References
Endodontics in dogs and cats
Abstract
The term endodontic refers to the inside of the tooth, so endodontic treatment encompasses all procedures involving the endodontic tissues, predominantly the pulp. Endodontic treatment is typically performed on strategic teeth within the oral cavity such as the canines and large posterior teeth, which have pulpal and some periapical pathology; it facilitates their retention rather than their extraction. Endodontic treatment should always be offered to clients as an option for their pets in appropriate cases, so they can make a fully informed decision about the fate of the affected dentition. Having considered all of the options they may not want to opt for extraction if there is an alternative treatment available. Endodontic treatment should be performed by veterinary surgeons (VS) with a specialist interest in veterinary oral and maxillofacial surgery for a number of reasons: they are in the best position to assess the tooth and recommend the most appropriate treatment plan; in most circumstances they will have a specialist veterinary nurse (VN) working alongside them which will make the procedure more efficient; and they will have the specialist equipment available to perform the procedures, and know how to use it. This article aims to recap the endodontic anatomy of a tooth before discussing the main endodontic treatment available for adult teeth, which is root canal therapy (RCT). It will consider indications for RCT, an overview of the procedure and a discussion of the potential complications and implications of treatment, before discussing the role of the VN in endodontics.
The pulp is the embryological and functional tissue contained within the dentine of a tooth, and the pulp-dentine unit is collectively termed the ‘endodontium’. The pulp cavity is correctly known as the ‘pulpal chamber’ within the crown of a tooth and the ‘root canal’ within the root, and the root canal opens apically into the surrounding periapical tissues via the apical delta (Figure 1).
The endodontium is responsible for the vitality of a tooth, and contains:
As with any other tissue in the body, the pulpal tissue will react to different stimuli by initiating an inflammatory response, and the stimulus could be bacterial ingress, chemical irritation, thermal changes or disruption of the apical blood supply. Pulpitis is inflammation of the pulp, which can be categorised as detailed in Table 1.
If the pulpitis is untreated, is irreversible or is caused by infarction following trauma, the pulp will eventually become necrotic, which means the tooth is no longer vital and requires treatment (Gorrel, 2004; Holmstrom, 2011). The veterinary surgeon (VS) and veterinary nurse (VN) inspecting an oral cavity must be aware that the most common route for the further spread of inflammation from a pulp that is inflamed or necrotic is apically; down through the root canal and out into the periapical region, which can then result in further problems such as periapical abscess formation.
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