to get an idea of how competitive your area is. In my area, region 9(California and Arizona) they only need 4 male dogs for a 3 point major, which is very low. You'll need to review your standard to determine if the tooth damage is a disqualifying fault, in some breeds it may be. And if it is affecting more than one tooth or it glaringly obvious that there's something wrong with the tooth than it will be harder to finish his championship. If your breeder is relatively local to you they should be able to help advise you on where and who to show your dog to. 

Since there is a dental issue you'll want to avoid showing your pup to a Doberman judge. By this I mean there are judges out there who specialize in certain breeds. Dobermans are required by their standard to have full dentition without any defects, the judges are trained to fully open a Dobermans jaw and examine all the teeth when they judge. Because of that they have a tendency to carry that requirement over to all the other breeds they judge, regardless if it's in the standard or not, and will often put down a great dog because of a minor dental "imperfection" that is allowable or routine within the breed.


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