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An Urban Experience
B.A. Niemiec1
1Southern Califormia Veterinary Dental Specialties, Dentistry, San Diego, USA
A luxated or avulsed tooth has been traumatically torn out of the alveolus. This most commonly occurs with the canine teeth (especially maxillary), but incisors can be affected as well. This typically occurs following dog fights, but can also result from significant cage chewing or trauma.
Clinical presentation:
These patients will either present with a swelling on the muzzle or a missing tooth. Oral exam reveals a displaced tooth or an open alveolus.
Diagnostic tests:
Skull films are helpful, but dental radiographs are strongly recommended prior to definitive therapy. Skull films
are typically not detailed enough to diagnose subtle problems such as root fractures, periodontal disease or small areas missing bone. Radiographs can be delayed until the patient is stabilized, ideally during the definitive fixation.
Emergency treatment:
This should consist of pain control as well as managing any other systemic issues.
Support of the area could be considered until definitive therapy can be performed. This can be achieved with a tape muzzle, but a loose nylon muzzle works well. The client should be instructed to feed a gruel or liquid diet until surgery as well as during healing (see below).
Definitive therapy:
If possible, these cases should be referred to a veterinary dentist ASAP for replacement and stabilization. This is one of the true dental emergencies, as saving these teeth is very time dependent. Reimplantation within 30 minutes allows for the best outcome.26 However, if this is not possible due to schedule or the stability of the patient, good results have been seen with longer exposure. The fixation method is typically a figure-8 wire and acrylic splint, however some veterinary dentists prefer a flexible fixation to avoid ankylosis and root resorption. At this time, or at time of splint removal, a root canal will be necessary on the affected tooth.
If a veterinary dentist is not available in the area or near future, surgeons and ER veterinarians can learn this procedure.
Figure 8 wire procedure:
A: Replace tooth and close soft tissues with absorbable suture
B: Scale and polish maxillary canines (with a fluoride free pumice)
C: Place a figure-8 wire
D: Etch the teeth with 37% phosphoric acid. Avoid the soft tissues
D: Cover wire with dental acrylic
E: Smooth with a diamond or acrylic bur on a high speed air driven hand piece.

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