Oral pathology (Proceedings)

Oral and dental lesions are common in most animals.  Clinical oral pathology is concerned with the symptoms, signs, diagnosis, changes in structure and function, causes, progression and prognosis of oral lesions.

Dental pathology includes fractured teeth, luxated or avulsed teeth, and impacted or embedded teeth.  Discolored teeth can be from either intrinsic or extrinsic staining.  Extrinsic staining can result from chlorhexadine (varies in color), iron (brown), copper (green) or chewing on metal bowls or cages (silver).  Intrinsic staining can indicate bleeding into the dentinal tubules (pink, blue or brown), a dead pulp (beige or black) or tertiary dentin from attrition (brown).  When describing the abnormal shapes of crowns or roots, microdontia refers to a normal crown shape but smaller in size, macrodontia means the crown is oversized, but root and pulp cavity are normal.  Peg teeth are cone-shaped with single cusp most often noted on the upper third premolars or lower fourth premolars of dogs.  Enamel pearls are small beads of enamel found at the cementoenamel junction.  Another abnormal tooth finding is a gemination tooth in which the developing bud attempted to split but failed to do so completely.  Enamel hypocalcification (commonly called enamel hypoplasia) is due to the disturbance in enamel development from a systemic virus or fever resulting in enamel pitting and discoloration.  Supernumerary teeth and retained deciduous teeth are also commonly seen.   Caries (cavities) are not seen often in dogs or cats; however, resorptive lesions occur frequently in cats and less frequently in dogs.

Oral cavity problems would include foreign bodies in the roof of the mouth, between the teeth or under/around the tongue.  Mandibular or maxillary fractures are most often the result of trauma but can also be pathological from severe periodontal disease.  Gingival abscesses can be endodontal in origin from necrotic pulp or periodontal in origin from debris in the sulcus or a foreign body wedged between teeth.  Excess tissue under the tongue or in the buccal area can lead to traumatic granulomas from occlusal forces when the tissue gets caught between the teeth.  This is sometimes referred to as “gum-chewers” syndrome.  A chronic problem seen in Boxers, Collies, Great Danes and Dobermans is gingival hyperplasia.

Two very painful diseases of the oral cavity in dogs are Chronic Ulcerative Paradental Stomatitis (CUPS), which affects the oral mucosa most commonly in Maltese and King Charles Spaniels, and Acute Necrotizing Ulcerative Gingivitis (ANUG), which affects primarily the attached gingiva.  Some cats suffer from severe inflammation of the oral cavity and fausa known as Lymphocytic Plasmacytic Stomatitis (LPS).  These three conditions are usually refractory to most treatments and often require extraction of some to all of the teeth.

Viral papillomatosis are wart-like lesions that may occur anywhere in the mouth but most commonly on the lips, hard palate and tongue.  Normally these are self-limiting but may require treatment due to extent, trauma or chronicity.

Benign tumors of the oral cavity include odontomas (complex or compound), cementomas, acanthomatous ameloblastoma, fibromatous epulis and ossifying epulis.  The malignant tumors most often seen are melanoma, squamous cell carcinoma, fibrosarcoma, and osteosarcoma.

Suggested reading

Veterinary Dentistry - Principles & Practices.  Wiggs and Lobprise. Lippincott 1997.

Atlas of Canine & Feline Dental Radiography.  Mulligan, Aller & Williams. VLS 1998.

Veterinary Dental Techniques.  Holmstrom, Frost and Eisner. Saunders  3rd Ed. 2004.

Veterinary Dentistry for the Technician and Office Staff.  Holmstrom.  Saunders 2000.

Practitioner's Guide to Veterinary Dentistry.  Shipp and Fahrenkrug.  Griffin 1992.

Manual of Small Animal Dentistry.Crossley and Penman. Iowa State Press. 2nd Ed. 1995.