8/31/2016

1

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

8/31/2016

2

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

owner 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

8/31/2016

3

Carmel, 1 yrold FS BeagleJasper

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)

8/31/2016

4

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?

8/31/2016

5

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

8/31/2016

6

Presenting Expression, TMJ Luxation

The mandibles are

shifted towards the

normal side.

8/31/2016

7

1

• Gary

reduced

luxated

8/31/2016

8

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 GingivostomatitisFCGS

� 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.

8/31/2016

9

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

8/31/2016

10

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

8/31/2016

11

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!

8/31/2016

12

Extraction or Odontoplasty

This 8 mo. old Maine Coon

cat presents with a

complaint of halitosis.

A.) Begin to ease the

owner into the idea of

partial or full mouth

extractions

B.) Schedule a complete

oral 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

owner 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).

8/31/2016

13

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.