Dental case reviews: Interactive review of interesting cases (Proceedings)

Malocclusions

Malocclusions need to be recognized early to prevent damage to the maxillary palate. The occlusion should be checked at the initial puppy exam. A plan can be formed at this time to correct a malocclusion. Selective extractions of deciduous teeth may prevent or lessen the malocclusion.

Base narrow canines

If the malocclusion is not addressed trauma to the hard palate may result causing pain and possibly a draining tract or abscess.

An acrylic appliance may be applied to the hard palate to create an incline plane. This will make the tooth move to a comfortable position. This process usually takes about two months.

Selective extraction of deciduous teeth may allow the adult teeth to erupt in the proper occlusion. If the canine teeth are close to comfortable occlusion, trimming off the gingiva off the hard palate may make an incline plane allowing the lower canine tooth to move a comfortable position.

Deciduous canine fracture

If a deciduous canine is fractured, it is very important that the tooth be extracted. If left alone, the tooth will die and abscess. This may damage the adult canine, resulting in enamel defect or possibly causing the adult to not erupt or die.

This holds true for all deciduous teeth. If a baby tooth is fractured extract it sooner rather than later.

Looks may be deceiving

Be sure to probe around every tooth. Some arcades will look normal, but when a probe is placed at the gingival sulcus deep pockets are often found. Any pocket over 4 mm should be x-rayed to evaluate the periodontal bone. X-rays may often reveal deep bone loss.

It is also important to be sure to count and chart the teeth of you patient. Noting any missing or supernumerary teeth on the dental chart is extremely important. If a tooth is missing that was charted as present at the last procedure, that area should be x-rayed to make sure that there is not any root fragment left from a fracture. If supernumerary teeth are present, if it is not crowding other teeth causing a periodontal problem, it may be noted on the dental chart and not extracted.

Discolored teeth

Teeth that have a pink to black color to the pulp have had a trauma of some type. These teeth should be x-rayed. A bright light can be shined thru the tooth from the lingual side. If the tooth illuminates ( the light shines thru it with out seeing a dark pulp canal) the tooth may still be alive. These teeth should be monitored very closely. Repeating the x-ray every 3-4 months is advisable to make sure an apical abscess is not forming.

Tooth luxations/avulsions

Teeth that are luxated or avulsed out of the alveolus can be put back into place. This most often happens to the upper canine tooth. The tooth is put back into place and a figure eight wire is placed around that tooth and the canine tooth on the other side. An acrylic is then applied to the hard palate between the canines for support to hold the canine in proper occlusion. This is left on 4-6 weeks until the bone heals. Endodontic therapy must be done to these teeth for the tooth dies when the vessels are torn away when the luxation happened. If the owner is not willing to pursue a root canal, the teeth should be extracted.

Dentigerous cyst

Teeth that do not erupt or that are impacted, will cause a cyst to form. This will cause bone destruction around the cyst. The impacted or unerupted teeth need to be extracted along with the effected teeth in the cyst. All the cyst material should removed from the site. This will usually heal very nicely if all the teeth and material are removed. It is a very good practice to x-ray any area where teeth are missing. If there is a tooth that has not erupted it should be extracted before a cyst forms.

Summary

The most important tools a technician can bring to a practice is doing a detailed exam, counting and charting all the teeth. Knowing the correct dentition our patients will help recognize when something is wrong.

Dental radiology is essential in doing proper veterinary dentistry.