8/31/2016 Interesting Cases in Dentistry for the General - - PDF document

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Interesting Cases in Dentistry for the General Practitioner

Katie Kling, DVM Clinical Instructor, Dentistry University of Illinois Veterinary Teaching Hospital Jasper, 6 mo. Old std poodle

Linguoverted mandibular canine teeth

(used to be called base narrow mandibular canine teeth)

What are your recommendations for Jasper? A.) Discuss a removable orthodontic device with the owners B.) Recommend reducing the height of the crown (and vital pulp therapy) C.) Recommend gingivectomy D.) Extract the mandibular canine teeth (304, 404)

21122d1319823444-6-month-old-standard-poodle-minerva

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Would your patient and your owner be good candidates for ball therapy!?

Is there a place to move the mandibular canine that is comfortable? Is the dog willing to play? Is the

• wner willing to

encourage play 5-10 minutes 3 times a day?*

http://dfordog.co.uk/chuckit-ultra-dog-ball.html http://dogs.thefuntimesguide.com/2006/02/stuff_t his_in_a_kong.php

Ball Therapy Coaching

• Goal is to create comfortable, functional occlusion
• There are good alternatives to ball therapy; these

alternatives are a little more invasive (inclined plane, coronal extenders, crown reduction with vital pulp therapy)

• Ideal patient has a diastema wide enough to accommodate

the mandibular canine tooth and no major jaw

• discrepancies. Also, the patient has to be willing to play

with a ball!

• Ideal toy is smooth (non abrasive), and sits just in between

and a little behind the canine teeth.9

• Treatment takes 2 weeks to 2 months.9

34 d

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Carmel, 1 yr

• ld FS Beagle

Jasper

What are your recommendations for Carmel? A.) Discuss a removable

• rthodontic device with

the owners B.) Recommend reducing the height of the crown (and vital pulp therapy) C.) Recommend gingivectomy D.) Extract the mandibular canine teeth (304, 404)

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Crown Reduction with Vital Pulp Therapy Avoids Surgical Extraction Maintains the tooth as a living, functional, comfortable tooth Good prognosis (92% success rate) $400-600 Dental Radiograph in 6 months

Rocky, 7 yr Boston Terrier

What’s the problem?

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What is the recommendation in young dog with this problem? A.) If a swelling develops or if the dog seems painful, we should see the dog back. B.) Extract the tooth now because of concern for abscess formation. C.) Extract the tooth now because of concern for dentigerous cyst formation.

Quick point of clarification…

• A dentigerous cyst forms from the enamel organ

around the crown of an unerupted tooth.

• A radicular cyst forms around the root of an

erupted tooth that typically has pathology.

Post extraction radiograph

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Presenting Expression, TMJ Luxation

The mandibles are shifted towards the normal side.

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1

• Gary

reduced luxated

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What’s wrong with Gideon? A.) Stage 4 Periodontal disease of 410 and 411. B.) Stage 4 Periodontal disease of 104. C.) Mucosal erosion overlying 410, 411. D.) Mucosal erosion overlying 104. E.) A, C, D F.) B, C, D 104 104 410, 411 410, 411 Gideon, 9 yr old MC Miniature Schauzer

Chronic Ulcerative Paradental Stomatitis (CUPS)

Chronic Ulcerative Paradental Stomatitis CUPS

Overblown response to chronic exposure to plaque Tooth extraction is not the first option for treatment except for those teeth affected with stage 3 and stage 4 periodontal disease Steroids risk osteomyelitis1 The mainstay of treatment is meticulous cleaning of the tooth surface through regular professional dental cleanings and daily tooth brushing. Distribution is mucosa in contact with teeth, especially canine and maxillary 4th premolar teeth.

Feline Chronic Gingivostomatitis FCGS

Overblown response to chronic exposure to plaque The treatment option with the best success (6% failure) is partial or full mouth extraction.5 Steroid use in refractory cases may be helpful if occasional ‘flair ups’ respond. For many cat owners, tooth brushing is out of the question. Distribution is caudal buccal mucosa.

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Treating CUPS

• Extract the teeth affected with stage 3 and

stage 4 periodontal disease

• Ultrasonically scale and polish the teeth and

consider a dental sealant to slow plaque accumulation

• HOME CARE is key
• Daily tooth brushing (once your patient is

comfortable enough to tolerate it)

• Subantimicrobial Doxyclycline 2 mg/kg per

day6

• Niacinamide 500 mg ½-1 q8-12 hr
• Professional cleanings under anesthesia

every 6-12 months

http://adoggys.blogspot.com/2010/04/malt ese_5774.html

Facial swelling and cutaneous draining tract Fractured maxillary 4th premolar tumblr_nx7caq9DYA1ukpicto1_1280 What are Muffin’s problems? A.) Pulp polyp B.) Carious Lesion C.) Endodontic disease D.) All of the above

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What is affecting this left maxillary canine tooth? A.) Vertical bone loss (periodontal disease) B.) Tooth resorption C.) Neoplasia D.) Extrusion E.) A and D

Buccal Bone Expansion

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Let’s do an operculectomy!

• perculum

allie landis, tape muzzle, not tape muzzle

Feline pyogenic granuloma. Have you seen this in your practice?? A.) Yes! B.) No!

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Extraction or Odontoplasty This 8 mo. old Maine Coon cat presents with a complaint of halitosis. A.) Begin to ease the

• wner into the idea of

partial or full mouth extractions B.) Schedule a complete

• ral exam and professional

cleaning as soon as possible

Notice in contrast how this cat has Feline Chronic Gingivostomatitis, and inflammation is most pronounced in the caudal buccal mucosa 8 mo.s 11 mo.s Treatment plan for Juvenile Stomatitis Early intervention with professional scaling and polishing under anesthesia and consider dental sealant Meticulous home care, daily tooth brushing and supplementary products like water additives (have your

• wner reference the VOHC

website) If you can get these patients to 2 years of age without developing advanced periodontal disease, there can be resolution! 10 This is a different condition than Feline Chronic Gingivostomatitis (FCGS).

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dentistry@vetmed.Illinois.edu (217) 333-5859

FURTHER READING 1.Boutouille F, Hennet P, Maxillary osteomyelitis in two Scottish terrior dogs with chronic ulcerative paradental

• stomatitis. J Vet Dent 2011;28:96-100.

2.Çetinkaya MA. Temporomandibular joint injuries and ankylosis in the cat. Vet Comp Ortho Traumatol 2012; 25:366-374

• 3. Gracis M, Molinari E, Ferro S. Caudal mucogingival lesions secondary to traumatic dental occlusion in 27 cats:

macroscopic and microscopic description, treatment and follow-up. J Feline Med Surg. 2014; 17(4):318-28. 4.Hale FA. Dental Caries in the Dog. J Vet Dent 1998;15:79-83. 5.Jennings MW, Lewis JR, Soltero-Rivera MM, Brown DC, et al. Effect of tooth extraction on stomatitis in cats: 95 cases (2000-2013). JAVMA 2015; 246:654-660. 6.Kim SE, Jeong M. Experimental determination of a sub antimicrobial dosage of doxycycline hyclate for treatment of periodontitis in Beagles. Am J Vet Res. 2013; 74:130-5.

• 7. Riehl J, Bell CM, Constantaras ME, et al. Clinicopathologic characterization of oral pyogenic granuloma in 8
• cats. J Vet Dent. 2014;31:80-86.
• 8. Somrak A. Management of temporomandibular joint luxation in a cat using a custom-made tape muzzle. J Vet

Dent 2015; 32(4):239-246.

• 9. Verhaert, L. A Removable Orthodontic Device for the Treatment of Lingually Displaced Mandibular Canine

teeth in Young Dogs. J Vet Dent 16(2); 69-75, 1999.

• 10. Wiggs RB, Lobeprise HB. Domestic feline oral and dental disease. In: Wiggs RB, Lobprise HB, eds. Veterinary

dentistry: Principles and practice. Philadelphia: Lippincott-Raven Publishers; 1997: 484, 505, 506.