Myth #2: If a broken tooth does not seem to be bothering the patient, there is no need to treat it.
Basis for Myth: Often patients will present with a fractured or worn tooth in which the pulp has been exposed but the owner will state categorically that it is not bothering the animal. They point out that the dog or cat is still eating and chewing normally and shows no signs of discomfort (see Myth #1). On physical examination, there is often no evidence of oral swelling or gingival inflammation.
The Truth: If a tooth has been broken or worn to allow pulp exposure, it is a problem that must be treated. A tooth with an open pulp chamber becomes a direct pathway for bacteria to enter the periodontal space around the root tip and the body is powerless to stop this. Even superficial enamel chips lead to tooth sensitivity and possible abscessation.
The result will be a chronic inflammatory response (abscess) at the root tip. This causes a chronic, dull ache as well as acting as a source of septicemia. Occasionally, these root abscesses will eat through the bone, spreading the infection into the surrounding tissues. This is the situation with facial swelling associated with fourth upper premolar fractures. However, only about 20% of these diseased teeth will provide such an obvious indication for treatment. The other 80% of tooth abscesses will remain encased in bone or fester to a less obvious site (nasal passages or oral cavity).
Recommendation: A fractured or worn tooth with pulp exposure must either be extracted or have root canal treatment. Superficial enamel fractures can have protective sealants bonded to the tooth that reduce sensitivity and the risk of abscessation. To recommend nothing could be considered negligence. In the case of a facial swelling or draining fistula associated with an abscessed tooth, antibiotics will often bring temporary relief, but the problem will recur after the medication is discontinued. Giving antibiotics for a few days pre-operatively is a good idea, but antibiotics should never be offered as a substitute for surgical treatment.