Understanding dentistry beyond the extraction (Proceedings)

This presentation will summarize the seven disciplines of dentistry, and familiarize the attendee with exodontics, periodontics, endodontics, orthodontics, prosthodontics, restorative dentistry, and oral surgery. Several cases will be reviewed, with a breakdown of why a particular treatment was performed, and the outcome. This will give the attendee a comprehensive understanding that can be articulated to the client when alternative treatments are recommended or sought after, other than extractions (exodontics).

Exodontics

Extractions (exodontics) are the most common treatment for periodontal and endodontic disease. Why is this? It could be secondary to the cost associated with other dental procedures and/or lack of education on the part of the veterinary staff. Most people want the simplest and most inexpensive solution to a problem. But what about those clients who are willing to spend a little more to help their pet maintain a healthy and functional mouth? There are other options to choose from if the client is willing to make a commitment to their pet's oral health.

Periodontics

Periodontal disease is the most common malady affecting dogs and cats over the age of 3.

Most common procedures can be performed in a private practice setting, and are things that a certified and well trained technician and veterinarian can perform. Periodontal care includes supragingival and subgingival cleaning as well as periodontal surgery, guided tissue regeneration (GTR), application of local medications, and bone grafts.

Endodontics

Endodontics refers to disease, diagnosis and treatment of the tooth pulp system. This is being performed more in private practice by veterinarians who have extensive training, but is still done mostly through specialty hospitals due to the cost of specialized equipment and materials. Different types of endodontic procedures include conventional endodontics (standard root canal), surgical endodontics (apicoectomy and retrograde filling), and vital pulpotomy.

Indications for endodontic procedures include:

           Tooth fracture with pulp exposure

           Tooth discoloration secondary to pulp trauma

           Worn teeth

Orthodontics

More private practice veterinarians are looking into orthodontics for minor malocclusions. However, complicated cases should be referred to a veterinary dentist. Trauma can occur with inexperienced attempts at moving teeth.

Indications are:    *Base narrowing of canines    *Anterior crossbite    *Attrition

Restorative dentistry

Restorative dentistry helps create an aesthetic tooth appearance and function. It also helps protect the pulp tissue from thermal, mechanical, and bacterial insult.

There are different levels of restorative dentistry. These can be done in private practice for those cases with minor enamel defects; however the equipment and materials can be costly.

Indications for restorative dentistry are:    *Near pulp exposure    *Enamel hyperplasia    *Enamel defects    *Caries

Resorptive lesions stage one or two (no longer recommended).

Prosthodontics

This could be seen as an extension of restorative dentistry. Prosthodontics are mainly performed

by a dental specialist, and involves placing crowns on teeth for extra protection from trauma. Stone models are made from impressions of teeth, and crowns are cast from these models to form a perfect fit. The use of Implantology (dental implants) is being evaluated, but due to the shape of and force used by the canine jaw, this has not been very successful to date.

Oral surgery

This too can vary in difficulty level, from minor mass removals to palatal and reconstructive surgery.

Some procedures will include:

           Cleft palate

           Tight lip syndrome

           Maxillectomy

           Mandibulectomy

Reference

1. Small Animal Dental Equipment, Materials, and Techniques, Bellows, J., Blackwell Publishing, 2004.