Incident Report:
A visit from the Tooth Fairy:
Teeth are the most important tools for our dogs, so one has to keep them healthy and agile. The foundation for good teeth is a healthy diet and good care, but your dog can loose or break a tooth through an accident (tooth avulsion). The consequences of such an avulsion and the reattachment of that tooth is described here with following example of Twigas Nonea (* November 19th, 2006), a female basenji:

On May 23, 2007 our daily afternoon walk was coming to an end with a thorough search for ticks on both our female dogs. It’s high season for ticks in Baden–Württemberg. All the preferred areas where ticks like to hide (belly, groin, shoulders, around the ears and collar) are searched numerous times. When checking Nonea around her head, she started to fight quite a bit and we realized an area on her snout was sensitive to pressure and touch.

After lifting her chaps, we saw her molar P3 had broken off toward the outside but was still dangling on the gums on the outside of her jaw. The tooth was only hanging on to the mucous membrane of the oral cavity. We could never figure out the cause of this accident, but after a short while we realized that Nonea had all her permanent teeth including molar P3. First, I was tempted to remove the molar, since it was bothering Nonea when closing her jaws. Thanks to a TV program we had seen a few weeks earlier on German channel “Vox”, called: “Dog, Cat, Mouse”, we had heard that it was possible to reattach even dogs teeth. We immediately called our dentist (for humans!), who confirmed that this was possible and we drove straight to our vet. With a very low dose of anesthetics the vet evaluated the situation of Nonea’s tooth.

To be absolutely sure it was not one of her baby teeth and to determine that nothing was damaged on the jaw, the doctor ordered an x-ray. (Please see Photo a). Since one could not see another tooth on the x-ray and no other damage to the jaw, the doctor put the tooth back into place and sewed it with a self-dissolving thread with enough tension around the tooth so it wouldn’t fall out again. It was amazing to witness the force needed to pull the needle and thread through the mucus membrane of the oral cavity. The membrane is very tough skin, which in general, contrary to the normal skin, will grow back without leaving scars. On photo b) you can see the reattached and sewed tooth P3.

What can we learn from this experience for the future?
Your dog looses a tooth. (Tooth avulsion), which is the worst kind of injury for a tooth and it is in big danger. In general teeth can be reattached and grow back into the gums. Although a tooth is not allowed to stay dry for longer than 20-30 minutes.

The lost tooth needs to be found immediately, put into a petri dish and brought to the vet or dentist. It is little known that the best way to transport a tooth is in UHT-milk, if you don’t have a so-called “tooth box”, i.e. Dentosafe, tooth rescue box.
Cold UHT-milk will keep the tooth for 4-5 hours, in a salt-solution for about 3 hours and just in a dry towel only for 30 minutes maximum. After that amount of time, the cementoblasts are decaying, without them the tooth will not survive. With them, your dentist should be able to reattach the tooth.
Scientific studies at the University of Giesen concluded that the cells of the connective tissue of teeth, which are put into a “tooth box”, will survive at room temperature for at least 24-48 hours. But in any case you should go to a dentist immediately, if your dog looses a tooth. A tooth box is also convenient to transport a part of a tooth. Normally he can then reattach the part with a special glue. Those pieces should be kept moist. The tooth box contains a special cell culture, as similarly used when transporting organs. A special component will allow a shelf life of up to 3 years and should always be stored at room temperature. You can find the “tooth box at a pharmacy for around 20 Euros. If you don’t have any of those options, you can always keep the tooth of your “darling” carefully in your own mouth. That way it is guaranteed that the attaching fibers survive and the sensitive skin around the roots will not dry out – deciding factors to be able to reattach the tooth. In an emergency, please use your own mouth!
To act appropriately
• Keep calm and think before you act. If your dog is bleeding heavily let him/her bite into a gauze.
• Depending on the tooth injury keep following things in mind:
• If a tooth broke off: Look for the piece and place it in the appropriate container.
• If a tooth is very loose or moved: Leave as is, don’t manipulate the tooth.
• If a tooth is gone: Look for the tooth and when you find pick it up only on top - do not touch the roots.

• Never clean the tooth, even when it is filthy!
• Put the tooth as fast as possible into an appropriate container, hopefully in a special „tooth box“, UHT-milk, sterilized salt solution or if all else fails in your own mouth. Please only feed your dog soft or pureed food until the tooth is stabilized enough. Don’t feed bones, chew toys or dry food.
The Jaw – physiological saving of the tooth
If the tooth is saved properly, the special cells around the root, which are responsible for the reattachment of the skin of the root stay alive: The tooth will heal into the jaw normally and will work like it did before.

The Jaw – non physiological saving of the tooth
If the tooth has not been saved properly, the special cells of the skin around the root will die off, this can happen already after 15-30 minutes, if the tooth is not kept moist. Keeping the tooth in milk, salt solution, plastic bags or in our mouth cavity will only prolong it for a while. Even though the tooth is kept moist the cells will start dying off. Then there might not be enough cells to reattach the tooth to its cavity and the body won’t recognize the tooth as its own. The bone around the tooth will grow directly to it (Ankylosis). Slowly the body will absorb the tooth. After months or a few year the tooth will be lost. We don’t know what will exactly happen to Nonea’s tooth. But we believe we have tried to do our best and have a 50 percent chance that her tooth will heal completely, because the tooth was fully reattached after only 3 weeks.

Conclusion: Every household needs a “tooth box”, until owner and doggy will put their dentures on the nightstand!