8/31/2016 Interesting Cases in Dentistry for the General Practitioner Katie Kling, DVM Clinical Instructor, Dentistry University of Illinois Veterinary Teaching Hospital Linguoverted mandibular canine teeth (used to be called base narrow mandibular canine teeth) Jasper, 6 mo. Old std poodle 21122d1319823444-6-month-old-standard-poodle-minerva 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) 1
8/31/2016 Would your patient and your owner be good candidates for ball therapy!? http://dfordog.co.uk/chuckit-ultra-dog-ball.html Is there a place to move the mandibular canine that is comfortable? Is the dog willing to play? Is the owner willing to encourage play 5-10 minutes 3 times a day? * 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 2
8/31/2016 Carmel, 1 yr Jasper old FS Beagle What are your recommendations for Carmel? 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) 3
8/31/2016 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? 4
8/31/2016 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 5
8/31/2016 Presenting Expression, TMJ Luxation The mandibles are shifted towards the normal side. 6
8/31/2016 1 luxated reduced • Gary 7
8/31/2016 Gideon, 9 yr old MC Miniature Schauzer What’s wrong with Gideon? A.) Stage 4 Periodontal disease of 410 and 411. 104 B.) Stage 4 Periodontal 104 disease of 104. C.) Mucosal erosion overlying 410, 411. D.) Mucosal erosion overlying 410, 411 104. 410, 411 E.) A, C, D F.) B, C, D Chronic Ulcerative Paradental Stomatitis (CUPS) Chronic Ulcerative Paradental Feline Chronic Gingivostomatitis Stomatitis FCGS CUPS � Overblown response to chronic � Overblown response to chronic exposure to plaque exposure to plaque � The treatment option with the best � Tooth extraction is not the first option success (6% failure) is partial or full mouth extraction. 5 for treatment except for those teeth affected with stage 3 and stage 4 � Steroid use in refractory cases may periodontal disease be helpful if occasional ‘flair ups’ � Steroids risk osteomyelitis 1 respond. � The mainstay of treatment is � For many cat owners, tooth brushing meticulous cleaning of the tooth is out of the question. surface through regular professional � Distribution is caudal buccal mucosa. dental cleanings and daily tooth brushing. � Distribution is mucosa in contact with teeth, especially canine and maxillary 4 th premolar teeth. 8
8/31/2016 Treating CUPS • Extract the teeth affected with stage 3 and stage 4 periodontal disease • Ultrasonically scale and polish the teeth and http://adoggys.blogspot.com/2010/04/malt consider a dental sealant to slow plaque ese_5774.html accumulation • HOME CARE is key • Daily tooth brushing (once your patient is comfortable enough to tolerate it) • Subantimicrobial Doxyclycline 2 mg/kg per day 6 • Niacinamide 500 mg ½-1 q8-12 hr • Professional cleanings under anesthesia every 6-12 months Fractured Facial swelling and maxillary 4 th cutaneous draining tract premolar tumblr_nx7caq9DYA1ukpicto1_1280 What are Muffin’s problems? A.) Pulp polyp B.) Carious Lesion C.) Endodontic disease D.) All of the above 9
8/31/2016 Buccal Bone Expansion 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 10
8/31/2016 Let’s do an operculectomy! operculum allie landis, tape muzzle, not tape muzzle Feline pyogenic granuloma. Have you seen this in your practice?? A.) Yes! B.) No! 11
8/31/2016 Extraction or Odontoplasty This 8 mo. old Maine Coon cat presents with a complaint of halitosis. Notice in contrast how this cat has Feline Chronic A.) Begin to ease the Gingivostomatitis, owner into the idea of and inflammation is most pronounced partial or full mouth in the caudal buccal extractions mucosa B.) Schedule a complete oral exam and professional cleaning as soon as possible 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 8 mo.s supplementary products like water additives (have your owner reference the VOHC website) � If you can get these patients 11 mo.s 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). 12
8/31/2016 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. 13
Recommend
More recommend
