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Industry Reviews Foreword p. Veterinary Dental Radiology Brook A. Pathologies of the Salivary System Brook A. All Rights Reserved. Practical Veterinary Dental Radiography.
Veterinary Dentistry A Team Approach. Dentistry in Rabbits and Rodents. Veterinary Dentistry for the General Practitioner, 2e. Atlas of Dental Radiography in Dogs and Cats. Understanding the Horse's Teeth and Mouth.
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Oral and Maxillofacial Surgery in Dogs and Cats. A systematic review. Proceedings of the Nutrition Society, Oral health in America: a report of the surgeon general. WHO, Geneva.
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Common disorders of the teeth Enamel Hypoplasia Trauma, heredity, poor nutritional status, or inflammatory conditions such as viral e. Dupont Trauma and localized infection tend to damage a single tooth or teeth in the same area. However, systemic disease and genetic conditions generally affect most or all the teeth. These episodes may manifest with microscopic changes that produce a tooth with thin enamel that is easy damaged, termed enamel hypoplasia Figure 1.
Also, commonly noted, enamel hypomineralisation causes enamel pitting, flakiness and discolouration Figure 2. Enamel or dentine may appear absent on examination, or it may be thinner and weaker and separate during chewing or examination. The terms hypoplasia and hypomineralisation are often used incorrectly in the veterinary literature.
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Physiological wear from mastication, resulting in loss of enamel, dentine and in advanced cases pulp exposure is termed dental attrition. If attrition is due to malocclusion of teeth, it is termed pathological attrition. Figure 3 Enamel or dentine loss due to an external object, such as metal cages, sticks, balls or bones, is termed dental abrasion Figure 4 Dupont If the process is gradual, odontoblasts can produce tertiary dentine to protect the underlying pulp tissues.
However, in cases where attrition or abrasion is rapid, it can result in pulp exposure. This is especially true in cases of chronic cage or fence chewing. Fractured teeth have been found in Golden et al. A significant number of dogs and cats have access to bones, sticks, and antlers resulting in injuries caused during chewing; they may be involved in high impact trauma such as car accidents, sporting injuries, i.
Trauma to the tooth may be classified based on the amount of tooth structure exposed, i. It is further classified accordingly as enamel damage or infraction Figures 7 and 8 , enamel loss with no exposure of dentine Figures 9 and 10 , enamel and dentine exposure without pulp exposure Figures 11 and 12 , crown and root involvement without pulp exposure Figures 13 and 14 , root fracture without crown damage or pulp exposure Figures 15 and 16 , and whether there is pulp exposure, isolated to the crown Figure 17 and 18 or involving both crown and root Figure 19 and An injury that does not expose the pulp is termed uncomplicated, whilst pulp exposure is termed complicated.
A tooth that has suffered trauma without fracture may result in painful pulpitis and eventually pulpal necrosis. Some of these teeth will appear dull or discoloured Figure 21 termed intrinsic staining and most require root canal treatment or extraction similar to a tooth with direct pulp exposure see below Hale Sequela All vital teeth with driect pulp exposure are exceedingly painful. Bender ; Hargreaves et al.
In most cases, a non-vital tooth which is not appropriately treated will become infected. This may be seen on radiographs as periapical rarefaction Figure Patients with non-vital teeth rarely show signs of the pain and or infection, but it is present. Those teeth which are not treated by root canal therapy or extraction may result in a draining sinus tract at or near the apex of the root.
The most common sites for this are adjacent to the medial canthus of the eye or lateral bridge of the nose maxillary canine or premolar , or a sinus tract on the lateral or ventral surface of the mandible mandibular canine tooth. Diagnosis Endodontic examination is incomplete without dental exploration and radiographs to confirm or rule out pulp exposure and to assess the degree of periapical pathology respectively, prior to treatment.
In recent fractures, the teeth are quite painful and the patient may resist conscious oral examination. Once the pulp is necrotic, there is usually no pain on probing; however, there is long term low grade pain and infection.
Small Animal Dental, Oral and Maxillofacial Disease : Brook A. Niemiec :
Therapy Treatment options are directly related to the type and degree of damage as well as the presence or absence of endodontic infection. All teeth with any type of damage should be radiographically examined for signs of non-vitality or inflammation. If the defect is confined to the enamel or dentine, without radiographic signs of periapical pathology, smoothing any sharp edges and restoration is all that is required. Treatment of dentin exposure is always recommended to reduce sensitivity, block off the pathway for infection, and smooth the tooth, thus decreasing periodontal disease Theuns et al Chronic wear results in the production of tertiary or reparative dentine so the tooth pulp continues to be protected by a dentinal layer.
These teeth require no therapy, as long as they are radiographically healthy. If a therapeutic delay is necessary, pain management should be provided until surgery. Note, however that antibiotics are not indicated in these cases. Teeth with advanced periapical lesions or root resorption may benefit from extraction over root canal treatment.
A complete endodontic examination requires dental exploration and radiographs to confirm or rule out pulp exposure and to assess the degree of periapical pathology respectively, prior to treatment. If the defect is confined to the enamel or dentine, without radiographic signs of periapical inflammation, smoothing any sharp edges and restoration is all that is required.
References Hale FA Localized intrinsic staining of teeth due to pulpitis and pulp necrosis in dogs. Hale FA. J Vet Dent. Am Anim Hosp Assoc J Vet Dent; Munksgaard, AVDC website. Niemiec BA Assessment of vital pulp therapy for nine complicated crown fractures and fifty-four crown reductions in dogs and cats. Clarke DE Vital pulp therapy for complicated crown fracture of permanent canine teeth in dogs: a three-year retrospective study.
Can Vet J. Practical Veterinary Publishing, San Diego, pp Bender IB. J Endod. Den Clin North Am. Pathology Enamel Infraction - Incomplete fracture crack of the enamel without loss of tooth substance Enamel fracture - fracture in which crown substance is lost, limited to enamel A fracture of the enamel and dentine not involving the pulp. Tooth Resorption Tooth resorption TR is, by definition, the loss of dental hard tissue. Tooth resorption can be physiological resorption of the root of primary teeth or pathological.
In these guidelines only pathologic TR is discussed. TR has been reported in human dentistry Heithersay GS, and various species including the dog Arnbjerg , feral cat Verstraete et al. In veterinary dentistry, it is of most importance in the domestic cat where it occurs quite frequently, and it is increasingly noted in the canine population. In a study, which investigated the incidence of TR in a clinically healthy population of cats using a combination of clinical examination and radiography, it was found that the mandibular 3rd premolars , were the most commonly affected teeth and the pattern of TR development was symmetrical in most cats Ingham KE et al.
Aetiology The resorptive process is quite well understood Okuda and Harvey ; Shigeyana et al. Resorption was traditionally considered a disease of modern civilisation but it has also been reported in wild cats Berger et al. Tooth resorption is due to an active process where odontoclasts become activated. The resorption appears to be a progressive process. It initiates on the root surface, typically at the cementoenamel junction in type 1 lesions. It then invades the root and spreads within the root dentine up into the coronal dentine, where it may undermine the enamel.
This loss of support may cause the enamel to collapse or break off. Therefore, clinical findings visual or tactile , even if they are very small, represent an advanced stage of the disease Fig. There appear to be two distinct types of tooth resorption: idiopathic and inflammatory. Dupont G , Niemiec BA Any trauma can create resorption of the root surface, however some of these defects heal while others do not.
The pulp resists becoming exposed by the resorption by the creation of tertiary dentin until late in the disease course. Above the gum line, smaller defects are often covered by a highly vascular granulation tissue, which is an attempt by the body to cover the exposed dentine tubules Fig.
https://tr.gorocosexuny.tk Classification A distinction is made depending on the localisation of the resorption: internal resorption starts within the endodontic system and is mostly due to pulpitis. External resorption has its origin at the root surface and can have several causes. In an advanced stage, the two forms can hardly be distinguished. In dogs and especially cats, external resorption is much more common. Tooth resorption is classified based on the severity of the resorption Stages and on the radiographic appearance of the resorption Types American Veterinary Dental College, The AVDC classification of tooth resorption assumes that tooth resorption is a progressive condition.
Types of Resorption Based on Radiographic Appearance Type 1 T1 : On a radiograph of a tooth with type 1 T1 appearance, a focal or multifocal radiolucencies are present in the tooth with otherwise normal radiopacity and normal periodontal ligament space and endodontic system. There is tooth destruction but no replacement. Type 2 T2 : On a radiograph of a tooth with type 2 T2 appearance, there is narrowing or obliteration of the periodontal ligament space in at least some areas and decreased radiopacity of at least part of the tooth. There are signs of replacement resorption.