WikiVet English - User contributions [en]

Dental Indices and Criteria

2014-11-18T17:04:37Z

LisaMilella: /* Furcation Involvement */

{{OpenPagesTop}}
==Introduction==
[[File:Periodontal probe in situ.jpg|right|200px|thumb|Periodontal probe used to measure gingival sulcus depth and feel for attachment loss. Here the probing depth is 2mm and considered normal on a canine tooth''© Lisa Milella 2013'']]
[[File:Periodontal probe and furcation.jpg|right|200px|thumb|Periodontal probe used to check for furcation exposure. The probe is passed horizontally between the roots. The probe extends from the palatal aspect through to the buccal aspect, indicating that there is complete bone loss between the roots, a grade 3 furcation exposure.''© Lisa Milella 2013'']]
[[File:Worn dog teeth.jpg|right|200px|thumb|Severely worn maxillary canine and premolars. The canine and 2nd premolar have pulp exposure (black spot) and draining fistulae just above the mucogingival junction. The first and 3rd premolars are worn with tertiary (or reparative) [[Tooth - Anatomy & Physiology#Dentin|dentine]] (tan colour).''© Lisa Milella 2013'']]
The following indices and criteria should be evaluated for each tooth:
#Gingivitis and gingival index
#Periodontal probing depth
#Gingival recession
#Furcation involvement
#Mobility
 
In animals with large accumulations of dental deposits (plaque and calculus) on the [[:Category:Teeth - Anatomy & Physiology|teeth]], it may be necessary to remove these to assess periodontal status accurately. Care must be taken not to damage the [[Gingiva|gingival tissues]] whilst removing the calculus.
 
==Gingivitis and Gingival Index==

The presence and degree of '''[[gingivitis]]''' (inflammation of the [[gingiva]]) is assessed based on a combination of redness and swelling, as well as presence or absence of '''bleeding''' on gentle probing of the '''gingival sulcus'''. An index which relies on both visual inspection and bleeding, namely the '''modified Löe and Silness gingival index''' <ref>Loe. H (1967) '''The gingival Index, the plaque index and the retention index system.''''' Journal of Periodontology'' 38: 610-616</ref>, can also be used:
 
:'''Gingival index 0''' - Clinically healthy gingiva
:'''Gingival index 1''' - Mild gingivitis: slight reddening and swelling of the gingival margin; no bleeding on gentle probing of the gingival sulcus
:'''Gingival index 2''' - Moderate gingivitis: the gingival margin is red and swollen; gentle probing of the gingival sulcus results in bleeding
:'''Gingival index 3''' - Severe gingivitis: the gingival margin is very swollen with a red or bluish-red color; there is spontaneous hemorrhage and/or ulceration of the gingival margin
 
==Periodontal Probing Depth (PPD)==

The depth of the sulcus can be assessed by gently inserting a graduated [[Periodontal Probe|periodontal probe]] '''until resistance is encountered at the base of the sulcus'''. The depth from the free [[Gingiva|gingival margin]] to the base of the sulcus is measured in mm at several locations around the whole circumference of the [[:Category:Teeth - Anatomy & Physiology|tooth]]. The probe is moved gently horizontally, walking along the floor of the sulcus. The '''gingival sulcus is normally 1–3 mm deep in the dog''' and '''0.5–1 mm in the cat'''. Measurements in excess of these values usually indicate [[Periodontal Disease|periodontal disease]], when the [[Tooth - Anatomy & Physiology#Periodontal Ligament|periodontal ligament]] has been destroyed and [[Tooth - Anatomy & Physiology#Alveolar Bone|alveolar bone]] resorbed, thus allowing the probe to be inserted to a greater depth. The term used to describe this is '''periodontal pocketing'''. All sites with periodontal pocketing should be accurately recorded. Gingival inflammation resulting in swelling or hyperplasia of the free [[gingiva]] will, of course, also result in measuring sulcus depths in excess of normal values. In these situations, the term '''pseudopocketing''' is used, as the periodontal ligament and bone are intact (i.e.there is no evidence of [[periodontitis]]) and the increase in PPD is due to swelling or [[Gingival Hyperplasia|hyperplasia of the gingiva]].
 

==Gingival Recession==

Gingival recession is also measured using a [[Periodontal Probe|periodontal probe]]. It is the '''distance (in mm) from the [[Tooth - Anatomy & Physiology|cemento-enamel]] junction to the free [[Gingiva|gingival margin]]'''. At sites with gingival recession, [[#Periodontal Probing Depth (PPD)|PPD]] may be within normal values despite loss of [[Tooth - Anatomy & Physiology#Alveolar Bone|alveolar bone]] due to [[periodontitis]].
 
==Furcation Involvement==

Furcation involvement refers to the situation where the '''bone between the roots of multirooted teeth is destroyed''' due to [[periodontitis]]. The furcation sites of multirooted teeth should be examined with either a '''[[Periodontal Probe|periodontal probe]]''' . Furcation involvement is graded as follows:
 
:'''Grade 0''' - No furcation involvement
:'''Grade 1''' - Initial furcation involvement: the furcation can be felt with the [[Periodontal Probe|probe]]/[[Dental Explorer|explorer]], but horizontal tissue destruction is less than 1/3 of the horizontal width of the furcation
:'''Grade 2''' - Partial furcation involvement: it is possible to explore the furcation but the probe/explorer cannot be passed through it from buccal to palatal/lingual; horizontal tissue destruction is more than 1/3 of the horizontal width of the furcation
:'''Grade 3''' - Total furcation involvement: the probe/explorer can be passed through the furcation from the buccal to palatal/lingual aspect of the mouth
 

==Tooth Mobility==

The extent of tooth mobility should be assessed using a suitable instrument, e.g. the blunt end of the handle of a [[Dental Mirror|dental mirror]] or [[Periodontal Probe|probe]]. It should not be assessed using fingers directly, since the yield of the soft tissues of the fingers will mask the extent of tooth mobility. Tooth mobility is graded as follows:
 
:'''Grade 0''' - No mobility
:'''Grade 1''' - Horizontal movement of 1 mm or less
:'''Grade 2''' - Horizontal movement of more than 1 mm. Note that multirooted teeth are scored more severely and a horizontal mobility in excess of 1 mm is usually considered a Grade 3 even in the absence of vertical movement.
:'''Grade 3''' - Vertical as well as horizontal movement
 

==Crown Abnormalities==

Any '''surface defect of the [[Tooth - Anatomy & Physiology#Crown|crown]]''' needs to be identified and recorded. Surface defects are diagnosed using the [[Dental Explorer|explorer probe]] – the sharp point is run across the crown to identify any catches. Crown defects such as [[Radiographic Interpretation of Dental Developmental Abnormalities - Small Animal#Abnormal Tooth Shape or Structure|enamel dysplasia]], fractured teeth (with or without pulp exposure), worn teeth, [[Dental Caries|caries lesions]] or [[Feline Odontoclastic Resorptive Lesions|odontoclastic resorptive lesions]] are noted on the [[Dental Recording|chart]] and treated appropriately.

==References==
<references />
Gorrel, C. (2004) '''Oral examination and recording.''' In : Veterinary Dentistry for the general practitioner. ''Saunders'', Chpt 6, pp47-55

Robinson, J, Gorrel, C. (1995) '''Oral Examination and radiography.''' In : Crossley, D.A & Penman, S (eds) ''Manual of Small Animal Dentistry''. Cheltenham, UK, BSAVA Chpt 5 pp35-49

{{Lisa Milella written
|date = 20 October 2014}}

{{Waltham}}

{{OpenPages}}
[[Category:Oral Examination]]
[[Category:Waltham reviewed]]

Dental Chart Notation

2014-10-14T11:43:53Z

LisaMilella:

[[File:Filled in dental chart.jpg|center|700px|thumb|Example of completed dental chart]]

<center>
{|border="2" width="60%" align="center" cellspacing="0" cellpadding="4" rules="all" style="margin:1em 1em 1em 0; border:solid 1px #AAAAAA; border-collapse:collapse;empty-cells:show"
!bgcolor="#E5EEFF" width="10%"|Abbreviation
!bgcolor="#E5EEFF" width="20%"|Term
!bgcolor="#E5EEFF"|Explanation
|-
!align="left"|NAD
!align="left"|No Abnormality Detected
|Not always used – usually if there is no pathology, nothing is recorded on the chart.
|-
!align="left"|RL
!align="left"|[[FORL|Odontoclastic Resorptive Lesion]]
|The extent of the lesion is shaded in on the chart – the buccal view is used, TR can be used instead.
|-
!align="left"|TR
!align="left"|Tooth Resorption
|See RL above.
|-
!align="left"|GR
!align="left"|[[Dental Indices and Criteria#Gingival Recession|Gingival Recession]]
|The gingival margin is drawn down on the root and the measurement is written in mm. eg.GR3. This is drawn on the buccal and/or lingual/palatal aspect.
|-
!align="left"|GH
!align="left"|[[Gingival Hyperplasia]]
|This is measured in mm and the gingival margin is drawn out over the crown of the tooth. This is drawn on the buccal and/or lingual/palatal aspect.
|-
!align="left"|UCF
!align="left"|Uncomplicated Crown Fracture
|The extent of the fracture is shown on the buccal view of the tooth.
|-
!align="left"|CCF
!align="left"|Complicated Crown Fracture
|#PE is also sometimes used (fracture with pulp exposure). The fracture line is drawn through the crown of the tooth.
|-
!align="left"|W
!align="left"|Wear
|(Abrasion or attrition) facet, and the wear is drawn on to the chart.
|-
!align="left"|Ca
!align="left"|[[Dental Caries|Caries]] defect
|Since the lesions occur on the occlusal surface of the tooth, the open mouth view/occlusal view is used to shade in the lesion.
|-
!align="left"|G I-III
!align="left"|[[Dental Indices and Criteria#Gingivitis and Gingival Index|Gingivitis]]
|Graded out of 3 and recorded in the box.
|-
!align="left"|PPD
!align="left"|[[Dental Indices and Criteria#Periodontal Probing Depth (PPD)|Periodontal Probing Depths]]
|Recorded on the occlusal view of the tooth, a small number representing the depth is written at the corresponding location
|-
!align="left"|F 1-3
!align="left"|[[Dental Indices and Criteria#Furcation Involvement|Furcation]]
|Exposure.
|-
!align="left"|M 1-3
!align="left"|[[Dental Indices and Criteria#Tooth Mobility|Mobility]]
|
|-
!align="left"|OM
!align="left"|Oral Mass
|The extent of the lesion is drawn onto the chart. Either the buccal view or the occlusal view can be used depending on the location of the mass. Measurements of the mass are also recorded.
|-
!align="left"|RR
!align="left"|Root Remnants
|Visible or felt root remnants during the examination, rr is recorded at the site.
|-
!align="left"|
!align="left"|Missing teeth
|Usually circled, in cases of dispute, it is essential to have a record of missing teeth prior to the procedure so this should always be noted.
|-
!align="left"|X
!align="left"|Extracted teeth
|Usually marked with a X.
|-
|}
</center>
 
Ensure that all abnormal findings are recorded on the chart and, where possible, give details including location, severity, size (mm) & direction.

<big>Download a blank dental chart:
* [http://commons.wikivet.net/images/f/fc/Canine_Dental_Chart.pdf Canine]
* [http://commons.wikivet.net/images/a/aa/Feline_Dental_Chart.pdf Feline]
</big>

[[Category:Oral Examination]]
[[Category:To Do - Mars Check]]

Dental Extraction Power Equipment - Small Animal

2014-08-06T13:58:05Z

LisaMilella: /* Burs */

==Micromotor Unit==
[[File:High speed dental drill.jpg|right|200px|thumb|High speed dental drill with a tapered fissure cross cut bur''© Lisa Milella 2013'']]
[[File:Contra-angle hand piece.jpg|right|200px|thumb|Slow speed, contra-angle hand piece with a latch grip attachment.''© Lisa Milella 2013'']]
A micromotor unit is a small electric motor that connects to an e-fitting handpiece. Micromotors can be used for polishing teeth as well as sectioning them. The control box has a forward and reverse switch and a speed control knob. Micromotor units do not generally include water cooling of the bur and an external source (e.g. assistant applying coolant continuously to the tissues) is required to prevent thermal damage. For sectioning [[:Category:Teeth - Anatomy & Physiology|teeth]], the micromotor should be set at maximum speed (30 000 rpm).

==Compressed Air Driven Unit==
The basic compressed air driven unit consists of a '''high-speed hand piece with water cooling''', a slow-speed hand piece (with or without water cooling) and a combination air/water syringe, driven by a air compressor. 
The high-speed hand piece facilitates extraction by allowing easy sectioning of multi-rooted teeth and [[Bones - Anatomy & Physiology|bone]] prior to extraction. It allows accurate application of coolant water to the end of the drill tip. The turbine spins at about 300000-400000 rpm. It is designed for high speed and low-torque and should be used with the foot pedal fully depressed to achieve this. The cartridge in the head of the handpiece is driven by compressed air. The cartridge is a turbine, mounted on bearings around a clutch mechanism that holds the bur in place. Investing in a high-speed hand piece with fibre-optic light is strongly recommended. 
The slow-speed hand pieces are driven by an air motor, driven by the compressor. Each handpiece can be adjusted for direction (forward and reverse) and speed. The air motor speed has a maximum of 25000 - 30000 rpm. The slow speed handpiece accommodates the contra-angle hand piece used for polishing the teeth as well as straight or nose-cone handpieces. Contra-angle handpieces are slightly offset, and have a latch grip mechanism to hold burs or polishing heads/brushes. Contra-angle handpieces most commonly used in veterinary practice are 1:1 meaning that the output speed is the same as the air motor speed. Speed increasing handpieces are available and are better for sectioning teeth, whilst speed reducing handpieces which are also available are more commonly used for restorative dental procedures. 
The three-way syringe can deliver either a stream of water or a spray of water and air, or air only. It is used to irrigate/lavage the [[Oral Cavity Overview - Anatomy & Physiology|mouth]] (water or water/air spray) and to dry the teeth (air only). Suction is also available with some units. 
Investing in a compressed air driven unit from the outset is recommended. The high-speed hand piece greatly facilitates tooth sectioning and the three-way syringe (for lavage and drying) will aid in the removal of debris and improve visibility during examination and any procedure.

==Burs==
Dental burs are made of a variety of materials and are available in a range of sizes and shapes. For veterinary use only a few patterns and sizes are actually needed. 
The cutting surface of the bur is made of stainless steel, tungsten-carbide steel or diamond. Tungsten carbide and stainless steel types have cutting blades. The fastest bur is a tungsten carbide bur. Diamond burs have a coating of tiny diamonds embedded in resin on the bur shank. As the diamonds are lost, the bur becomes less efficient at cutting. 
'''Shapes of Burs:'''
 
The most commonly used shapes in veterinary dentistry are tapered fissure burs and round burs. Fissure burs can be either cylindrical or tapered with cutting surfaces on the side of the bur. Round burs are ball shape and have cutting surfaces around the whole surface of the ball. Other shapes are available and include pear shaped, inverted cones amongst others.
Burs suitable for use in a high speed handpiece are called friction grip burs (FG). Latch grip (RA) burs are suitable for contra-angle handpieces and HP burs are suitable for straight handpieces.

Burs used in high speed handpieces are typically used for sectioning the teeth during extraction, for crown preparation or for endodontic access into the tooth
Latch grip burs are used in slow speed handpieces and are used for bone removal (with coolant) or finer, more controlled cavity prepartaions
HP burs are used on a straigh nose cone hand piece - the most common bur used for removal of tooth substance for crown height reduction in rabbits, typically a small round or fissure bur or an acrylic trimmer as illustrated.
Needs explanation

[[Category:Dental Instruments]]
[[Category:To Do - Dentistry questions]]
[[Category:To Do - Mars Check]]

Dental Formula - Dog

2014-08-04T14:28:39Z

LisaMilella: /* Incisors */

{{OpenPagesTop}}
==Overview==
[[Image:Aspinall Slide12.JPG|thumb|right|300px|Image from [http://www.elsevierhealth.co.uk/veterinary-nursing/spe-60136/ Aspinall, The Complete Textbook of Veterinary Nursing], Elsevier Health Sciences, ''All rights reserved'']]

Dogs are toothless at birth. Their '''deciduous''' teeth are complete and functional within 2 months of birth in most breeds. '''Permanent''' teeth are complete and funtional by the end of the 7th month.

The formula for '''deciduous''' teeth: 2 (i3/3 c1/1 p3/3)

The formula for '''permanent''' teeth: 2 (I3/3 C1/1 P4/4 M2/3)

===Canine teeth===

The canine teeth are large, curved and laterally compressed. Their [[Enamel Organ#Root|root]] is longer than their [[Enamel Organ#Crown|crown]]. They have a single [[Enamel Organ#Root|root]].

===Molars===

The molars are broader than the premolars. The large flat surface is used for grinding.
===Incisors===

They have a single [[Enamel Organ#Root|root]].

===Premolars===

The premolars are irregular and closely-spaced. They are more complex and larger caudally.

==Breed Differences==

Eruption times differ between breeds so it is difficult to age dogs by their teeth.

{{Template:Learning
|OVAM = [http://www.onlineveterinaryanatomy.net/content/canine-dentition Image - Canine Dentition]
}}

{{OpenPages}}
[[Category:Teeth - Anatomy & Physiology]]
[[Category:Dog - Alimentary System]]
[[Category:A&P Done]]
[[Category:LisaM reviewing]]
[[Category:Dental Anatomy - Small Animal]]

Gingiva

2014-08-04T14:23:54Z

LisaMilella: /* Mucogingival line */

{{OpenPagesTop}}
==Introduction==

Gingiva is the oral mucosa surrounding the neck of each tooth forming the gums.

==Structure and Function of the Gingiva==

Gingiva is mucosal tissue over [[Enamel Organ#Alveolar Bone|alveolar bone]]. It has a stratified squamous epithelium, with some keratinisation. It resists friction of food during [[Mastication|mastication]] by being tightly bound to the underlying bone. It recedes with age, exposing the cervical part of the tooth. It is usually salmon pink in healthy animals. A colour change indicates pathology.

===Mucogingival junction===
[[Image:Labiogingival Groove Histology.jpg|thumb|right|250px|Labiogingival Groove Histology - Copyright RVC 2008]]

The '''mucogingival junction''' is the junction between the '''attached gingiva''' and '''the free alveolar mucosa'''

==Vasculature and Innervation of the Gingiva==

The gingiva is supplied by the '''superior''' and '''inferior alveolar arteries'''.

Innervation is from the '''trigeminal nerve''' ([[Cranial Nerves - Anatomy & Physiology|CN V]]).

==Species Differences==

===Canine===
Some breeds of dog have dark gums, e.g. chow chow.

{{Learning
|flashcards = [[Teeth and Gingiva Flashcards]]
|powerpoints = [[Oral Cavity Histology resource|Histology tutorial on the oral cavity]]
}}

{{OpenPages}}
[[Category:Oral Cavity - Anatomy & Physiology]]
[[Category:A&P Done]]
[[Category:LisaM reviewing]]
[[Category:Dental Anatomy - Small Animal]]

Tooth Fractures

2014-08-04T14:20:49Z

LisaMilella: /* Crown Fractures */

{{OpenPagesTop}}
==Introduction==
Tooth fractures may affect the [[Enamel Organ#Crown|crown]], the crown and the [[Enamel Organ#Root|root]] or just the root.

Fractures are termed '''complicated''' if there is exposure of the pulp.

==Signalment==
All teeth are susceptible to fracture, but in the mature dog and cat, '''maxillary canines''' are most commonly broken, followed by the mandibular canine, the maxillary fourth premolars, and incisors. In the immature dog less than 6 months old, '''deciduous canine''' teeth are the teeth that most commonly fracture.

==Aetiology==
'''Causes''' of fracture include: chewing on metal fences or gates, hard chew toys, stones, ice cubes, horse and cow hooves.

A slab fracture of the [[Dental Formula - Dog|carnassial tooth]] usually results from dogs chewing, whilst trauma to the anterior teeth (canines and incisors) results from catching a hard object for eg. Stones/Frisbees. Trauma to the front teeth can also result from an anterior collision – with a stationary object or another dog.

External head trauma from road traffic accidents (RTAs) or external blows/kicks can also result in tooth fractures.

==Classification of tooth fractures==

:'''Class A1''' – involves the [[Enamel Organ#Enamel|enamel]] only
:'''Class A2a''' – involves the enamel and [[Enamel Organ#Dentin|dentine]] but has not exposed the [[Enamel Organ#Pulp|pulp chamber]]
:'''Class A2b''' – involves the enamel and dentine but has also exposed the pulp cavity

Fractures may also be classified as '''crown only''', '''crown-root fractures''' or '''root fracture'''.

==Crown Fractures==
Crown fractures are usually obvious visually.

Enamel fracture: if only the [[Enamel Organ#Enamel|enamel]] is fractured, this will appear as chips in the enamel surface.

The treatment of choice is to smooth any sharp edges with fine diamond burs or sanding disks in order to prevent trauma to the lips and tongue.

[[Intra-Oral Radiography - Small Animal|'''Radiography''']] should be obtained to check for any apical root fractures and a follow-up radiograph should be performed within the year to check for periapical pathology.

Enamel and [[Enamel Organ#Dentine|dentin]] fracture: this provides a direct pathway for bacteria to the pulp via the dentinal tubules. [[Enamel Organ#Pulp|Pulp]] exposure should be evaluated for by probing with an [[Dental Explorer|explorer tip]] with the animal [[Oral Examination Under General Anaesthesia|under general anaesthesia]]. Radiographs should be taken to evaluate the root.

*'''Indirect pulp capping''': covers exposed dentin with a crown restoration. Follow-up radiographs are taken at 6-monthly intervals.
*'''Direct pulp capping''': the dentin is removed and the pulp is covered with calcium hydroxide or MTA, followed by crown restoration.

Enamel and dentin fracture with pulp exposure: if the pulp is exposed '''endodontic treatment''' must be performed or the tooth must be '''extracted'''. An untreated exposed pulp leads to necrosis of tissue in the direction of the [[Enamel Organ#Root|root]] apex.

==Crown-Root Fracture==
A crown-root fracture involves the enamel, dentine and [[Enamel Organ#Cementum|cementum]]. It can be further classified into complicated or uncomplicated.

==Root Fracture==
A root fracture involves dentin, cementum and pulp and is generally complicated.

Some root fractures which are reasonably stable, horizontal and uncontaminated, may heal unaided with the pulp remaining vital. The [[Enamel Organ#Alveolar Bone|alveolus]] acts as a '''natural splint''' which maintains the segments of tooth in close proximity.

If the fracture is unstable, the coronal segment of the fracture should be removed and the apical segment either extracted or treated endodontically.

==Endodontic Treatment==
Treatment and prognosis of fractures depends on:
:The degree of displacement and mobility of the fracture segments
:The extent of contamination
:The amount of damage to the alveolar crest bone

For complicated fractures, endodontic treatment should be performed in adult animals.

Mature teeth have narrow pulp cavities and fully formed roots. '''Root canal treatment''' involves:
#Cleaning out the remaining pulp
#Shaping and disinfecting the root canal
#Filling the root
#Restoring the surface

==Crown Restoration==
Fractures with pulp exposure require endodontic treatment but the '''prosthodontic build-up of the crown''' is optional.

It may be sufficient to simply close the fracture sites with composite resin.

'''Full crown restoration''' may be important for working dogs who rely on normally functioning teeth. It may also be of aesthetic advantage in show dogs.

It may also be indicated to protect the tooth against '''further trauma'''. It will reduce the risk of further breakdown of the remaining tooth structure.

Restoration of the tooth structure may help prevent [[Periodontal Disease|'''periodontal disease''']] by preventing food entrapment in the [[gingiva]].

'''Radiography''' should be performed regularly to check for periapical inflammation or bone disorders.

==Prevention==
Chewing hard objects should be avoided. Stones, bones and certain toys are harder than the tooth substance and can result in fracture of the tooth.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 06]]
}}

==References==
Verstaete, F. (1999) '''Veterinary Dentistry: Self assessment colour review''' ''Manson Publishing''

Gorrel, C. (2004) '''Veterinary Dentistry for the General Practitioner''' ''Elsevier Health Sciences''

Bellows, J. (1999) '''The practice of veterinary dentistry: a team effort''' ''Wiley-Blackwell''

Wiggs, R. (1997) '''Veterinary Dentistry: principles and practice''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Dog]]
[[Category:Dental Diseases - Cat]]
[[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]
[[Category:Traumatic Dental Conditions]]

Tooth Fractures

2014-08-04T14:19:04Z

LisaMilella: /* Signalment */

{{OpenPagesTop}}
==Introduction==
Tooth fractures may affect the [[Enamel Organ#Crown|crown]], the crown and the [[Enamel Organ#Root|root]] or just the root.

Fractures are termed '''complicated''' if there is exposure of the pulp.

==Signalment==
All teeth are susceptible to fracture, but in the mature dog and cat, '''maxillary canines''' are most commonly broken, followed by the mandibular canine, the maxillary fourth premolars, and incisors. In the immature dog less than 6 months old, '''deciduous canine''' teeth are the teeth that most commonly fracture.

==Aetiology==
'''Causes''' of fracture include: chewing on metal fences or gates, hard chew toys, stones, ice cubes, horse and cow hooves.

A slab fracture of the [[Dental Formula - Dog|carnassial tooth]] usually results from dogs chewing, whilst trauma to the anterior teeth (canines and incisors) results from catching a hard object for eg. Stones/Frisbees. Trauma to the front teeth can also result from an anterior collision – with a stationary object or another dog.

External head trauma from road traffic accidents (RTAs) or external blows/kicks can also result in tooth fractures.

==Classification of tooth fractures==

:'''Class A1''' – involves the [[Enamel Organ#Enamel|enamel]] only
:'''Class A2a''' – involves the enamel and [[Enamel Organ#Dentin|dentine]] but has not exposed the [[Enamel Organ#Pulp|pulp chamber]]
:'''Class A2b''' – involves the enamel and dentine but has also exposed the pulp cavity

Fractures may also be classified as '''crown only''', '''crown-root fractures''' or '''root fracture'''.

==Crown Fractures==
Crown fractures are usually obvious visually.

Enamel fracture: if only the [[Enamel Organ#Enamel|enamel]] is fractured, this will appear as chips in the enamel surface.

The treatment of choice is to smooth any sharp edges with fine diamond burs or sanding disks in order to prevent trauma to the lips and tongue.

[[Intra-Oral Radiography - Small Animal|'''Radiography''']] should be obtained to check for any apical root fractures and a follow-up radiograph should be performed within the year to check for periapical pathology.

Enamel and [[Enamel Organ#Dentine|dentin]] fracture: this provides a direct pathway for bacteria to the pulp via the dentinal tubules. [[Enamel Organ#Pulp|Pulp]] exposure should be evaluated for by probing with an [[Dental Explorer|explorer tip]] with the animal [[Oral Examination Under General Anaesthesia|under general anaesthesia]]. Radiographs should be taken to evaluate the root.

*'''Indirect pulp capping''': covers exposed dentin with glass ionomer cement followed by crown restoration. Follow-up radiographs are taken at 6-monthly intervals.
*'''Direct pulp capping''': the dentin is removed and the pulp is covered with calcium hydroxide or glass ionomer cement, followed by crown restoration.

Enamel and dentin fracture with pulp exposure: if the pulp is exposed '''endodontic treatment''' must be performed or the tooth must be '''extracted'''. An untreated exposed pulp leads to necrosis of tissue in the direction of the [[Enamel Organ#Root|root]] apex.

==Crown-Root Fracture==
A crown-root fracture involves the enamel, dentine and [[Enamel Organ#Cementum|cementum]]. It can be further classified into complicated or uncomplicated.

==Root Fracture==
A root fracture involves dentin, cementum and pulp and is generally complicated.

Some root fractures which are reasonably stable, horizontal and uncontaminated, may heal unaided with the pulp remaining vital. The [[Enamel Organ#Alveolar Bone|alveolus]] acts as a '''natural splint''' which maintains the segments of tooth in close proximity.

If the fracture is unstable, the coronal segment of the fracture should be removed and the apical segment either extracted or treated endodontically.

==Endodontic Treatment==
Treatment and prognosis of fractures depends on:
:The degree of displacement and mobility of the fracture segments
:The extent of contamination
:The amount of damage to the alveolar crest bone

For complicated fractures, endodontic treatment should be performed in adult animals.

Mature teeth have narrow pulp cavities and fully formed roots. '''Root canal treatment''' involves:
#Cleaning out the remaining pulp
#Shaping and disinfecting the root canal
#Filling the root
#Restoring the surface

==Crown Restoration==
Fractures with pulp exposure require endodontic treatment but the '''prosthodontic build-up of the crown''' is optional.

It may be sufficient to simply close the fracture sites with composite resin.

'''Full crown restoration''' may be important for working dogs who rely on normally functioning teeth. It may also be of aesthetic advantage in show dogs.

It may also be indicated to protect the tooth against '''further trauma'''. It will reduce the risk of further breakdown of the remaining tooth structure.

Restoration of the tooth structure may help prevent [[Periodontal Disease|'''periodontal disease''']] by preventing food entrapment in the [[gingiva]].

'''Radiography''' should be performed regularly to check for periapical inflammation or bone disorders.

==Prevention==
Chewing hard objects should be avoided. Stones, bones and certain toys are harder than the tooth substance and can result in fracture of the tooth.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 06]]
}}

==References==
Verstaete, F. (1999) '''Veterinary Dentistry: Self assessment colour review''' ''Manson Publishing''

Gorrel, C. (2004) '''Veterinary Dentistry for the General Practitioner''' ''Elsevier Health Sciences''

Bellows, J. (1999) '''The practice of veterinary dentistry: a team effort''' ''Wiley-Blackwell''

Wiggs, R. (1997) '''Veterinary Dentistry: principles and practice''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Dog]]
[[Category:Dental Diseases - Cat]]
[[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]
[[Category:Traumatic Dental Conditions]]

Persistent Deciduous Teeth

2014-08-04T14:12:39Z

LisaMilella: /* Treatment */

{{OpenPagesTop}}
==Introduction==
Usually, as the permanent tooth erupts, '''resorption of the deciduous tooth root''' occurs and the deciduous tooth is lost.

A deciduous tooth is considered '''persistent''' when it is present in the mouth together with its permanent counterpart. The permanent tooth does not need to be fully erupted for the deciduous tooth to be considered persistent.

The most common cause for a persistent deciduous tooth is an '''incorrect eruption path of the permanent tooth'''. This means that there will be no impetus for the root of the deciduous tooth to be resorbed, and the permanent tooth will erupt alongside it.

Another potential cause is '''primary impaction or ankylosis of the deciduous tooth'''. There will then be either impaction or improper eruption of the permanent tooth, creating a persistent deciduous tooth.

This is thought to be an '''inherited problem''' and occurs most commonly in small and toy breed dogs and also in cats.

Potential problems associated with this condition include:
:'''overcrowding of the dental arch''', and permanent teeth in abnormal locations leading to malocclusion
:abnormal development of the roots and periodontal support around the permanent tooth, leading to '''early loss'''
:accumulation of plaque leading to the development of [[Periodontal Disease|'''periodontal disease''']]

==Clinical Signs==
The teeth most commonly affected are the '''canines''', and the condition is often '''bilateral'''.

There will be additional teeth in the arcades, which appear crowded. The permanent teeth may be in an '''abnormal position''', and this may have lead to '''tooth, gingival or palatine trauma and damage'''.

There is weakened periodontal attachment and '''periodontal disease''', often seen as [[gingivitis]], tartar and loosening of the tooth.

==Diagnosis==
A thorough '''oral examination''' should enable the persistent deciduous teeth to be found.

'''Radiographs''' help distinguish deciduous from permanent dentition, determine the location of the developing permanent tooth/teeth, and the integrity of the deciduous [[Enamel Organ#Root|tooth root]] structure.

==Treatment==
'''There should never be two teeth of the same type in the same place at the same time.'''

Any persistent deciduous teeth should be '''extracted as soon as possible''' to avoid all the sequelae of the condition.

The time of permanent dentition eruption is between 3 and 6 months, and therefore waiting to extract the teeth at the same time as neutering is not acceptable.

Extraction can be difficult as the deciduous teeth have '''thin walls and are of considerable length'''. There is also sometimes resorption and ankylosis of the tooth. The extraction should be '''gentle and careful''' to avoid damaging the permanent tooth.

'''Closed extraction''' is usually sufficient, and it is the fastest method causing the least trauma.

'''Root fracture''' commonly occurs, and every effort should be made to remove the remaining piece, as a retained root tip can act as a nidus of infection and inflammation.

'''Dental radiographs''' should be taken post-extraction to confirm complete removal of the deciduous tooth and to document the condition of the permanent tooth.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 03]]
}}

==References==
Tutt, C. (2006) '''Small Animal Dentistry: a manual of techniques''' ''Wiley-Blackwell''

Bellows, J. (2010) '''Feline Dentistry: oral assessment, treatment and preventative care''' ''John Wiley and Sons''

Niemiec, B. (2010) '''A colour handbook of small animal dental and oral maxillofacial disease''' ''Manson Publishing''

{{review}}

{{OpenPages}}

[[Category:Teeth - Developmental Pathology]][[Category:Oral Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Developmental Dental Conditions]]
[[Category:LisaM reviewing]]

Persistent Deciduous Teeth

2014-08-04T14:11:27Z

LisaMilella: /* Clinical Signs */

{{OpenPagesTop}}
==Introduction==
Usually, as the permanent tooth erupts, '''resorption of the deciduous tooth root''' occurs and the deciduous tooth is lost.

A deciduous tooth is considered '''persistent''' when it is present in the mouth together with its permanent counterpart. The permanent tooth does not need to be fully erupted for the deciduous tooth to be considered persistent.

The most common cause for a persistent deciduous tooth is an '''incorrect eruption path of the permanent tooth'''. This means that there will be no impetus for the root of the deciduous tooth to be resorbed, and the permanent tooth will erupt alongside it.

Another potential cause is '''primary impaction or ankylosis of the deciduous tooth'''. There will then be either impaction or improper eruption of the permanent tooth, creating a persistent deciduous tooth.

This is thought to be an '''inherited problem''' and occurs most commonly in small and toy breed dogs and also in cats.

Potential problems associated with this condition include:
:'''overcrowding of the dental arch''', and permanent teeth in abnormal locations leading to malocclusion
:abnormal development of the roots and periodontal support around the permanent tooth, leading to '''early loss'''
:accumulation of plaque leading to the development of [[Periodontal Disease|'''periodontal disease''']]

==Clinical Signs==
The teeth most commonly affected are the '''canines''', and the condition is often '''bilateral'''.

There will be additional teeth in the arcades, which appear crowded. The permanent teeth may be in an '''abnormal position''', and this may have lead to '''tooth, gingival or palatine trauma and damage'''.

There is weakened periodontal attachment and '''periodontal disease''', often seen as [[gingivitis]], tartar and loosening of the tooth.

==Diagnosis==
A thorough '''oral examination''' should enable the persistent deciduous teeth to be found.

'''Radiographs''' help distinguish deciduous from permanent dentition, determine the location of the developing permanent tooth/teeth, and the integrity of the deciduous [[Enamel Organ#Root|tooth root]] structure.

==Treatment==
'''There should never be two teeth of the same type in the same place at the same time.'''

Any persistent deciduous teeth should be '''extracted as soon as possible''' to avoid all the sequelae of the condition.

The time of permanent dentition eruption is between 3 and 6 months, and therefore waiting to extract the teeth at the same time as neutering is not acceptable.

Extraction can be difficult as the deciduous teeth have '''thin walls and are of considerable length'''. There is also sometimes resorption and ankylosis of the tooth. The extraction should be '''gentle and careful''' to avoid damaging the permanent tooth.

'''Closed extraction''' is usually sufficient, and it is the fastest method causing the least trauma.

'''Root fracture''' commonly occurs, and every effort should be made to remove the remaining piece, as a retained root tip can act as a nidus of infection and inflammation.

'''Dental radiographs''' should be taken post-extraction to confirm complete removal of the deciduous tooth and to document the condition of the permanent tooth.

'''Antibiotics''' should be given if periodontal disease is present.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 03]]
}}

==References==
Tutt, C. (2006) '''Small Animal Dentistry: a manual of techniques''' ''Wiley-Blackwell''

Bellows, J. (2010) '''Feline Dentistry: oral assessment, treatment and preventative care''' ''John Wiley and Sons''

Niemiec, B. (2010) '''A colour handbook of small animal dental and oral maxillofacial disease''' ''Manson Publishing''

{{review}}

{{OpenPages}}

[[Category:Teeth - Developmental Pathology]][[Category:Oral Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Developmental Dental Conditions]]
[[Category:LisaM reviewing]]

Persistent Deciduous Teeth

2014-08-04T14:10:45Z

LisaMilella: /* Introduction */

{{OpenPagesTop}}
==Introduction==
Usually, as the permanent tooth erupts, '''resorption of the deciduous tooth root''' occurs and the deciduous tooth is lost.

A deciduous tooth is considered '''persistent''' when it is present in the mouth together with its permanent counterpart. The permanent tooth does not need to be fully erupted for the deciduous tooth to be considered persistent.

The most common cause for a persistent deciduous tooth is an '''incorrect eruption path of the permanent tooth'''. This means that there will be no impetus for the root of the deciduous tooth to be resorbed, and the permanent tooth will erupt alongside it.

Another potential cause is '''primary impaction or ankylosis of the deciduous tooth'''. There will then be either impaction or improper eruption of the permanent tooth, creating a persistent deciduous tooth.

This is thought to be an '''inherited problem''' and occurs most commonly in small and toy breed dogs and also in cats.

Potential problems associated with this condition include:
:'''overcrowding of the dental arch''', and permanent teeth in abnormal locations leading to malocclusion
:abnormal development of the roots and periodontal support around the permanent tooth, leading to '''early loss'''
:accumulation of plaque leading to the development of [[Periodontal Disease|'''periodontal disease''']]

==Clinical Signs==
The teeth most commonly affected are the '''canines''', and the condition is often '''bilateral'''.

There will be additional teeth in the arcades, which appear crowded. The permanent teeth may be in an '''abnormal position''', and this may have lead to '''tooth, gingival or palatine trauma and damage'''.

There may be '''traumatic pulpitis''' in the permanent dentition.

There is weakened periodontal attachment and '''periodontal disease''', often seen as [[gingivitis]], tartar and loosening of the tooth.

==Diagnosis==
A thorough '''oral examination''' should enable the persistent deciduous teeth to be found.

'''Radiographs''' help distinguish deciduous from permanent dentition, determine the location of the developing permanent tooth/teeth, and the integrity of the deciduous [[Enamel Organ#Root|tooth root]] structure.

==Treatment==
'''There should never be two teeth of the same type in the same place at the same time.'''

Any persistent deciduous teeth should be '''extracted as soon as possible''' to avoid all the sequelae of the condition.

The time of permanent dentition eruption is between 3 and 6 months, and therefore waiting to extract the teeth at the same time as neutering is not acceptable.

Extraction can be difficult as the deciduous teeth have '''thin walls and are of considerable length'''. There is also sometimes resorption and ankylosis of the tooth. The extraction should be '''gentle and careful''' to avoid damaging the permanent tooth.

'''Closed extraction''' is usually sufficient, and it is the fastest method causing the least trauma.

'''Root fracture''' commonly occurs, and every effort should be made to remove the remaining piece, as a retained root tip can act as a nidus of infection and inflammation.

'''Dental radiographs''' should be taken post-extraction to confirm complete removal of the deciduous tooth and to document the condition of the permanent tooth.

'''Antibiotics''' should be given if periodontal disease is present.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 03]]
}}

==References==
Tutt, C. (2006) '''Small Animal Dentistry: a manual of techniques''' ''Wiley-Blackwell''

Bellows, J. (2010) '''Feline Dentistry: oral assessment, treatment and preventative care''' ''John Wiley and Sons''

Niemiec, B. (2010) '''A colour handbook of small animal dental and oral maxillofacial disease''' ''Manson Publishing''

{{review}}

{{OpenPages}}

[[Category:Teeth - Developmental Pathology]][[Category:Oral Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Developmental Dental Conditions]]
[[Category:LisaM reviewing]]

Peripheral Odontogenic Fibroma

2014-08-04T14:08:29Z

LisaMilella: /* Diagnostic Imaging */

{{OpenPagesTop}}
Also known as: ''''' Fibromatous epulis of periodontal ligament — Epulis — Ossifying Epulis

==Introduction==
[[File:Fibrous epulis.JPG|thumb|200px|right|Fibrous epulis]]
Peripheral odontogenic fibroma is a benign tumour that arises from the [[Enamel Organ#Periodontal Ligament|periodontal ligament]]. It was previously known as a fibromatous epulis and ossifying epulis depending on the degree of mineralization.
They present as firm, smooth swellings of the [[Gingiva|gingiva]] and are normally indistinguishable from [[Gingival Hyperplasia|gingival hyperplasia]].

==Typical Signalment==
Most common benign tumour found in the oral cavity in dogs but is less common in cats. Is seen in dogs of any age but more common in those older than 6 years. .

==Clinical Signs==
Include halitosis, oral bleeding, dental disruption or loss, facial or mandibular deformity, excessive salivation, growth protruding from the mouth and rarely dysphagia.

==Diagnostic Imaging==
Radiographs are required to differentiate this benign neoplasm from malignant or locally aggressive lesions. Intra-oral radiographs will evaluate the oral lesion itself and thoracic radiography to evaluate for metastasies (if a malignancy is a diagnostic possibility). Radiographs typically show a soft tissue opacity in the the gingiva region with varying degrees of mineralization. Bone involvement is not a feature of this neoplasm and hence is not to be confused with [[Acanthomatous Ameloblastoma|Acanthomatous Ameloblastoma]] which often invades bone.

Radiography cannot be used to differentiate a peripheral odontogenic fibroma from a hyperplastic gingival lesion.

==Biopsy==
An incisional biopsy is required to obtain a definitive diagnosis.

==Pathology==
[[Image:epulis.gif|right|thumb|200px|<center>Canine Epulis(Courtesy of Alun Williams (RVC))</center>]]
Proliferation of fibrous tissue with a variety of osteoid, [[Enamel Organ#Cementum|cementum]] or [[Enamel Organ#Dentine|dentine]] like material. Isolated strands or islands of odontogenic epithelium are always present (ie: suggesting induction of connective tissue by the epithelial cells).
The stroma contains neoplastic fibroblasts, with varying cellularity and the overlying epitheluim is normal.

==Treatment==
A surgical excision of the neoplasm should be performed. The depth of the excision is determined by the location of the origin of the neoplasm at the periodontal ligament.
Excision may be at the gingival level or a deep resection involving the extraction of the affected tooth and curettage of the alveolar socket.

They do not recur if adequately excised.

==Prognosis==
Good following surgical resection. Recurrence is common following incomplete surgical resection.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=title%3A%28%22Peripheral+Odontogenic+Fibroma%22%29+OR+%28title%3A%28epulis%29+AND+%28title%3A%28fibromatous%29+OR+title%3A%28ossifying%29%29%29 Peripheral Odontogenic Fibroma publications]
}}

==References==

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

Verstraete, F.J.M., Ligthelmf, A.J. and Weber, A,(1992) '''The Histological Nature of Epulides in Dogs'''. Journal of comparative Pathology. (106) 169-182.

With thanks to Andrew Jefferies (Cambridge) and Alun Williams (RVC) for providing access to their lecture materials

{{review}}

{{OpenPages}}

[[Category:Teeth_-_Proliferative_Pathology]]
[[Category:Neoplasia]]
[[Category:Expert_Review - Small Animal]]
[[Category:Oral Diseases - Dog]]
[[Category:Oral Diseases - Cat]]
[[Category:Bones - Pathology]]
[[Category:Oral Proliferations]]
[[Category:LisaM reviewing]]

Peripheral Odontogenic Fibroma

2014-08-04T14:07:16Z

LisaMilella: /* Typical Signalment */

{{OpenPagesTop}}
Also known as: ''''' Fibromatous epulis of periodontal ligament — Epulis — Ossifying Epulis

==Introduction==
[[File:Fibrous epulis.JPG|thumb|200px|right|Fibrous epulis]]
Peripheral odontogenic fibroma is a benign tumour that arises from the [[Enamel Organ#Periodontal Ligament|periodontal ligament]]. It was previously known as a fibromatous epulis and ossifying epulis depending on the degree of mineralization.
They present as firm, smooth swellings of the [[Gingiva|gingiva]] and are normally indistinguishable from [[Gingival Hyperplasia|gingival hyperplasia]].

==Typical Signalment==
Most common benign tumour found in the oral cavity in dogs but is less common in cats. Is seen in dogs of any age but more common in those older than 6 years. .

==Clinical Signs==
Include halitosis, oral bleeding, dental disruption or loss, facial or mandibular deformity, excessive salivation, growth protruding from the mouth and rarely dysphagia.

==Diagnostic Imaging==
Radiographs are required to differentiate this benign neoplasm from malignant or locally aggressive lesions. Skull radiographs will evaluate the oral lesion itself and thoracic radiography to evaluate for metastasies (if a malignancy is a diagnostic possibility). Radiographs typically show a soft tissue opacity in the the gingiva region with varying degrees of mineralization. Bone involvement is not a feature of this neoplasm and hence is not to be confused with [[Acanthomatous Ameloblastoma|Acanthomatous Ameloblastoma]] which often invades bone.

Radiography cannot be used to differentiate a peripheral odontogenic fibroma from a hyperplastic gingival lesion.

==Biopsy==
An incisional biopsy is required to obtain a definitive diagnosis.

==Pathology==
[[Image:epulis.gif|right|thumb|200px|<center>Canine Epulis(Courtesy of Alun Williams (RVC))</center>]]
Proliferation of fibrous tissue with a variety of osteoid, [[Enamel Organ#Cementum|cementum]] or [[Enamel Organ#Dentine|dentine]] like material. Isolated strands or islands of odontogenic epithelium are always present (ie: suggesting induction of connective tissue by the epithelial cells).
The stroma contains neoplastic fibroblasts, with varying cellularity and the overlying epitheluim is normal.

==Treatment==
A surgical excision of the neoplasm should be performed. The depth of the excision is determined by the location of the origin of the neoplasm at the periodontal ligament.
Excision may be at the gingival level or a deep resection involving the extraction of the affected tooth and curettage of the alveolar socket.

They do not recur if adequately excised.

==Prognosis==
Good following surgical resection. Recurrence is common following incomplete surgical resection.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=title%3A%28%22Peripheral+Odontogenic+Fibroma%22%29+OR+%28title%3A%28epulis%29+AND+%28title%3A%28fibromatous%29+OR+title%3A%28ossifying%29%29%29 Peripheral Odontogenic Fibroma publications]
}}

==References==

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

Verstraete, F.J.M., Ligthelmf, A.J. and Weber, A,(1992) '''The Histological Nature of Epulides in Dogs'''. Journal of comparative Pathology. (106) 169-182.

With thanks to Andrew Jefferies (Cambridge) and Alun Williams (RVC) for providing access to their lecture materials

{{review}}

{{OpenPages}}

[[Category:Teeth_-_Proliferative_Pathology]]
[[Category:Neoplasia]]
[[Category:Expert_Review - Small Animal]]
[[Category:Oral Diseases - Dog]]
[[Category:Oral Diseases - Cat]]
[[Category:Bones - Pathology]]
[[Category:Oral Proliferations]]
[[Category:LisaM reviewing]]

Periodontal Disease

2014-08-04T14:03:21Z

LisaMilella: /* Introduction */

Includes: '''''Gingivitis — Periodontitis — Periodontal Pockets'''''

== Introduction ==
[[File:Healthy gingiva cat.jpg|200px|thumb|right|Healthy gingiva]]
[[File:Gingivitis.jpg|200px|thumb|right|Gingivitis]]
[[File:PD3-visibleAL.jpg|200px|thumb|right|Gingival recession of canine tooth with exposed root surface]]
Periodontal disease is essentially an inflammatory response by the supporting structures of the [[:Category:Teeth - Anatomy & Physiology|teeth]] known as the periodontium. These structures include the [[gingiva]], [[Enamel Organ#Periodontal Ligament|periodontal ligaments]], [[Enamel Organ#Cementum|cementum]] and [[Enamel Organ#Alveolar Bone|alveolar bone]]. It is the most common [[:Category:Oral Diseases - Dog|dental disease in dogs]] and [[:Category:Oral Diseases - Cat|cats]] and the major cause of tooth loss in both species. There are numerous factors that contribute to the formation of the disease but the primary agent is dental plaque. Plaque accumulates at the gingival margin, partly due to insufficient [[Oral Hygiene - Small Animal|oral hygiene]].

Periodontal disease is the result of the inflammatory response to dental plaque, i.e. oral bacteria, and is limited to the periodontium. It is probably the most common disease seen in small animal practice, with the great majority of dogs and cats over the age of 3 years having a degree of disease that warrants intervention.

Periodontal disease is a collective term for a number of plaque-induced inflammatory lesions that affect the periodontium. It is a unique infection in that it is not associated with a massive bacterial invasion of the tissues. '''Gingivitis''' is inflammation of the gingiva and is the earliest sign of disease. Individuals with untreated gingivitis may develop '''periodontitis'''. The inflammatory reactions in periodontitis result in destruction of the periodontal ligament and alveolar bone. The result of untreated periodontitis is ultimately exfoliation of the affected tooth. Thus, gingivitis is inflammation that is not associated with destruction (loss) of supporting tissue – it is reversible. In contrast, periodontitis is inflammation where the tooth has lost a variable degree of its support (attachment) – it is irreversible. Infection of the periodontium may cause discomfort to the affected animal. There is also strong evidence that a focus of infection in the [[Oral Cavity Overview - Anatomy & Physiology|oral cavity]] has been associated with disease of distant organs. Consequently, prevention and treatment of periodontal diseases is, contrary to common belief, not a cosmetic issue, but a general health and welfare issue.

Initially, the bacterial flora tend to be non-motile aerobes or facultative anaerobes. However, as the supply of oxygen is reduced by supragingival plaque accumulation and pocket formation, the bacterial flora become more motile and anaerobic. Important bacterial flora responsible include ''Porphyromonas gingivalis, Bacteroides asaccharolyticus, Fusobacterium nucleatum, Actinomyces viscosus'' and ''Actinomyces odontolyticus''.

Gingival inflammation starts because of dental calculus (tartar) from diets high in minerals and diets consisting of soft rather than hard crunchy food. Dental plaque becomes calcified and whole [[Enamel Organ#Crown|crown]] may become covered in brown chalky material. Calculus gives brittle dirty brown covering to tooth which may not affect [[Enamel Organ#Enamel|enamel]] at all but may produce mild gingivitis round edge and the gum may start to recede. This exposes more of crown, may reach level of [[Enamel Organ#Dentine|dentine]] and infection may enter the alveolus and loosen ligaments holding tooth in and ultimately the tooth will become loose and fall out.

'''Gingivitis''' - Reversible inflammation of the marginal gingival tissues that does not affect the [[Enamel Organ|periodontal ligament or the alveolar bone]].

'''Periodontitis''' - Inflammation and irreversible destruction of the tooth's supporting structures that includes the [[gingiva]], periodontal ligament, alveolar bone and root cementum. It usually occurs after years of plaque accumulation and gingivitis. The epithelial attachments of the tooth regress apically and there is absorption of the associated alveolar bone, resulting in permanent loss of tooth support.

'''Periodontal pocket''' - this describes the area of tissue destruction left by periodontitis. It is an attachment loss due to destruction of the fibres and bone that support the tooth which results in a pathological deepening of the gingival sulcus.

==Aetiology==

The primary cause of gingivitis and periodontitis is '''accumulation of dental plaque''' on the tooth surfaces. '''Calculus''' (tartar) is only a secondary aetiological factor.

Dental plaque is a biofilm composed of aggregates of [[:Category:Bacteria|bacteria]] and their by-products, salivary components, oral debris, and occasional epithelial and inflammatory cells. Plaque accumulation starts within minutes on a clean tooth surface. The initial accumulation of plaque occurs supragingivally but will extend into the sulcus and populate the subgingival region if left undisturbed. The formation of plaque involves two processes, namely the initial adherence of bacteria and then the continued accumulation of bacteria due to a combination of bacterial multiplication and further aggregation of bacteria to those cells that are already attached.

As soon as a tooth becomes exposed to the [[:Category:Oral Cavity - Anatomy & Physiology|oral cavity]], its surfaces are covered by the '''pellicle '''(an amorphous coating of salivary proteins and glycoproteins). The pellicle alters the charge and free energy of the tooth surfaces, which increases the efficiency of bacterial adhesion. Certain specific bacteria can adhere directly to the pellicle. These bacteria produce extracellular polysaccharides, which then aggregate other bacteria that are not otherwise able to adhere. The plaque associated with healthy [[Gingiva|gingiva]] is mainly comprised of aerobic and facultative anaerobic bacteria. As gingivitis develops, plaque extends subgingivally. Aerobes consume oxygen and a low redox potential is created, which makes the environment more suitable for the growth of anaerobic species. The aerobic population does not decrease, but with increasing numbers of anaerobes, the aerobic/anaerobic ratio decreases. The subgingival florae associated with periodontitis are predominantly [[:Category:Anaerobic bacteria|anaerobic bacteria]].

Dental calculus (tartar) is mineralized plaque. However, a layer of plaque always covers calculus. Both supragingival and subgingival plaque becomes mineralized. Supragingival calculus per se does not exert an irritant effect on the gingival tissues. The main importance of calculus in periodontal disease seems to be its role as a plaque-retentive surface. This is supported by well-controlled animal and clinical studies that have shown that the removal of subgingival plaque on top of subgingival calculus will result in healing of periodontal lesions and the maintenance of healthy periodontal tissues.

==Pathogenesis==
[[File:Alveolar bone destruction.jpg|right|200px|thumb|Alveolar bone destruction]]
The pathogenic mechanisms involved in periodontal disease include:
*Direct injury by plaque microorganisms
*Indirect injury by plaque microorganisms via inflammation

The microbiota in periodontal pockets is in a continual state of flux; periodontitis is a dynamic infection caused by a combination of bacterial vectors that change over time. As a result, the molecular events that trigger and sustain the inflammatory reactions constantly change. Many microbial products have little or no direct toxic effect on the host. However, they possess the potential to activate inflammatory reactions that cause the tissue damage. It is now well accepted that it is the host’s response to the plaque bacteria, rather than microbial virulence per se, that directly causes the tissue damage. In gingivitis, the plaque-induced inflammation is limited to the soft tissue of the gingiva. As periodontitis occurs, the inflammatory destruction of the coronal part of the periodontal ligament allows apical migration of the epithelial attachment and the formation of a pathological periodontal pocket (i.e. [[Dental Indices and Criteria#Periodontal Probing Depth (PPD)|periodontal probing depths]] around the tooth increase). If the inflammatory disease is permitted to progress, the crestal portion of the alveolar process begins to resorb. Alveolar bone destruction type and extent are [[Radiographic Interpretation of Periodontal Disease - Small Animal|diagnosed radiographically]].

Disease progression is generally an episodic occurrence rather than a continuous process. Tissue destruction occurs as acute bursts of disease activity followed by relatively quiescent periods. The acute burst is clinically characterized by rapid deepening of the periodontal pocket as periodontal ligament fibres and alveolar bone are destroyed by the inflammatory reactions. The quiescent phase is not associated with clinical or radiographic evidence of disease progression. However, complete healing does not occur during this quiescent phase, because subgingival plaque remains on the root surfaces and inflammation persists in the connective tissue. The inactive phase can last for extended periods. Other conditions, such as physical or psychological stress and malnutrition, may impair protective responses, such as the production of antioxidants and acute phase proteins, and can aggravate periodontitis, but do not actually cause destructive tissue inflammation.

A genetic predisposition to destructive inflammation of the periodontium may be important in some individuals.

== Signalment ==

Pure bred cats are particularly susceptible and include: Burmese, Persian, Siamese and Maine Coon. The disease affects majority of cats over two years of age.

Certain breeds of dogs are thought to be susceptible to an aggressive form of the disease and include: Greyhound and Maltese. Small breed dogs are more prone to tooth crowding, predisposing the animal to the initiation and rapid progression of the disease.

== Clinical Signs ==

Clinical signs include fetid breath odour (halitosis), excessive salivation, blood in saliva, dysphagia, pain on mastication and difficulty eating. There may also be loose teeth. The animal may be lethargic and show signs of weight loss and poor grooming (cats).

== Diagnosis ==
[[File:Periodontal probe in situ.jpg|right|thumb|200px|Using the probe to check the periodontal probing depth]]
[[File:PD6.jpg|right|thumb|200px|Using the probe all around the tooth to assess the degree of gingivitis]]
[[File:Severe periodontitis (grade 4).jpg|200px|right|thumb|Grade 4 periodontitis]]
An [[Oral Examination - Introduction|oral examination]] should be performed. This is the most important part of the diagnostic procedure and should include inspection of extraoral structures (looking for swelling, atrophy or asymmetry), such as face, lips, muscles of mastication, temporomandibular joints, salivary glands, lymph nodes, maxillae and mandibles. Intraoral structures such as the dentition, gingiva, mucosa, tongue, tonsils and dental occlusion should also be thoroughly examined. On visual inspection of the intraoral structures, an animal with periodontitis may demonstrate oral mucosal ulceration, inflammed and bleeding gingiva, loss of normal gingival contour, purulent discharge from the periodontal pocket, gingival recession, loose teeth and presence of variable quantities of plaque and calculus on the tooth surface.

Periodontal disease is associated with loss of the attachment apparatus of the tooth. Clinically this is hard to detect and there is no correlation between the amount of calculus seen on the tooth and the degree of destruction. Loss of attachment usually involves the periodontal ligament, bone, root cementum and gingiva. Clinically, [[Dental Indices and Criteria#Tooth Mobility|mobile teeth]] may be evident and some teeth may have evidence of [[Dental Indices and Criteria#Gingival Recession|gingival recession]] and root exposure indicating that there is periodontal disease but for a full assessment, an examination has to be performed under [[Oral Examination Under General Anaesthesia|general anaesthesia]]. A [[Periodontal Probe|periodontal probe]] is used to assess the depth of the gingival sulcus and whether there is loss of bone or periodontal ligament. A [[Dental Indices and Criteria#Periodontal Probing Depth (PPD)|probing depth]] greater than 3mm in most dogs would be considered abnormal. This does vary based on the tooth and the size of the dog. Any depth over 0.5mm in cats would be considered abnormal. The periodontal probe is used to assess the degree of gingivitis, measure the pocket depth, check whether the tooth is mobile, whether there is bone loss between the roots ([[Dental Indices and Criteria#Furcation Involvement|furcation exposure]]) and measure the amount of gingival recession. The whole circumference of the tooth needs to be evaluated.

There are a number of methods that grade the severity of periodontal disease. It must be remembered though that different teeth in the mouth may be affected by different severities of the disease and even around each tooth, the degree of attachment loss may vary. Grading is based on the extent of attachment loss as this is indicative of periodontal destruction.

:'''Grade 0''' = Healthy Gingiva
:'''Grade 1''' = Established gingivitis
:'''Grade 2 '''= Mild periodontitis (<25% attachment loss based on radiographs)
:'''Grade 3''' = Moderate periodontitis (25-50% attachment loss based on radiographs)
:'''Grade 4''' = Severe periodontitis (>50% attachment loss)

Oral radiography should be used to assess periodontal disease. Cases of periodontitis will show generalised horizontal and vertical alveolar bone loss in focal areas. Radiographic signs of periodontal disease include resorption/rounding of the alveolar margin, widening of the periodontal space, loss of the lamina dura (cortical bone of the alveolus) and alveolar bone destruction. Find more information about [[Radiographic Interpretation of Periodontal Disease - Small Animal|radiographic interpretation of periodontal disease]].

== Treatment ==

Treatment of periodontitis is two stage – periodontal therapy performed under general anaesthesia, and the most important stage is then follow up home care following an oral hygiene program.

'''Gingivitis'''

Treatment of gingivitis relies heavily on owner compliance. It is important to stress to the owner that the disease is reversible and treatment and control may prevent this disease from becoming peridontitis, which is a lot more severe.

The owner should receive information on good daily [[Oral Hygiene - Small Animal|dental home care]] such as [[Tooth Brushing|tooth brushing]] and [[Dental Diet|diet]].

Treatment involves performing a dental scale and polish and ensuring the owner is aware that regular examinations to assess the condition of the teeth will be required from now on.

'''Periodontitis'''

Educate the owner of the disease process and also educate them on good daily dental home care such as tooth brushing and diet.

Perform a dental scale and polish and root surface debridement. Teeth with severe periodontitis will need to be extracted and periodontal surgery may be necessary.

Regular examinations to assess the condition of the teeth are vital and the owner needs to be made aware of this.

'''Periodontal pockets'''

With pocket depths below 5mm, dental scaling and polishing should be performed, and then subgingival curettage and the placement of an antibiotic gel in the pocket may help rejuvenate the periodontal tissues and reduce pocket depth.

With pocket depths greater that 5mm, surgery is needed to either expose the root for treatment or extract. Gingival flaps or bony replacement procedures for infrabony pockets can be used to decrease pocket depths in areas of alveolar bone loss.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 11]]
}}

== References ==

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Merck & Co (2008) '''The Merck Veterinary Manual''' ''Merial''

Lobprise, H. (2007) '''Blackwell's five minute consult clinical companion: small animal dentistry''' ''Wiley-Blackwell''

[[Category:Teeth_-_Inflammatory_Pathology]] [[Category:Oral_Cavity_and_Gingiva_-_Pathology]] [[Category:Expert_Review - Small Animal]] [[Category:Dental_Diseases_-_Cat]] [[Category:Dental_Diseases_-_Dog]]
[[Category:Periodontal Conditions]]
[[Category:To Do - Dentistry questions]]
[[Category:To Do - Dentistry preMars]] 
[[Category:LisaM reviewing]]

Odontodystrophy

2014-08-04T13:55:51Z

LisaMilella: /* Clinical Signs */

{{OpenPagesTop}}
Also known as: '''''Enamel Hypoplasia'''''

== Introduction ==
[[Image:enamal-hypoplasia.gif|right|thumb|125px|Enamal (Courtesy of Alun Williams (RVC))<center></center>]]

See Enamel Dysplasia

== Clinical Signs ==
In ruminants, one will see a chalky mottling and yellow brown pitting of the [[:Category:Teeth - Anatomy & Physiology|tooth]], due to enamel hypoplasia. There is usually no difficulty in mastication detected and the animal is clinically well.

In dogs, enamel hypoplasia may result in severe discoloration or pitting of a tooth or teeth due to the effect on [[Enamel Organ#Enamel|enamel]] formation.

== Diagnosis ==
Clinical signs are diagnostic, plus history e.g. of CDV in dogs, fluoride in cattle.

== Treatment and Control ==
There is no treatment for this condition. Control measures are prevention of the causes of the disease, e.g. vaccination against CDV and prevention of fluoride poisoning in cattle.

If only a single tooth is affected, restorative treatment can be performed using dental composites or a metal-alloy jacket crown.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 13]]
}}

== References ==
Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry''' (3rd Edition), ''British Small Animal Veterinary Association.''

Williams, A (2008) '''Alimentary System Study Guide,''''' Royal Veterinary College.''

Verstraete, F. (1999) '''Self-assessment colour review in Veterinary Dentistry''' ''Manson Publishing''

{{review}}

{{OpenPages}}

[[Category:Teeth - Degenerative Pathology]]
[[Category:Dental Diseases - Cattle]][[Category:Dental Diseases - Dog]]
[[Category:Expert_Review - Small Animal]]
[[Category:Developmental Dental Conditions]]
[[Category:LisaM reviewing]]

Odontodystrophy

2014-08-04T13:55:10Z

LisaMilella: /* Introduction */

{{OpenPagesTop}}
Also known as: '''''Enamel Hypoplasia'''''

== Introduction ==
[[Image:enamal-hypoplasia.gif|right|thumb|125px|Enamal (Courtesy of Alun Williams (RVC))<center></center>]]

See Enamel Dysplasia

== Clinical Signs ==
In ruminants, one will see a chalky mottling and yellow brown pitting of the [[:Category:Teeth - Anatomy & Physiology|tooth]], due to enamel hypoplasia. There is usually no difficulty in mastication detected and the animal is clinically well.

In dogs, enamel hypoplasia may result in severe discoloration or pitting of a tooth or teeth due to the effect on [[Enamel Organ#Enamel|enamel]] formation.

== Diagnosis ==
Clinical signs are diagnostic, plus history e.g. of CDV in dogs, fluoride in cattle.

== Treatment and Control ==
There is no treatment for this condition. Control measures are prevention of the causes of the disease, e.g. vaccination against CDV and prevention of fluoride poisoning in cattle.

If only a single tooth is affected, restorative treatment can be performed using dental composites or a metal-alloy jacket crown.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 13]]
}}

== References ==
Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry''' (3rd Edition), ''British Small Animal Veterinary Association.''

Williams, A (2008) '''Alimentary System Study Guide,''''' Royal Veterinary College.''

Verstraete, F. (1999) '''Self-assessment colour review in Veterinary Dentistry''' ''Manson Publishing''

{{review}}

{{OpenPages}}

[[Category:Teeth - Degenerative Pathology]]
[[Category:Dental Diseases - Cattle]][[Category:Dental Diseases - Dog]]
[[Category:Expert_Review - Small Animal]]
[[Category:Developmental Dental Conditions]]
[[Category:LisaM reviewing]]

Odontodystrophy

2014-08-04T13:53:36Z

LisaMilella: /* Introduction */

{{OpenPagesTop}}
Also known as: '''''Enamel Hypoplasia'''''

== Introduction ==
[[Image:enamal-hypoplasia.gif|right|thumb|125px|Enamal (Courtesy of Alun Williams (RVC))<center></center>]]
This condition is a consequence of abnormalities occurring during the period of [[Tooth Eruption|tooth eruption]]. It involves damage to [[Enamel Organ#Ameloblasts|ameloblasts]] (which form [[Enamel Organ#Enamel|enamel]]) prior to eruption, which upsets permanent incisor formation. The [[Enamel Organ#Enamel|enamel]] is marked by pits and lines etc.

In ruminants, damage to [[Enamel Organ#Enamel|enamel]] formation is most often caused by fluoride poisoning and is seen in cattle grazing on pasture contaminated by cement works effluent.

In dogs, hypoplasia may occur following a [[Canine Distemper Virus]] (CDV) infection during tooth development. This is a very severe systemic disease seen early in life or in utero in dogs.

Hypoplasia may also occur in single teeth following damage to the permanent tooth germ, for example if a deciduous tooth is fractured or extracted without care. The damaged ameloblasts will fail to form enamel and abnormalities will be evident.

== Clinical Signs ==
In ruminants, one will see a chalky mottling and yellow brown pitting of the [[:Category:Teeth - Anatomy & Physiology|tooth]], due to enamel hypoplasia. There is usually no difficulty in mastication detected and the animal is clinically well.

In dogs, enamel hypoplasia may result in severe discoloration or pitting of a tooth or teeth due to the effect on [[Enamel Organ#Enamel|enamel]] formation.

== Diagnosis ==
Clinical signs are diagnostic, plus history e.g. of CDV in dogs, fluoride in cattle.

== Treatment and Control ==
There is no treatment for this condition. Control measures are prevention of the causes of the disease, e.g. vaccination against CDV and prevention of fluoride poisoning in cattle.

If only a single tooth is affected, restorative treatment can be performed using dental composites or a metal-alloy jacket crown.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 13]]
}}

== References ==
Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry''' (3rd Edition), ''British Small Animal Veterinary Association.''

Williams, A (2008) '''Alimentary System Study Guide,''''' Royal Veterinary College.''

Verstraete, F. (1999) '''Self-assessment colour review in Veterinary Dentistry''' ''Manson Publishing''

{{review}}

{{OpenPages}}

[[Category:Teeth - Degenerative Pathology]]
[[Category:Dental Diseases - Cattle]][[Category:Dental Diseases - Dog]]
[[Category:Expert_Review - Small Animal]]
[[Category:Developmental Dental Conditions]]
[[Category:LisaM reviewing]]

Masticatory Muscle Myositis

2014-08-04T13:52:07Z

LisaMilella:

(MMM)
*Occurs in dogs
*Tends to affect the masseter and temporalis muscles
*Autoantibodies selectively attack muscles of mastication (type IIM fibres)
*Acute stage = eosinophilic myositis
**Extremely swollen, painful, hard masticatory muscles
*Chronic stage = atrophic myositis
**Atrophy may occur without previous acute stage
*Grossly:
**Bilateral but not necessarily symmetrical
*Histologically:
**Acute lesions:
***Mainly eosinophilic infiltrate, few lymphocytes, [[Monocytes|monocytes]] and plasma cells
***In recurrent disease plasma cells predominate
***[[Muscle Necrosis|Necrotic]] myofibres, [[Muscle Atrophy|atrophy]] and attempted [[Muscle Regeneration|regeneration]]
**Chronic stage:
***[[Muscle Atrophy|Atrophy]] predominates
***Fasciculi are shrunken
***Condensation of stroma -> enlarged endomysium
***Focal plasma cell and lymphocyte infiltration

[[Category:Immune-Mediated Myositis]]
[[Category:To Do - Musculoskeletal]]
[[Category:LisaM reviewing]]

Mandibular Fractures - Cat & Dog

2014-08-04T13:49:50Z

LisaMilella: /* Ramus fractures */

{{OpenPagesTop}}
==Introduction==
'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular]] fractures''' are commonly seen in dogs and cats. With cats they often form part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease (most notably periodontal disease in small breed dogs), metabolic disease and neoplasia'''.

==Signalment==
'''Symphyseal fractures''' are most common in '''cats'''. Fracture of the '''mandibular ramus''' is far more common in the '''dog''', and there are no breed, age or sex predispositions.

==Clinical Signs==
Animals may present with a '''history of trauma''' - it is particularly important to check any trauma cases (particularly cats) for mandibular [[Fractures|fractures]]. Otherwise they may have a history of '''dysphagia''' or '''inappetance'''. On physical exam '''instability of the jaw''', '''malocclusion, halitosis and oral pain''' may be evident. Often mandibular body fractures are open, therefore there may be an '''open wound''' over the fracture site. Patients may be presented when the owner notices blood from the mouth.

==Treatment==
The method of fracture fixation varies according to the type of fracture. However the aims of the fixation is always the same:''' to restore normal, functional occlusion, to avoid iatrogenic damage to teeth, achieving stable fixation that encourages healing and early return to function'''.

===Symphyseal Fractures===
Symphyseal fractures are repaired using '''circumferential wire'''. A skin incision should be made in the ventral mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliers'''. The wire is then cut short and placed flush with the skin. The skin incision is closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.

===Mandibular Ramus Fractures===
Fractures of the mandibular ramus are normally more complex and healing takes approximately''' 8 weeks'''. Numerous methods available for fracture stabilisation:

'''Conservative treatment''':
Conservative treatment can be attempted but it is associated with high complication rates and slow recovery.

'''Interarcade canine acrylic bonding (ICAB)''':
This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. It is a fairly simple, cheap and effective method for caudal mandibular fractures.

'''Tape muzzle''':
A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. A modified technique can be used in cats and brachycephalic dogs but is unlikely to be of use in non-compliant patients.

'''Interdental wire and acrylic bonding (IWAB)''':
This method is an effective and cheap technique for use in the dog and can be used in cats although is more fiddly. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.

'''Interfragmentary wiring''':
This technique is not recommended as it rarely achieves appropriate stabilisation and tends to cause damage to the surrounding teeth and soft tissues.

'''External skeletal fixator''':
ESF pins connected by acrylic frames provide good fracture stabilisation. The acrylic is light, cheap and easy to apply, however it is important to avoid damage to adjacent structures when placing the pins.

'''Bone plates''':
Bone plates cane be used but have limited positions of application to avoid iatrogenic damage to neurovascular bundles and teeth unless miniplates are used.

'''Hemimandibulectomy''':
This is considered a salvage procedure.

===Fractures of the coronoid process===

These may be treated either '''conservatively''' or with '''interdental wire and acrylic bonding (ICAB)''', and healing is normally achieved within '''6 weeks'''.

'''Placement of an oesophageal feeding tubes is recommended for all mandibular fracture cases other than simple symphyseal fractures to prevent nutritional complications.'''

If the fracture is open, then suitable '''[[Antibiotics|antibiotics]]''' should be given to prevent [[Osteomyelitis|osteomyelitis]] and soft tissue infection.

==Prognosis==
The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[:Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.

{{Learning
|flashcards = [[Small Animal Orthopaedics Q&A 03]]
}}

==References==
Glyde, M & Lidbetter, D (2003) '''Management of fractures of the mandible in small animals''' ''In Practice 2003;25:570-585''

Lewis, DD & Parker, RB & Bloomberg, MS (1998) '''Self-Assessment Colour Review Small Animal Orthopaedics''' ''Manson''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

{{review}}

{{OpenPages}}

[[Category:Oral Diseases - Dog]]
[[Category:Musculoskeletal Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Oral Diseases - Cat]]
[[Category:Musculoskeletal Diseases - Cat]]
[[Category:Traumatic Dental Conditions]]
[[Category:LisaM reviewing]]

Mandibular Fractures - Cat & Dog

2014-08-04T13:48:26Z

LisaMilella: /* Mandibular Body Fractures */

{{OpenPagesTop}}
==Introduction==
'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular]] fractures''' are commonly seen in dogs and cats. With cats they often form part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease (most notably periodontal disease in small breed dogs), metabolic disease and neoplasia'''.

==Signalment==
'''Symphyseal fractures''' are most common in '''cats'''. Fracture of the '''mandibular ramus''' is far more common in the '''dog''', and there are no breed, age or sex predispositions.

==Clinical Signs==
Animals may present with a '''history of trauma''' - it is particularly important to check any trauma cases (particularly cats) for mandibular [[Fractures|fractures]]. Otherwise they may have a history of '''dysphagia''' or '''inappetance'''. On physical exam '''instability of the jaw''', '''malocclusion, halitosis and oral pain''' may be evident. Often mandibular body fractures are open, therefore there may be an '''open wound''' over the fracture site. Patients may be presented when the owner notices blood from the mouth.

==Treatment==
The method of fracture fixation varies according to the type of fracture. However the aims of the fixation is always the same:''' to restore normal, functional occlusion, to avoid iatrogenic damage to teeth, achieving stable fixation that encourages healing and early return to function'''.

===Symphyseal Fractures===
Symphyseal fractures are repaired using '''circumferential wire'''. A skin incision should be made in the ventral mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliers'''. The wire is then cut short and placed flush with the skin. The skin incision is closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.

===Mandibular Ramus Fractures===
Fractures of the mandibular ramus are normally more complex and healing takes approximately''' 8 weeks'''. Numerous methods available for fracture stabilisation:

'''Conservative treatment''':
Conservative treatment can be attempted but it is associated with high complication rates and slow recovery.

'''Interarcade canine acrylic bonding (ICAB)''':
This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. It is a fairly simple, cheap and effective method for caudal mandibular fractures.

'''Tape muzzle''':
A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. A modified technique can be used in cats and brachycephalic dogs but is unlikely to be of use in non-compliant patients.

'''Interdental wire and acrylic bonding (IWAB)''':
This method is an effective and cheap technique for use in the dog and can be used in cats although is more fiddly. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.

'''Interfragmentary wiring''':
This technique is not recommended as it rarely achieves appropriate stabilisation and tends to cause damage to the surrounding teeth and soft tissues.

'''External skeletal fixator''':
ESF pins connected by acrylic frames provide good fracture stabilisation. The acrylic is light, cheap and easy to apply, however it is important to avoid damage to adjacent structures when placing the pins.

'''Bone plates''':
Bone plates cane be used but have limited positions of application to avoid iatrogenic damage to neurovascular bundles and teeth unless miniplates are used.

'''Hemimandibulectomy''':
This is considered a salvage procedure.

===Ramus fractures===

Ramus fractures may be treated either '''conservatively''' or with '''interdental wire and acrylic bonding (ICAB)''', and healing is normally achieved within '''6 weeks'''.

'''Placement of an oesophageal feeding tubes is recommended for all mandibular fracture cases other than simple symphyseal fractures to prevent nutritional complications.'''

If the fracture is open, then suitable '''[[Antibiotics|antibiotics]]''' should be given to prevent [[Osteomyelitis|osteomyelitis]] and soft tissue infection. Antibiotics should also be given to any animals with dental disease.

==Prognosis==
The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[:Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.

{{Learning
|flashcards = [[Small Animal Orthopaedics Q&A 03]]
}}

==References==
Glyde, M & Lidbetter, D (2003) '''Management of fractures of the mandible in small animals''' ''In Practice 2003;25:570-585''

Lewis, DD & Parker, RB & Bloomberg, MS (1998) '''Self-Assessment Colour Review Small Animal Orthopaedics''' ''Manson''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

{{review}}

{{OpenPages}}

[[Category:Oral Diseases - Dog]]
[[Category:Musculoskeletal Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Oral Diseases - Cat]]
[[Category:Musculoskeletal Diseases - Cat]]
[[Category:Traumatic Dental Conditions]]
[[Category:LisaM reviewing]]

Mandibular Fractures - Cat & Dog

2014-08-04T13:43:59Z

LisaMilella: /* Symphyseal Fractures */

{{OpenPagesTop}}
==Introduction==
'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular]] fractures''' are commonly seen in dogs and cats. With cats they often form part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease (most notably periodontal disease in small breed dogs), metabolic disease and neoplasia'''.

==Signalment==
'''Symphyseal fractures''' are most common in '''cats'''. Fracture of the '''mandibular ramus''' is far more common in the '''dog''', and there are no breed, age or sex predispositions.

==Clinical Signs==
Animals may present with a '''history of trauma''' - it is particularly important to check any trauma cases (particularly cats) for mandibular [[Fractures|fractures]]. Otherwise they may have a history of '''dysphagia''' or '''inappetance'''. On physical exam '''instability of the jaw''', '''malocclusion, halitosis and oral pain''' may be evident. Often mandibular body fractures are open, therefore there may be an '''open wound''' over the fracture site. Patients may be presented when the owner notices blood from the mouth.

==Treatment==
The method of fracture fixation varies according to the type of fracture. However the aims of the fixation is always the same:''' to restore normal, functional occlusion, to avoid iatrogenic damage to teeth, achieving stable fixation that encourages healing and early return to function'''.

===Symphyseal Fractures===
Symphyseal fractures are repaired using '''circumferential wire'''. A skin incision should be made in the ventral mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliers'''. The wire is then cut short and placed flush with the skin. The skin incision is closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.

===Mandibular Body Fractures===
Fractures of the mandibular body are normally more complex and healing takes approximately''' 9-10 weeks'''. Numerous methods available for fracture stabilisation:

'''Conservative treatment''':
Conservative treatment can be attempted but it is associated with high complication rates and slow recovery.

'''Interarcade canine acrylic bonding (ICAB)''':
This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. It is a fairly simple, cheap and effective method.

'''Tape muzzle''':
A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. It cannot be used in cats, brachycephalic dogs and non-compliant patients.

'''Interdental wire and acrylic bonding (IWAB)''':
This method cannot be used in cats but is an effective and cheap technique for use in the dog. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.

'''Interfragmentary wiring''':
This technique is not recommended as it rarely achieves appropriate stabilisation and tends to cause damage to the surround teeth and soft tissues.

'''External skeletal fixator''':
ESF pins connected by acrylic frames provide good fracture stabilisation. The acrylic is light, cheap and easy to apply, however it is important to avoid damage to adjacent structures when placing the pins.

'''Bone plates''':
Bone plates cane be placed at the junction of the body and ramus of the mandible, at the ventral border of the mandibular body and the mid-buccal surface of the mandible.

'''Hemimandibulectomy''':
This is considered a salvage procedure.

===Ramus fractures===

Ramus fractures may be treated either '''conservatively''' or with '''interdental wire and acrylic bonding (ICAB)''', and healing is normally achieved within '''6 weeks'''.

'''Placement of an oesophageal feeding tubes is recommended for all mandibular fracture cases other than simple symphyseal fractures to prevent nutritional complications.'''

If the fracture is open, then suitable '''[[Antibiotics|antibiotics]]''' should be given to prevent [[Osteomyelitis|osteomyelitis]] and soft tissue infection. Antibiotics should also be given to any animals with dental disease.

==Prognosis==
The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[:Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.

{{Learning
|flashcards = [[Small Animal Orthopaedics Q&A 03]]
}}

==References==
Glyde, M & Lidbetter, D (2003) '''Management of fractures of the mandible in small animals''' ''In Practice 2003;25:570-585''

Lewis, DD & Parker, RB & Bloomberg, MS (1998) '''Self-Assessment Colour Review Small Animal Orthopaedics''' ''Manson''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

{{review}}

{{OpenPages}}

[[Category:Oral Diseases - Dog]]
[[Category:Musculoskeletal Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Oral Diseases - Cat]]
[[Category:Musculoskeletal Diseases - Cat]]
[[Category:Traumatic Dental Conditions]]
[[Category:LisaM reviewing]]

Mandibular Fractures - Cat & Dog

2014-08-04T13:42:56Z

LisaMilella: /* Clinical Signs */

{{OpenPagesTop}}
==Introduction==
'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular]] fractures''' are commonly seen in dogs and cats. With cats they often form part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease (most notably periodontal disease in small breed dogs), metabolic disease and neoplasia'''.

==Signalment==
'''Symphyseal fractures''' are most common in '''cats'''. Fracture of the '''mandibular ramus''' is far more common in the '''dog''', and there are no breed, age or sex predispositions.

==Clinical Signs==
Animals may present with a '''history of trauma''' - it is particularly important to check any trauma cases (particularly cats) for mandibular [[Fractures|fractures]]. Otherwise they may have a history of '''dysphagia''' or '''inappetance'''. On physical exam '''instability of the jaw''', '''malocclusion, halitosis and oral pain''' may be evident. Often mandibular body fractures are open, therefore there may be an '''open wound''' over the fracture site. Patients may be presented when the owner notices blood from the mouth.

==Treatment==
The method of fracture fixation varies according to the type of fracture. However the aims of the fixation is always the same:''' to restore normal, functional occlusion, to avoid iatrogenic damage to teeth, achieving stable fixation that encourages healing and early return to function'''.

===Symphyseal Fractures===
Symphyseal fractures are repaired using '''circumferential wire'''. A skin incision should be made in the ventral mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliers'''. The wire is then cut short and places flush with the skin. The skin incision closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.

===Mandibular Body Fractures===
Fractures of the mandibular body are normally more complex and healing takes approximately''' 9-10 weeks'''. Numerous methods available for fracture stabilisation:

'''Conservative treatment''':
Conservative treatment can be attempted but it is associated with high complication rates and slow recovery.

'''Interarcade canine acrylic bonding (ICAB)''':
This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. It is a fairly simple, cheap and effective method.

'''Tape muzzle''':
A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. It cannot be used in cats, brachycephalic dogs and non-compliant patients.

'''Interdental wire and acrylic bonding (IWAB)''':
This method cannot be used in cats but is an effective and cheap technique for use in the dog. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.

'''Interfragmentary wiring''':
This technique is not recommended as it rarely achieves appropriate stabilisation and tends to cause damage to the surround teeth and soft tissues.

'''External skeletal fixator''':
ESF pins connected by acrylic frames provide good fracture stabilisation. The acrylic is light, cheap and easy to apply, however it is important to avoid damage to adjacent structures when placing the pins.

'''Bone plates''':
Bone plates cane be placed at the junction of the body and ramus of the mandible, at the ventral border of the mandibular body and the mid-buccal surface of the mandible.

'''Hemimandibulectomy''':
This is considered a salvage procedure.

===Ramus fractures===

Ramus fractures may be treated either '''conservatively''' or with '''interdental wire and acrylic bonding (ICAB)''', and healing is normally achieved within '''6 weeks'''.

'''Placement of an oesophageal feeding tubes is recommended for all mandibular fracture cases other than simple symphyseal fractures to prevent nutritional complications.'''

If the fracture is open, then suitable '''[[Antibiotics|antibiotics]]''' should be given to prevent [[Osteomyelitis|osteomyelitis]] and soft tissue infection. Antibiotics should also be given to any animals with dental disease.

==Prognosis==
The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[:Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.

{{Learning
|flashcards = [[Small Animal Orthopaedics Q&A 03]]
}}

==References==
Glyde, M & Lidbetter, D (2003) '''Management of fractures of the mandible in small animals''' ''In Practice 2003;25:570-585''

Lewis, DD & Parker, RB & Bloomberg, MS (1998) '''Self-Assessment Colour Review Small Animal Orthopaedics''' ''Manson''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

{{review}}

{{OpenPages}}

[[Category:Oral Diseases - Dog]]
[[Category:Musculoskeletal Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Oral Diseases - Cat]]
[[Category:Musculoskeletal Diseases - Cat]]
[[Category:Traumatic Dental Conditions]]
[[Category:LisaM reviewing]]

Mandibular Fractures - Cat & Dog

2014-08-04T13:41:41Z

LisaMilella: /* Signalment */

{{OpenPagesTop}}
==Introduction==
'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular]] fractures''' are commonly seen in dogs and cats. With cats they often form part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease (most notably periodontal disease in small breed dogs), metabolic disease and neoplasia'''.

==Signalment==
'''Symphyseal fractures''' are most common in '''cats'''. Fracture of the '''mandibular ramus''' is far more common in the '''dog''', and there are no breed, age or sex predispositions.

==Clinical Signs==
Animals may present with a '''history of trauma''' - it is particularly important to check any trauma cases (particularly cats) for mandibular [[Fractures|fractures]]. Otherwise they may have a history of '''dysphagia''' or '''inappetance'''. On physical exam '''instability of the jaw''', '''malocclusion, halitosis and oral pain''' may be evident. Often mandibular body fractures are open, therefore there may be an '''open wound''' over the fracture site.

==Treatment==
The method of fracture fixation varies according to the type of fracture. However the aims of the fixation is always the same:''' to restore normal, functional occlusion, to avoid iatrogenic damage to teeth, achieving stable fixation that encourages healing and early return to function'''.

===Symphyseal Fractures===
Symphyseal fractures are repaired using '''circumferential wire'''. A skin incision should be made in the ventral mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliers'''. The wire is then cut short and places flush with the skin. The skin incision closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.

===Mandibular Body Fractures===
Fractures of the mandibular body are normally more complex and healing takes approximately''' 9-10 weeks'''. Numerous methods available for fracture stabilisation:

'''Conservative treatment''':
Conservative treatment can be attempted but it is associated with high complication rates and slow recovery.

'''Interarcade canine acrylic bonding (ICAB)''':
This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. It is a fairly simple, cheap and effective method.

'''Tape muzzle''':
A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. It cannot be used in cats, brachycephalic dogs and non-compliant patients.

'''Interdental wire and acrylic bonding (IWAB)''':
This method cannot be used in cats but is an effective and cheap technique for use in the dog. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.

'''Interfragmentary wiring''':
This technique is not recommended as it rarely achieves appropriate stabilisation and tends to cause damage to the surround teeth and soft tissues.

'''External skeletal fixator''':
ESF pins connected by acrylic frames provide good fracture stabilisation. The acrylic is light, cheap and easy to apply, however it is important to avoid damage to adjacent structures when placing the pins.

'''Bone plates''':
Bone plates cane be placed at the junction of the body and ramus of the mandible, at the ventral border of the mandibular body and the mid-buccal surface of the mandible.

'''Hemimandibulectomy''':
This is considered a salvage procedure.

===Ramus fractures===

Ramus fractures may be treated either '''conservatively''' or with '''interdental wire and acrylic bonding (ICAB)''', and healing is normally achieved within '''6 weeks'''.

'''Placement of an oesophageal feeding tubes is recommended for all mandibular fracture cases other than simple symphyseal fractures to prevent nutritional complications.'''

If the fracture is open, then suitable '''[[Antibiotics|antibiotics]]''' should be given to prevent [[Osteomyelitis|osteomyelitis]] and soft tissue infection. Antibiotics should also be given to any animals with dental disease.

==Prognosis==
The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[:Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.

{{Learning
|flashcards = [[Small Animal Orthopaedics Q&A 03]]
}}

==References==
Glyde, M & Lidbetter, D (2003) '''Management of fractures of the mandible in small animals''' ''In Practice 2003;25:570-585''

Lewis, DD & Parker, RB & Bloomberg, MS (1998) '''Self-Assessment Colour Review Small Animal Orthopaedics''' ''Manson''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

{{review}}

{{OpenPages}}

[[Category:Oral Diseases - Dog]]
[[Category:Musculoskeletal Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Oral Diseases - Cat]]
[[Category:Musculoskeletal Diseases - Cat]]
[[Category:Traumatic Dental Conditions]]
[[Category:LisaM reviewing]]

Mandibular Fractures - Cat & Dog

2014-08-04T13:40:44Z

LisaMilella: /* Introduction */

{{OpenPagesTop}}
==Introduction==
'''[[Skull and Facial Muscles - Anatomy & Physiology|Mandibular]] fractures''' are commonly seen in dogs and cats. With cats they often form part of the '''[[High-Rise Syndrome|high-rise syndrome]]''', when a cat falls from a height and suffers facial trauma as a result, or as a consequence of a '''road traffic accident'''. Canine mandibular fractures are normally caused by '''fighting''' or other '''trauma'''. Fractures can also occur in both species as a result of '''dental disease (most notably periodontal disease in small breed dogs), metabolic disease and neoplasia'''.

==Signalment==
'''Symphyseal fractures''' are most common in '''cats''', particularly entire males as they have a tendency to try and escape buildings to find mating females. Fracture of the '''mandibular body''' is far more common in the '''dog''', and there are no breed, age or sex predispositions.

==Clinical Signs==
Animals may present with a '''history of trauma''' - it is particularly important to check any trauma cases (particularly cats) for mandibular [[Fractures|fractures]]. Otherwise they may have a history of '''dysphagia''' or '''inappetance'''. On physical exam '''instability of the jaw''', '''malocclusion, halitosis and oral pain''' may be evident. Often mandibular body fractures are open, therefore there may be an '''open wound''' over the fracture site.

==Treatment==
The method of fracture fixation varies according to the type of fracture. However the aims of the fixation is always the same:''' to restore normal, functional occlusion, to avoid iatrogenic damage to teeth, achieving stable fixation that encourages healing and early return to function'''.

===Symphyseal Fractures===
Symphyseal fractures are repaired using '''circumferential wire'''. A skin incision should be made in the ventral mandible. The wire (0.5-0.7mm gauge - dependant on the size of the animal) should then be guided around the lateral borders of the mandible using an 18G hypodermic needle. The fracture should be aligned and the wires tightened by twisting them together using '''wire-tightening pliers'''. The wire is then cut short and places flush with the skin. The skin incision closed with a single suture. Healing occurs in '''5-7 weeks''', at which point the wire can be removed.

===Mandibular Body Fractures===
Fractures of the mandibular body are normally more complex and healing takes approximately''' 9-10 weeks'''. Numerous methods available for fracture stabilisation:

'''Conservative treatment''':
Conservative treatment can be attempted but it is associated with high complication rates and slow recovery.

'''Interarcade canine acrylic bonding (ICAB)''':
This method uses acrylic dental composite to bond the mandibular and maxillary canine teeth and stabilise the fracture. It is necessary to clean and acid etch the teeth before a thin layer of dental adhesive is applied to the canine teeth. Dental adhesive and the composite are applied to the canines, with the fracture held in reduction until the composite has dried. It is a fairly simple, cheap and effective method.

'''Tape muzzle''':
A tape muzzle can be used in dogs to stabilise the fracture before it is repaired surgically or in cases with financial constraints. It is also suitable for ramus fracture stabilisation. It cannot be used in cats, brachycephalic dogs and non-compliant patients.

'''Interdental wire and acrylic bonding (IWAB)''':
This method cannot be used in cats but is an effective and cheap technique for use in the dog. The wire and bonding are placed on the dorsal tension side of the mandible, causing minimal iatrogenic damage and good stabilisation.

'''Interfragmentary wiring''':
This technique is not recommended as it rarely achieves appropriate stabilisation and tends to cause damage to the surround teeth and soft tissues.

'''External skeletal fixator''':
ESF pins connected by acrylic frames provide good fracture stabilisation. The acrylic is light, cheap and easy to apply, however it is important to avoid damage to adjacent structures when placing the pins.

'''Bone plates''':
Bone plates cane be placed at the junction of the body and ramus of the mandible, at the ventral border of the mandibular body and the mid-buccal surface of the mandible.

'''Hemimandibulectomy''':
This is considered a salvage procedure.

===Ramus fractures===

Ramus fractures may be treated either '''conservatively''' or with '''interdental wire and acrylic bonding (ICAB)''', and healing is normally achieved within '''6 weeks'''.

'''Placement of an oesophageal feeding tubes is recommended for all mandibular fracture cases other than simple symphyseal fractures to prevent nutritional complications.'''

If the fracture is open, then suitable '''[[Antibiotics|antibiotics]]''' should be given to prevent [[Osteomyelitis|osteomyelitis]] and soft tissue infection. Antibiotics should also be given to any animals with dental disease.

==Prognosis==
The prognosis for '''symphyseal''' and '''ramus''' fractures is '''good'''. '''Complications''' are much more common with fractures of the mandibular '''body''' - particularly if '''[[:Category:Teeth - Anatomy & Physiology|teeth]]''' are involved in the fracture, and prognosis will depend on whether or not these complications occur. They include '''poor occlusion, implant failure, infection of the bone or soft tissue, joint disease, non-union and malunion'''.

{{Learning
|flashcards = [[Small Animal Orthopaedics Q&A 03]]
}}

==References==
Glyde, M & Lidbetter, D (2003) '''Management of fractures of the mandible in small animals''' ''In Practice 2003;25:570-585''

Lewis, DD & Parker, RB & Bloomberg, MS (1998) '''Self-Assessment Colour Review Small Animal Orthopaedics''' ''Manson''

RVC staff (2009) '''Urogenital system''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

{{review}}

{{OpenPages}}

[[Category:Oral Diseases - Dog]]
[[Category:Musculoskeletal Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Oral Diseases - Cat]]
[[Category:Musculoskeletal Diseases - Cat]]
[[Category:Traumatic Dental Conditions]]
[[Category:LisaM reviewing]]

Luxated and Avulsed Teeth

2014-08-04T13:39:21Z

LisaMilella: /* Introduction */

==Introduction==
[[File:Luxated tooth.jpg|200px|right|thumb|Luxated tooth]]
Occasionally, veterinarians are presented with luxated or avulsed teeth.

Luxated = partly dislocated from the socket. The most common luxation is a lateral luxation together with fracture of the alveolar bone plate.

Avulsed = completely removed/pulled out of the socket

In these cases of trauma, the blood supply to the tooth is affected, resulting in [[Pulp and Periapical Disease|pulp necrosis]].

Injured teeth will require treatment - either extraction or replacement and stabilization, and once the tooth has re-attached, endodontic treatment will be required.
{{Unfinished}}

[[Category:Endodontic Conditions]]
[[Category:LisaM reviewing]]

Gingiva

2014-08-03T14:16:57Z

LisaMilella: /* Vasculature and Innervation of the Gingiva */

{{OpenPagesTop}}
==Introduction==

Gingiva is the oral mucosa surrounding the neck of each tooth forming the gums.

==Structure and Function of the Gingiva==

Gingiva is mucosal tissue over [[Enamel Organ#Alveolar Bone|alveolar bone]]. It has a stratified squamous epithelium, with some keratinisation. It resists friction of food during [[Mastication|mastication]] by being tightly bound to the underlying bone. It recedes with age, exposing the cervical part of the tooth. It is usually salmon pink in healthy animals. A colour change indicates pathology.

===Mucogingival line===
[[Image:Labiogingival Groove Histology.jpg|thumb|right|250px|Labiogingival Groove Histology - Copyright RVC 2008]]

The '''mucogingival line''' is the junction between the '''attached gingiva''' and '''the free alveolar mucosa'''

==Vasculature and Innervation of the Gingiva==

The gingiva is supplied by the '''superior''' and '''inferior alveolar arteries'''.

Innervation is from the '''trigeminal nerve''' ([[Cranial Nerves - Anatomy & Physiology|CN V]]).

==Species Differences==

===Canine===
Some breeds of dog have dark gums, e.g. chow chow.

{{Learning
|flashcards = [[Teeth and Gingiva Flashcards]]
|powerpoints = [[Oral Cavity Histology resource|Histology tutorial on the oral cavity]]
}}

{{OpenPages}}
[[Category:Oral Cavity - Anatomy & Physiology]]
[[Category:A&P Done]]
[[Category:LisaM reviewing]]
[[Category:Dental Anatomy - Small Animal]]

Gingiva

2014-08-03T14:16:27Z

LisaMilella: /* Mucogingival line */

{{OpenPagesTop}}
==Introduction==

Gingiva is the oral mucosa surrounding the neck of each tooth forming the gums.

==Structure and Function of the Gingiva==

Gingiva is mucosal tissue over [[Enamel Organ#Alveolar Bone|alveolar bone]]. It has a stratified squamous epithelium, with some keratinisation. It resists friction of food during [[Mastication|mastication]] by being tightly bound to the underlying bone. It recedes with age, exposing the cervical part of the tooth. It is usually salmon pink in healthy animals. A colour change indicates pathology.

===Mucogingival line===
[[Image:Labiogingival Groove Histology.jpg|thumb|right|250px|Labiogingival Groove Histology - Copyright RVC 2008]]

The '''mucogingival line''' is the junction between the '''attached gingiva''' and '''the free alveolar mucosa'''

==Vasculature and Innervation of the Gingiva==

The gingiva is supplied by the '''superior''' and '''inferior alveolar arteries'''.

There are blood vessels in the dental [[Enamel Organ#Pulp|pulp cavity]] and a single branch in each major elevation of the [[Enamel Organ#Crown|crown]].

Innervation is from the '''trigeminal nerve''' ([[Cranial Nerves - Anatomy & Physiology|CN V]]).

==Species Differences==

===Canine===
Some breeds of dog have dark gums, e.g. chow chow.

{{Learning
|flashcards = [[Teeth and Gingiva Flashcards]]
|powerpoints = [[Oral Cavity Histology resource|Histology tutorial on the oral cavity]]
}}

{{OpenPages}}
[[Category:Oral Cavity - Anatomy & Physiology]]
[[Category:A&P Done]]
[[Category:LisaM reviewing]]
[[Category:Dental Anatomy - Small Animal]]

Gingiva

2014-08-03T14:14:26Z

LisaMilella: /* Labiogingival groove */

{{OpenPagesTop}}
==Introduction==

Gingiva is the oral mucosa surrounding the neck of each tooth forming the gums.

==Structure and Function of the Gingiva==

Gingiva is mucosal tissue over [[Enamel Organ#Alveolar Bone|alveolar bone]]. It has a stratified squamous epithelium, with some keratinisation. It resists friction of food during [[Mastication|mastication]] by being tightly bound to the underlying bone. It recedes with age, exposing the cervical part of the tooth. It is usually salmon pink in healthy animals. A colour change indicates pathology.

===Mucogingival line===
[[Image:Labiogingival Groove Histology.jpg|thumb|right|250px|Labiogingival Groove Histology - Copyright RVC 2008]]

The '''labiogingival groove''' is the junction between the '''labial border''' and '''gingival line''' on the distal/medial surface of the incisor teeth.

==Vasculature and Innervation of the Gingiva==

The gingiva is supplied by the '''superior''' and '''inferior alveolar arteries'''.

There are blood vessels in the dental [[Enamel Organ#Pulp|pulp cavity]] and a single branch in each major elevation of the [[Enamel Organ#Crown|crown]].

Innervation is from the '''trigeminal nerve''' ([[Cranial Nerves - Anatomy & Physiology|CN V]]).

==Species Differences==

===Canine===
Some breeds of dog have dark gums, e.g. chow chow.

{{Learning
|flashcards = [[Teeth and Gingiva Flashcards]]
|powerpoints = [[Oral Cavity Histology resource|Histology tutorial on the oral cavity]]
}}

{{OpenPages}}
[[Category:Oral Cavity - Anatomy & Physiology]]
[[Category:A&P Done]]
[[Category:LisaM reviewing]]
[[Category:Dental Anatomy - Small Animal]]

Gingiva

2014-08-03T14:13:01Z

LisaMilella: /* Introduction */

{{OpenPagesTop}}
==Introduction==

Gingiva is the oral mucosa surrounding the neck of each tooth forming the gums.

==Structure and Function of the Gingiva==

Gingiva is mucosal tissue over [[Enamel Organ#Alveolar Bone|alveolar bone]]. It has a stratified squamous epithelium, with some keratinisation. It resists friction of food during [[Mastication|mastication]] by being tightly bound to the underlying bone. It recedes with age, exposing the cervical part of the tooth. It is usually salmon pink in healthy animals. A colour change indicates pathology.

===Labiogingival groove===
[[Image:Labiogingival Groove Histology.jpg|thumb|right|250px|Labiogingival Groove Histology - Copyright RVC 2008]]

The '''labiogingival groove''' is the junction between the '''labial border''' and '''gingival line''' on the distal/medial surface of the incisor teeth.

==Vasculature and Innervation of the Gingiva==

The gingiva is supplied by the '''superior''' and '''inferior alveolar arteries'''.

There are blood vessels in the dental [[Enamel Organ#Pulp|pulp cavity]] and a single branch in each major elevation of the [[Enamel Organ#Crown|crown]].

Innervation is from the '''trigeminal nerve''' ([[Cranial Nerves - Anatomy & Physiology|CN V]]).

==Species Differences==

===Canine===
Some breeds of dog have dark gums, e.g. chow chow.

{{Learning
|flashcards = [[Teeth and Gingiva Flashcards]]
|powerpoints = [[Oral Cavity Histology resource|Histology tutorial on the oral cavity]]
}}

{{OpenPages}}
[[Category:Oral Cavity - Anatomy & Physiology]]
[[Category:A&P Done]]
[[Category:LisaM reviewing]]
[[Category:Dental Anatomy - Small Animal]]

Focal Fibrous Hyperplasia

2014-08-03T14:11:22Z

LisaMilella:

*44% of cases of oral masses.
*Dense collagenous tissue, with ulceration/superficial inflammation
*Dystrophic calcification within the fibrous connective tissue stroma (often highly cellular, with 'young stellate fibroblasts'
*No odontogenic epithelium seen.
*Occasional strands of surface epithelium growing down into the stroma.
*Most of these were previously diagnosed as fibromatous or ossifying epulides.


With thanks to Andrew Jefferies (Cambridge) and Alun Williams (RVC) for providing access to their lecture materials


[[Category:Oral Proliferations]]
[[Category:Teeth - Proliferative Pathology]]
[[Category:To_Do_-_Clinical]]
[[Category:LisaM reviewing]]

Feline Lymphoplasmacytic Gingivitis Stomatitis Complex

2014-08-03T14:08:39Z

LisaMilella: /* Treatment */

{{OpenPagesTop}}
==Introduction==
Feline lymphoplasmacytic gingivitis [[stomatitis]] complex is a poorly understood condition. It presents as erythematous, ulcerative lesions of the gingiva, buccal mucosa, lips, palatoglossal folds and the lateral pharyngeal walls. No clear aetiology has yet been discovered but many different causes of the condition have been proposed. These include [[:Category:Hypersensitivity|hypersensitivity]] to oral antigens and bacterial infections including those caused by ''Porphyromonas'' sp and ''Haemobartonella henselae''. Certain viruses have also been implemented including [[Feline Calicivirus|Feline calicivirus]] (FCV),[[Feline Herpesvirus 1|Feline herpesvirus]] (FHV), [[Feline Immunodeficiency Virus|Feline immunodeficiency virus]] (FIV),[[Feline Leukemia Virus|Feline leukaemia virus]] (FeLV) and Feline coronavirus (FCoV).

==Typical Signalment==
No sex, age or breed predilection. The median age of those affected is 7 years (range 4 months - 17 years).

==Diagnosis==
Diagnosis of this condition can usually be made on the clinical appearance of the oral lesions and symptoms, together with a lack of response to professional teeth cleaning and home dental care.

===Clinical Signs===
Include halitosis, dysphagia, ptyalism, weight loss, cachexia, bilateral erythematous, ulcerative and/or proliferative lesions of the gingiva, submandibular lymphadenopathy and variable amounts of plaque and calculus accumulation.
Additionally teeth are often loose or missing.

===Laboratory Tests===
Tests to eliminate underlying viral causes include virus testing for [[Feline Immunodeficiency Virus|FIV]], [[Feline Leukemia Virus|FeLV]] and an oral Swab for [[Feline Calicivirus|FCV]].
Routine[[Feline Haematology| haematology]] and [[Feline Biochemistry|biochemistry]] are also useful to screen for underlying disease. High globulin levels may be indicative of a hypersensitive state.

===Diagnostic Imaging===
Full intra-oral dental radiography should be carried out to assess the teeth, alveolar bone and also to identify any fractured roots or root remnants.

===Biopsy===
Biopsies should be taken to rule out any malignant neoplasms (i.e. [[Squamous Cell Carcinoma| squamous cell carcinoma]]) or other pathology (i.e. [[Feline Eosinophilic Granuloma|eosinophilic granuloma]]) and to confirm the diagnosis. Histologically, dense band-like submucosal lymphocytic-plasmacytic infiltrates are reported with this condition.

==Treatment==
The aim of treatment of this condition is to improve the hygiene of the oral cavity. Initial treatment can include the following: Treating any underlying/existing dental disease, client education of the disease process and client education in dental homecare (diet and daily teeth brushing).
More often than not, full mouth extractions performed by a veterinary dentist are required.
Adjunctive treatment includes pain medication, anti-inflammatories and antibiotic treatment.

==Prognosis==
Partly due to the lack of understanding of this condition, feline lymphoplasmacytic gingivitis stomatitis complex is frustrating to treat. Many patients fail to respond to treatment, even after full mouth extraction. In these cases it is thought that the oral bacteria that remain are sufficient to maintain inflammation. In cases that undergo prolonged ineffective medical treatment, the disease appears to become more refractory to further treatment.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=title:(%22stomatitis%22)+AND+od:(cats) Stomatitis in cats publications]

[http://www.cabdirect.org/search.html?q=title%3A%28Gingivitis%29+AND+title%3A%28Stomatitis%29+AND+od%3A%28cats%29 Gingivitis and Stomatitis in cats publications]
}}

==References==

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Merck & Co (2008) '''The Merck Veterinary Manual'''(Eighth edition)''Merial''

{{review}}

{{OpenPages}}

[[Category:Oral_Cavity_-_Erosive_&_Ulcerative_Pathology]][[Category:Oral Diseases - Cat]]

[[Category:Expert_Review]]
[[Category:Periodontal Conditions]]
[[Category:LisaM reviewing]]

Feline Lymphoplasmacytic Gingivitis Stomatitis Complex

2014-08-03T14:06:37Z

LisaMilella: /* Diagnostic Imaging */

{{OpenPagesTop}}
==Introduction==
Feline lymphoplasmacytic gingivitis [[stomatitis]] complex is a poorly understood condition. It presents as erythematous, ulcerative lesions of the gingiva, buccal mucosa, lips, palatoglossal folds and the lateral pharyngeal walls. No clear aetiology has yet been discovered but many different causes of the condition have been proposed. These include [[:Category:Hypersensitivity|hypersensitivity]] to oral antigens and bacterial infections including those caused by ''Porphyromonas'' sp and ''Haemobartonella henselae''. Certain viruses have also been implemented including [[Feline Calicivirus|Feline calicivirus]] (FCV),[[Feline Herpesvirus 1|Feline herpesvirus]] (FHV), [[Feline Immunodeficiency Virus|Feline immunodeficiency virus]] (FIV),[[Feline Leukemia Virus|Feline leukaemia virus]] (FeLV) and Feline coronavirus (FCoV).

==Typical Signalment==
No sex, age or breed predilection. The median age of those affected is 7 years (range 4 months - 17 years).

==Diagnosis==
Diagnosis of this condition can usually be made on the clinical appearance of the oral lesions and symptoms, together with a lack of response to professional teeth cleaning and home dental care.

===Clinical Signs===
Include halitosis, dysphagia, ptyalism, weight loss, cachexia, bilateral erythematous, ulcerative and/or proliferative lesions of the gingiva, submandibular lymphadenopathy and variable amounts of plaque and calculus accumulation.
Additionally teeth are often loose or missing.

===Laboratory Tests===
Tests to eliminate underlying viral causes include virus testing for [[Feline Immunodeficiency Virus|FIV]], [[Feline Leukemia Virus|FeLV]] and an oral Swab for [[Feline Calicivirus|FCV]].
Routine[[Feline Haematology| haematology]] and [[Feline Biochemistry|biochemistry]] are also useful to screen for underlying disease. High globulin levels may be indicative of a hypersensitive state.

===Diagnostic Imaging===
Full intra-oral dental radiography should be carried out to assess the teeth, alveolar bone and also to identify any fractured roots or root remnants.

===Biopsy===
Biopsies should be taken to rule out any malignant neoplasms (i.e. [[Squamous Cell Carcinoma| squamous cell carcinoma]]) or other pathology (i.e. [[Feline Eosinophilic Granuloma|eosinophilic granuloma]]) and to confirm the diagnosis. Histologically, dense band-like submucosal lymphocytic-plasmacytic infiltrates are reported with this condition.

==Treatment==
The aim of treatment of this condition is to improve the hygiene of the oral cavity. Initial treatment can include the following: Treating any underlying/existing dental disease, client education of the disease process and client education in dental homecare (diet and daily teeth brushing).
[[Antibiotics]] may also be necessary and a dental scale and polish is recommended.

More advanced cases that have not responded to initial treatments may require a gingivectomy, repeated scale and polishing and extraction of cheek teeth followed by flushing of the alveolar sockets with saline or chlorhexidine (considered by many to be the most effective treatment).
Additionally [[Steroids|corticosteroids]] are often required to control inflammation when there is a hypersensitive response.

==Prognosis==
Partly due to the lack of understanding of this condition, feline lymphoplasmacytic gingivitis stomatitis complex is frustrating to treat. Many patients fail to respond to treatment, even after full mouth extraction. In these cases it is thought that the oral bacteria that remain are sufficient to maintain inflammation. In cases that undergo prolonged ineffective medical treatment, the disease appears to become more refractory to further treatment.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=title:(%22stomatitis%22)+AND+od:(cats) Stomatitis in cats publications]

[http://www.cabdirect.org/search.html?q=title%3A%28Gingivitis%29+AND+title%3A%28Stomatitis%29+AND+od%3A%28cats%29 Gingivitis and Stomatitis in cats publications]
}}

==References==

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Merck & Co (2008) '''The Merck Veterinary Manual'''(Eighth edition)''Merial''

{{review}}

{{OpenPages}}

[[Category:Oral_Cavity_-_Erosive_&_Ulcerative_Pathology]][[Category:Oral Diseases - Cat]]

[[Category:Expert_Review]]
[[Category:Periodontal Conditions]]
[[Category:LisaM reviewing]]

Feline Lymphoplasmacytic Gingivitis Stomatitis Complex

2014-08-03T14:05:49Z

LisaMilella: /* Typical Signalment */

{{OpenPagesTop}}
==Introduction==
Feline lymphoplasmacytic gingivitis [[stomatitis]] complex is a poorly understood condition. It presents as erythematous, ulcerative lesions of the gingiva, buccal mucosa, lips, palatoglossal folds and the lateral pharyngeal walls. No clear aetiology has yet been discovered but many different causes of the condition have been proposed. These include [[:Category:Hypersensitivity|hypersensitivity]] to oral antigens and bacterial infections including those caused by ''Porphyromonas'' sp and ''Haemobartonella henselae''. Certain viruses have also been implemented including [[Feline Calicivirus|Feline calicivirus]] (FCV),[[Feline Herpesvirus 1|Feline herpesvirus]] (FHV), [[Feline Immunodeficiency Virus|Feline immunodeficiency virus]] (FIV),[[Feline Leukemia Virus|Feline leukaemia virus]] (FeLV) and Feline coronavirus (FCoV).

==Typical Signalment==
No sex, age or breed predilection. The median age of those affected is 7 years (range 4 months - 17 years).

==Diagnosis==
Diagnosis of this condition can usually be made on the clinical appearance of the oral lesions and symptoms, together with a lack of response to professional teeth cleaning and home dental care.

===Clinical Signs===
Include halitosis, dysphagia, ptyalism, weight loss, cachexia, bilateral erythematous, ulcerative and/or proliferative lesions of the gingiva, submandibular lymphadenopathy and variable amounts of plaque and calculus accumulation.
Additionally teeth are often loose or missing.

===Laboratory Tests===
Tests to eliminate underlying viral causes include virus testing for [[Feline Immunodeficiency Virus|FIV]], [[Feline Leukemia Virus|FeLV]] and an oral Swab for [[Feline Calicivirus|FCV]].
Routine[[Feline Haematology| haematology]] and [[Feline Biochemistry|biochemistry]] are also useful to screen for underlying disease. High globulin levels may be indicative of a hypersensitive state.

===Diagnostic Imaging===
Full skull radiography should be carried out to assess the teeth, alveolar bone and also to identify any broken roots.

===Biopsy===
Biopsies should be taken to rule out any malignant neoplasms (i.e. [[Squamous Cell Carcinoma| squamous cell carcinoma]]) or other pathology (i.e. [[Feline Eosinophilic Granuloma|eosinophilic granuloma]]) and to confirm the diagnosis. Histologically, dense band-like submucosal lymphocytic-plasmacytic infiltrates are reported with this condition.

==Treatment==
The aim of treatment of this condition is to improve the hygiene of the oral cavity. Initial treatment can include the following: Treating any underlying/existing dental disease, client education of the disease process and client education in dental homecare (diet and daily teeth brushing).
[[Antibiotics]] may also be necessary and a dental scale and polish is recommended.

More advanced cases that have not responded to initial treatments may require a gingivectomy, repeated scale and polishing and extraction of cheek teeth followed by flushing of the alveolar sockets with saline or chlorhexidine (considered by many to be the most effective treatment).
Additionally [[Steroids|corticosteroids]] are often required to control inflammation when there is a hypersensitive response.

==Prognosis==
Partly due to the lack of understanding of this condition, feline lymphoplasmacytic gingivitis stomatitis complex is frustrating to treat. Many patients fail to respond to treatment, even after full mouth extraction. In these cases it is thought that the oral bacteria that remain are sufficient to maintain inflammation. In cases that undergo prolonged ineffective medical treatment, the disease appears to become more refractory to further treatment.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=title:(%22stomatitis%22)+AND+od:(cats) Stomatitis in cats publications]

[http://www.cabdirect.org/search.html?q=title%3A%28Gingivitis%29+AND+title%3A%28Stomatitis%29+AND+od%3A%28cats%29 Gingivitis and Stomatitis in cats publications]
}}

==References==

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Merck & Co (2008) '''The Merck Veterinary Manual'''(Eighth edition)''Merial''

{{review}}

{{OpenPages}}

[[Category:Oral_Cavity_-_Erosive_&_Ulcerative_Pathology]][[Category:Oral Diseases - Cat]]

[[Category:Expert_Review]]
[[Category:Periodontal Conditions]]
[[Category:LisaM reviewing]]

Dental Malocclusion

2014-08-03T13:58:59Z

LisaMilella: /* Dental Malocclusion */

==Introduction==
[[File:Dog teeth occlusion 2.jpg|right|200px|thumb|Occlusal assessment – mandibular incisors occlude on the palatal aspect of the maxillary incisors (known as a scissor bite), the mandibular canine interdigitates half way between the maxillary canine and third incisor, and the premolars interdigitate in a “picking shear” effect.''© Lisa Milella 2013'']]
[[File:Dog incisor occlusion.jpg|right|200px|thumb|Occlusal assessment of the incisors of a dog.''© Lisa Milella 2013'']]
By definition, malocclusion is an abnormality in the position of the [[:Category:Teeth - Anatomy & Physiology|teeth]]. The clinical significance of malocclusion is that it may cause discomfort and sometimes pain in the affected animal. In some cases, it may be the direct cause of severe oral pathology.

===Normal Occlusion===
The ideal occlusion can be described as the perfect interdigitation of the upper and lower teeth. In the normal dog, the ideal tooth positions in the arches are defined by the '''occlusal, inter-arch and interdental relationships''' of the teeth.

The '''ideal relationship''' with the [[Oral Cavity Overview - Anatomy & Physiology|mouth]] closed can be defined by the following:
:*Maxillary incisor teeth all positioned rostral to the corresponding mandibular incisor teeth.
:*Mandibular canine tooth is inclined labially and bisects the interproximal space between the opposing maxillary third incisor tooth and canine tooth.
:*Maxillary premolar teeth do not contact the mandibular premolar teeth.
:*The mesial crown cusp of the maxillary fourth premolar tooth is positioned lateral to the space between the mandibular fourth premolar tooth and the mandibular first molar tooth.

This is described as '''orthoclusion'''.

The length of a dog's jaw is most importantly determined by its '''genetic background'''. Problems exist commonly in dogs mainly due to the great variation in [[Skull and Facial Muscles - Anatomy & Physiology|skull]] types within the species. Other factors can influence jaw length during growth, such as diet, metabolism, trauma, infection and forces within the mouth.

==Signalment==
With the mesocephalic skull shape, the [[mandible]] is shorter and narrower than the upper jaw. In dolicocephalic breeds the upper jaw is longer than normal. The increased jaw length results in interdental spaces that are wider than normal. Brachycephalic animals have an upper jaw which is shorter than normal. A short jaw results in reduced interdental spaces with rotation and/or overlap of teeth.

Malocclusion is common in the dog, but also occurs in cats.

==Malocclusion Types==
Malocclusion can result from jaw length and/or width discrepancy (skeletal malocclusion), from tooth malpositioning (dental malocclusion), or a combination of both. The development of the occlusion is determined by both genetic and environmental factors. Specific genetic mechanisms regulating malocclusion are unknown. However, a polygenic mechanism is likely and explains why not all siblings in successive generations are affected by malocclusion to the same degree, if at all. With a polygenic mechanism, the severity of clinical signs is linked to the number of defective genes. The most reasonable approach to evaluate whether malocclusion is hereditary or acquired is as follows:
* Skeletal malocclusion is considered inherited unless a developmental cause can be reliably identified.
* Pure dental malocclusion, unless known to have breed or family predisposition, should be given the benefit of the doubt and is not necessarily considered to be inherited.

An outline of the more common types of malocclusion is given below.

===Skeletal Malocclusion===

'''Mandibular Prognathic Bite''': In the mandibular prognathic bite (pic4 malocclusion), often called ‘undershot’, the [[Skull and Facial Muscles - Anatomy & Physiology|mandible]] is longer than the [[maxilla]] and some or all of the mandibular teeth are rostral to their normal position. If the dental interlock prevents the mandible from growing rostrally to its full genetic potential, lateral or ventral bowing of the mandible may occur to accommodate the shortening in length. This results in an open bite and is characterized by increased space between the premolar cusp tips. In addition, the caudal angle of the mandible is caudal to the temporomandibular joint to accommodate the extra length of the mandible.

'''Mandibular Brachygnathic Bite''': A mandibular brachygnathic bite, often called ‘overshot’, and occurs when the mandible is shorter than normal. This often results in the mandibular canine [[Category:Teeth - Anatomy & Physiology|teeth]] contacting the [[Hard Palate|palate]], causing trauma. (pic 5malocclusion)

'''Wry Bite''': A wry bite occurs if one side of the head grows more than the other side. In its mildest form a one-sided prognathic or brachygnathic bite develops. In more severe cases, a crooked head and bite develop with a deviated midline. An open bite may also develop in the incisor region so that the affected teeth are displaced vertically and do not occlude. (pic6 malocclusion)

'''Narrow Mandible''': In some animals, the mandible is too narrow with respect to the upper jaw. The result is that the lower canines impinge on the maxillary [[Gingiva|gingivae]] or the [[Hard Palate|hard palate]] instead of fitting into the diastema between the upper third incisor and upper canine on either side. The animal may not be able to close its mouth and injury to the gingivae or palatal mucosa commonly occurs. In severe, untreated cases an oronasal communication may develop over time. This condition is seen in both the primary (deciduous) and permanent dentition. Persistent mandibular primary canines will further exacerbate the condition, as the permanent mandibular canines erupt medially to their primary counterparts. The incorrect dental interlock will interfere with the normal growth in width and length of the developing mandible. The condition can also be caused by persistent primary mandibular canines in a mandible of normal width. (pic 7 malocclusion)

===Dental Malocclusion===
Dental malocclusion is malpositioning of [[:Category:Teeth - Anatomy & Physiology|teeth]] where there is no obvious skeletal abnormality, i.e. there is no jaw length or width discrepancy.

'''Anterior Crossbite''': This is a clinical term used to describe a reverse scissor occlusion of one, several or all of the incisors. The condition can be secondary to persistent primary incisors. However, there is probably a skeletal origin as well, since affected animals often develop a mandibular prognathic bite. In other words, an anterior crossbite in an immature animal may be the first sign of a developing mandibular prognathism. The cause can either be a dental malocclusion (i.e. linguoversion of the upper incisors) or a skeletal malocclusion (i.e. mandibular prognathism or maxillary brachygnathism). Pic8 malocclusion

'''Malocclusion of the Canine Teeth''': The two most common abnormalities in canine tooth position are:
* Rostral displacement (mesioversion) of the maxillary canines (also known as lance canines). Persistent primary canines may be responsible for this condition. A breed predisposition has been reported in the Shetland sheepdog. (pic9malocclusion)
* Medial displacement of the lower canines. (pic10mal)

'''Malocclusion of the Premolars and Molars''': Posterior crossbite is used to describe an abnormal relationship of the carnassial teeth, seen commonly in the dolicocephalic breeds, where the normal buccolingual relationship is reversed.

==Classification of Malocclusion==
===Class 1 Malocclusion===
Also called '''neutroclusion''', this describes a normal rostral-caudal relationship of the maxillary and mandibular dental arches but there is '''malposition of one or more individual teeth'''.

===Class 2 Malocclusion===
Also called '''mandibular distoclusion, mandibular brachygnathism''' or '''mandibular retrognathism'''.

In layman's terms this is referred to as an overshot jaw or a parrot mouth.

This describes an abnormal rostral-caudal relationship between the dental arches in which the mandibular arch occludes caudal to its normal position relative to the maxillary arch.

Breeds commonly affected include the Rough Collie and the Borzoi.

===Class 3 Malocclusion===
Also called '''mandibular mesioclusion, mandibular prognathism'''.

In layman's terms this is referred to as an undershot jaw.

This describes an abnormal rostral-caudal relationship between the dental arches in which the mandibular arch occludes rostral to its position relative to the maxillary arch.

One of the breeds most commonly affected is the Boxer.

==Clinical Importance of Malocclusion==
Even an otherwise sound, well cared-for dentition may show '''asymmetric abrasion or attrition'''.

Problems may occur with mastication and temporomandibular joint function.

'''Soft tissue trauma''' is a common sequel of malpositioned teeth.

'''Premature loss''' of teeth may be caused by an increased liability to [[periodontitis]].

Owners should also be counselled with regard to the possible '''inheritance''' of the condition. Dogs with severe dental malocclusion should not be bred from.

==Prevention and Treatment of Malocclusion==
Prevention is always better than treatment. Early recognition of a problem is essential to avoid discomfort and pain to the animal and prevent the development of severe pathology. Malocclusion affecting the primary dentition may require interceptive [[Orthodontic Treatment|orthodontics]] (usually extraction of the deciduous teeth). Malocclusion affecting the permanent dentition may need no treatment at all, if it is not causing the animal discomfort or any oral pathology. Malocclusion causing discomfort and pathology always needs treating.

Primary teeth involved in malocclusion should be extracted as early as possible, i.e. at 6–8 weeks of age. This will allow the maxilla and mandible to develop to their full genetic potential independently before the permanent dental interlock forms. The roots of primary teeth are longer and narrower than the roots of the permanent teeth. Extraction requires care and patience to avoid tooth fracture. It is essential not to fracture the root, as a remnant may continue to deviate the eruption pathway of the permanent tooth. Every attempt should be made to minimize the risk of iatrogenic damage to the developing permanent teeth.

The treatment options available for permanent teeth causing a traumatic malocclusion are orthodontics, tooth shortening or extraction. In many instances, tooth shortening or extraction are preferable to [[Orthodontic Treatment|orthodontics]] on ethical grounds. Tooth shortening often requires pulpal exposure. In this situation, [[Endodontic Treatment|endodontic therapy]] of the shortened tooth is mandatory. Lingually displaced mandibular canines in young dogs can often be corrected by stimulating the dogs to play, as often as possible, with specific rubber toys of an appropriate size and shape.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 09]]
}}

==References==
Johnson, N. (2009) '''Dentistry 1''' ''RVC student notes''

Verstraete, F. (1999) '''Self-assessment colour review of veterinary dentistry''' ''Manson Publishing''

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Cat]]
[[Category:Dental Diseases - Dog]]
[[Category:Developmental Dental Conditions]]
[[Category:To Do - Dentistry Images]]
[[Category:To Do - Dentistry preMars]]
[[Category:LisaM reviewing]]

Dental Discolouration

2014-08-03T13:54:18Z

LisaMilella: /* Treatment */

{{OpenPagesTop}}
==Introduction==
[[File:Dental discoloration.jpg|right|200px|thumb|Tooth discolouration following trauma]]
The normal colour of teeth varies and depends on the shade, translucency and thickness of the [[Enamel Organ#Enamel|enamel]].

Teeth can discolour following trauma to the tooth. It can be any colour from pink to black, resulting from the haemoglobin breakdown products settling in the dentinal tubules. Studies show that 92% of discoloured teeth have irreversible pulpitis. The pulp may then get secondary infected by anachoresis.

There are two basic kinds of discolouration:
:'''Intrinsic staining''': secondary to endogenous factors discolouring the underlying [[Enamel Organ#Dentine|dentine]]
:'''Extrinsic staining''': from surface accumulation of exogenous pigment

Discolourations can also be generalised or local, and pseudodiscolourations refer to extrinsic staining by dental plaque or agents in foods.

Discolouration of teeth is '''extremely common in all animals''' and affects all species and all breeds.

==Aetiology==
===Extrinsic Staining===
'''Bacterial stains''': green to black-brown to orange colour, from chromogenic bacteria.

'''Plaque-related''': black-brown stain, due to the formation of ferric-sulfide from interaction of bacterial ferric sulfide and iron in the saliva.

'''Foods''': charcoal biscuits can penetrate pits and fissures in the enamel, green from foods containing abundant chlorophyll.

'''Dental restorative materials''': black-grey from amalgam (rare in animals)

'''Medications''': most commonly tetracyclines given prior to development of the permanent teeth.

'''Metal''': wear from chewing on cages or from removed orthodontic bands or wires

'''Discoloured restorations'''

'''Tooth wear and dentin exposure''': secondary dentin, tertiary dentin, reparative dentin

===Intrinsic Staining===
'''Red blood cell destruction''': following traumatic injury to the tooth. Haemoglobin breakdown in the pulp from a pulpitis, which progresses from pink to grey to black.

'''Amelogenesis imperfecta''': developmental alteration in the structure of the enamel, giving a chalky appearance. The teeth may appear pinkish in colour due to the visible pulp through the poor quality enamel.

===Internal Resorption===
'''Pulpal injury''' causes vascular changes with increased oxygen tension and a decreased pH, resulting in destruction of the tooth from within the pulp from odontoclasts.

The tooth has a pinkish hue.

===External Resorption===
This is caused by many conditions such as '''trauma, orthodontic treatment, [[Periodontal Disease|periodontal disease]], tumours and periapical inflammation'''. [[Bones - Anatomy & Physiology#Cells|Odontooclasts]] resorb the tooth structure.

===Medications===
'''Tetracycline''': binds to [[calcium]] and forms a calcium orthophosphate complex that is laid down into the collagen matrix of the enamel.
It results in a yellow-brown discolouration. This can only occur when the enamel is being formed.

'''Amalgam'''

'''Iodine or essential oils'''

'''Macrolide antibiotics''': hypocalcification leading to white lesions with horizontal stripes on the enamel

==Clinical Signs==
There will be abnormal colouration of a tooth or teeth.

There may only be rings or lines of discolouration.

==Diagnosis==
There may be a '''history of treatment''' with a particular drug or supplement, or a history of trauma.

If the animal is '''young''' this may indicate a developmental process.

Food or plaque-related discolourations should be obvious on close dental examination and probing.

'''Radiographs''' should be performed to assess the secondary complications from pulp necrosis of the tooth.

==Treatment==
For '''extrinsic staining''', veneers or crowns can be placed on the tooth.

For '''intrinsic staining''', endodontic treatment is often the treatment of choice if the pulp is nonvital.

Restorative procedures such as crowns or veneers will protect both the tooth and the pulp.

Unfortunately, the discolouration '''often persists''' following treatment.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 04]]
}}

==References==
Verstraete, F. (1999) '''Veterinary Dentistry Self-Assessment Colour Review''' ''Manson Publishing''

Lobprise, H. (2007) '''Blackwell's Five Minute Consult Clinical Companion: Veterinary Dentistry''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Cat]]
[[Category:Dental Diseases - Dog]]
[[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]

Dental Discolouration

2014-08-03T13:53:22Z

LisaMilella: /* Diagnosis */

{{OpenPagesTop}}
==Introduction==
[[File:Dental discoloration.jpg|right|200px|thumb|Tooth discolouration following trauma]]
The normal colour of teeth varies and depends on the shade, translucency and thickness of the [[Enamel Organ#Enamel|enamel]].

Teeth can discolour following trauma to the tooth. It can be any colour from pink to black, resulting from the haemoglobin breakdown products settling in the dentinal tubules. Studies show that 92% of discoloured teeth have irreversible pulpitis. The pulp may then get secondary infected by anachoresis.

There are two basic kinds of discolouration:
:'''Intrinsic staining''': secondary to endogenous factors discolouring the underlying [[Enamel Organ#Dentine|dentine]]
:'''Extrinsic staining''': from surface accumulation of exogenous pigment

Discolourations can also be generalised or local, and pseudodiscolourations refer to extrinsic staining by dental plaque or agents in foods.

Discolouration of teeth is '''extremely common in all animals''' and affects all species and all breeds.

==Aetiology==
===Extrinsic Staining===
'''Bacterial stains''': green to black-brown to orange colour, from chromogenic bacteria.

'''Plaque-related''': black-brown stain, due to the formation of ferric-sulfide from interaction of bacterial ferric sulfide and iron in the saliva.

'''Foods''': charcoal biscuits can penetrate pits and fissures in the enamel, green from foods containing abundant chlorophyll.

'''Dental restorative materials''': black-grey from amalgam (rare in animals)

'''Medications''': most commonly tetracyclines given prior to development of the permanent teeth.

'''Metal''': wear from chewing on cages or from removed orthodontic bands or wires

'''Discoloured restorations'''

'''Tooth wear and dentin exposure''': secondary dentin, tertiary dentin, reparative dentin

===Intrinsic Staining===
'''Red blood cell destruction''': following traumatic injury to the tooth. Haemoglobin breakdown in the pulp from a pulpitis, which progresses from pink to grey to black.

'''Amelogenesis imperfecta''': developmental alteration in the structure of the enamel, giving a chalky appearance. The teeth may appear pinkish in colour due to the visible pulp through the poor quality enamel.

===Internal Resorption===
'''Pulpal injury''' causes vascular changes with increased oxygen tension and a decreased pH, resulting in destruction of the tooth from within the pulp from odontoclasts.

The tooth has a pinkish hue.

===External Resorption===
This is caused by many conditions such as '''trauma, orthodontic treatment, [[Periodontal Disease|periodontal disease]], tumours and periapical inflammation'''. [[Bones - Anatomy & Physiology#Cells|Odontooclasts]] resorb the tooth structure.

===Medications===
'''Tetracycline''': binds to [[calcium]] and forms a calcium orthophosphate complex that is laid down into the collagen matrix of the enamel.
It results in a yellow-brown discolouration. This can only occur when the enamel is being formed.

'''Amalgam'''

'''Iodine or essential oils'''

'''Macrolide antibiotics''': hypocalcification leading to white lesions with horizontal stripes on the enamel

==Clinical Signs==
There will be abnormal colouration of a tooth or teeth.

There may only be rings or lines of discolouration.

==Diagnosis==
There may be a '''history of treatment''' with a particular drug or supplement, or a history of trauma.

If the animal is '''young''' this may indicate a developmental process.

Food or plaque-related discolourations should be obvious on close dental examination and probing.

'''Radiographs''' should be performed to assess the secondary complications from pulp necrosis of the tooth.

==Treatment==
For '''extrinsic staining''', internal or external bleaching can be performed, or veneers or crowns can be placed on the tooth.

For '''intrinsic staining''', endodontic treatment is often the treatment of choice.

Restorative procedures such as crowns or veneers will protect both the tooth and the pulp.

Unfortunately, the discolouration '''often persists''' following treatment.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 04]]
}}

==References==
Verstraete, F. (1999) '''Veterinary Dentistry Self-Assessment Colour Review''' ''Manson Publishing''

Lobprise, H. (2007) '''Blackwell's Five Minute Consult Clinical Companion: Veterinary Dentistry''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Cat]]
[[Category:Dental Diseases - Dog]]
[[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]

Dental Discolouration

2014-08-03T13:52:13Z

LisaMilella: /* External Resorption */

{{OpenPagesTop}}
==Introduction==
[[File:Dental discoloration.jpg|right|200px|thumb|Tooth discolouration following trauma]]
The normal colour of teeth varies and depends on the shade, translucency and thickness of the [[Enamel Organ#Enamel|enamel]].

Teeth can discolour following trauma to the tooth. It can be any colour from pink to black, resulting from the haemoglobin breakdown products settling in the dentinal tubules. Studies show that 92% of discoloured teeth have irreversible pulpitis. The pulp may then get secondary infected by anachoresis.

There are two basic kinds of discolouration:
:'''Intrinsic staining''': secondary to endogenous factors discolouring the underlying [[Enamel Organ#Dentine|dentine]]
:'''Extrinsic staining''': from surface accumulation of exogenous pigment

Discolourations can also be generalised or local, and pseudodiscolourations refer to extrinsic staining by dental plaque or agents in foods.

Discolouration of teeth is '''extremely common in all animals''' and affects all species and all breeds.

==Aetiology==
===Extrinsic Staining===
'''Bacterial stains''': green to black-brown to orange colour, from chromogenic bacteria.

'''Plaque-related''': black-brown stain, due to the formation of ferric-sulfide from interaction of bacterial ferric sulfide and iron in the saliva.

'''Foods''': charcoal biscuits can penetrate pits and fissures in the enamel, green from foods containing abundant chlorophyll.

'''Dental restorative materials''': black-grey from amalgam (rare in animals)

'''Medications''': most commonly tetracyclines given prior to development of the permanent teeth.

'''Metal''': wear from chewing on cages or from removed orthodontic bands or wires

'''Discoloured restorations'''

'''Tooth wear and dentin exposure''': secondary dentin, tertiary dentin, reparative dentin

===Intrinsic Staining===
'''Red blood cell destruction''': following traumatic injury to the tooth. Haemoglobin breakdown in the pulp from a pulpitis, which progresses from pink to grey to black.

'''Amelogenesis imperfecta''': developmental alteration in the structure of the enamel, giving a chalky appearance. The teeth may appear pinkish in colour due to the visible pulp through the poor quality enamel.

===Internal Resorption===
'''Pulpal injury''' causes vascular changes with increased oxygen tension and a decreased pH, resulting in destruction of the tooth from within the pulp from odontoclasts.

The tooth has a pinkish hue.

===External Resorption===
This is caused by many conditions such as '''trauma, orthodontic treatment, [[Periodontal Disease|periodontal disease]], tumours and periapical inflammation'''. [[Bones - Anatomy & Physiology#Cells|Odontooclasts]] resorb the tooth structure.

===Medications===
'''Tetracycline''': binds to [[calcium]] and forms a calcium orthophosphate complex that is laid down into the collagen matrix of the enamel.
It results in a yellow-brown discolouration. This can only occur when the enamel is being formed.

'''Amalgam'''

'''Iodine or essential oils'''

'''Macrolide antibiotics''': hypocalcification leading to white lesions with horizontal stripes on the enamel

==Clinical Signs==
There will be abnormal colouration of a tooth or teeth.

There may only be rings or lines of discolouration.

==Diagnosis==
There may be a '''history of treatment''' with a particular drug or supplement, or a history of trauma.

If the animal is '''young''' this may indicate a developmental process.

Food or plaque-related discolourations should be obvious on close dental examination and probing.

'''Radiographs''' should be performed to assess the viability of the tooth.

==Treatment==
For '''extrinsic staining''', internal or external bleaching can be performed, or veneers or crowns can be placed on the tooth.

For '''intrinsic staining''', endodontic treatment is often the treatment of choice.

Restorative procedures such as crowns or veneers will protect both the tooth and the pulp.

Unfortunately, the discolouration '''often persists''' following treatment.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 04]]
}}

==References==
Verstraete, F. (1999) '''Veterinary Dentistry Self-Assessment Colour Review''' ''Manson Publishing''

Lobprise, H. (2007) '''Blackwell's Five Minute Consult Clinical Companion: Veterinary Dentistry''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Cat]]
[[Category:Dental Diseases - Dog]]
[[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]

Dental Discolouration

2014-08-03T13:51:26Z

LisaMilella: /* Extrinsic Staining */

{{OpenPagesTop}}
==Introduction==
[[File:Dental discoloration.jpg|right|200px|thumb|Tooth discolouration following trauma]]
The normal colour of teeth varies and depends on the shade, translucency and thickness of the [[Enamel Organ#Enamel|enamel]].

Teeth can discolour following trauma to the tooth. It can be any colour from pink to black, resulting from the haemoglobin breakdown products settling in the dentinal tubules. Studies show that 92% of discoloured teeth have irreversible pulpitis. The pulp may then get secondary infected by anachoresis.

There are two basic kinds of discolouration:
:'''Intrinsic staining''': secondary to endogenous factors discolouring the underlying [[Enamel Organ#Dentine|dentine]]
:'''Extrinsic staining''': from surface accumulation of exogenous pigment

Discolourations can also be generalised or local, and pseudodiscolourations refer to extrinsic staining by dental plaque or agents in foods.

Discolouration of teeth is '''extremely common in all animals''' and affects all species and all breeds.

==Aetiology==
===Extrinsic Staining===
'''Bacterial stains''': green to black-brown to orange colour, from chromogenic bacteria.

'''Plaque-related''': black-brown stain, due to the formation of ferric-sulfide from interaction of bacterial ferric sulfide and iron in the saliva.

'''Foods''': charcoal biscuits can penetrate pits and fissures in the enamel, green from foods containing abundant chlorophyll.

'''Dental restorative materials''': black-grey from amalgam (rare in animals)

'''Medications''': most commonly tetracyclines given prior to development of the permanent teeth.

'''Metal''': wear from chewing on cages or from removed orthodontic bands or wires

'''Discoloured restorations'''

'''Tooth wear and dentin exposure''': secondary dentin, tertiary dentin, reparative dentin

===Intrinsic Staining===
'''Red blood cell destruction''': following traumatic injury to the tooth. Haemoglobin breakdown in the pulp from a pulpitis, which progresses from pink to grey to black.

'''Amelogenesis imperfecta''': developmental alteration in the structure of the enamel, giving a chalky appearance. The teeth may appear pinkish in colour due to the visible pulp through the poor quality enamel.

===Internal Resorption===
'''Pulpal injury''' causes vascular changes with increased oxygen tension and a decreased pH, resulting in destruction of the tooth from within the pulp from odontoclasts.

The tooth has a pinkish hue.

===External Resorption===
This is caused by many conditions such as '''trauma, orthodontic treatment, [[Periodontal Disease|periodontal disease]], tumours and periapical inflammation'''. [[Bones - Anatomy & Physiology#Cells|Osteoclasts]] resorb the tooth structure.

===Medications===
'''Tetracycline''': binds to [[calcium]] and forms a calcium orthophosphate complex that is laid down into the collagen matrix of the enamel.
It results in a yellow-brown discolouration. This can only occur when the enamel is being formed.

'''Amalgam'''

'''Iodine or essential oils'''

'''Macrolide antibiotics''': hypocalcification leading to white lesions with horizontal stripes on the enamel

==Clinical Signs==
There will be abnormal colouration of a tooth or teeth.

There may only be rings or lines of discolouration.

==Diagnosis==
There may be a '''history of treatment''' with a particular drug or supplement, or a history of trauma.

If the animal is '''young''' this may indicate a developmental process.

Food or plaque-related discolourations should be obvious on close dental examination and probing.

'''Radiographs''' should be performed to assess the viability of the tooth.

==Treatment==
For '''extrinsic staining''', internal or external bleaching can be performed, or veneers or crowns can be placed on the tooth.

For '''intrinsic staining''', endodontic treatment is often the treatment of choice.

Restorative procedures such as crowns or veneers will protect both the tooth and the pulp.

Unfortunately, the discolouration '''often persists''' following treatment.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 04]]
}}

==References==
Verstraete, F. (1999) '''Veterinary Dentistry Self-Assessment Colour Review''' ''Manson Publishing''

Lobprise, H. (2007) '''Blackwell's Five Minute Consult Clinical Companion: Veterinary Dentistry''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Cat]]
[[Category:Dental Diseases - Dog]]
[[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]

Dental Discolouration

2014-08-03T13:50:54Z

LisaMilella: /* Internal Resorption */

{{OpenPagesTop}}
==Introduction==
[[File:Dental discoloration.jpg|right|200px|thumb|Tooth discolouration following trauma]]
The normal colour of teeth varies and depends on the shade, translucency and thickness of the [[Enamel Organ#Enamel|enamel]].

Teeth can discolour following trauma to the tooth. It can be any colour from pink to black, resulting from the haemoglobin breakdown products settling in the dentinal tubules. Studies show that 92% of discoloured teeth have irreversible pulpitis. The pulp may then get secondary infected by anachoresis.

There are two basic kinds of discolouration:
:'''Intrinsic staining''': secondary to endogenous factors discolouring the underlying [[Enamel Organ#Dentine|dentine]]
:'''Extrinsic staining''': from surface accumulation of exogenous pigment

Discolourations can also be generalised or local, and pseudodiscolourations refer to extrinsic staining by dental plaque or agents in foods.

Discolouration of teeth is '''extremely common in all animals''' and affects all species and all breeds.

==Aetiology==
===Extrinsic Staining===
'''Bacterial stains''': green to black-brown to orange colour, from chromogenic bacteria.

'''Plaque-related''': black-brown stain, due to the formation of ferric-sulfide from interaction of bacterial ferric sulfide and iron in the saliva.

'''Foods''': charcoal biscuits can penetrate pits and fissures in the enamel, green from foods containing abundant chlorophyll.

'''Dental restorative materials''': black-grey from amalgam (rare in animals)

'''Medications''': most commonly tetracyclines given prior to development of the permanent teeth.

'''Metal''': wear from chewing on cages or from removed endodontic bands or wires

'''Discoloured restorations'''

'''Tooth wear and dentin exposure''': secondary dentin, tertiary dentin, reparative dentin

===Intrinsic Staining===
'''Red blood cell destruction''': following traumatic injury to the tooth. Haemoglobin breakdown in the pulp from a pulpitis, which progresses from pink to grey to black.

'''Amelogenesis imperfecta''': developmental alteration in the structure of the enamel, giving a chalky appearance. The teeth may appear pinkish in colour due to the visible pulp through the poor quality enamel.

===Internal Resorption===
'''Pulpal injury''' causes vascular changes with increased oxygen tension and a decreased pH, resulting in destruction of the tooth from within the pulp from odontoclasts.

The tooth has a pinkish hue.

===External Resorption===
This is caused by many conditions such as '''trauma, orthodontic treatment, [[Periodontal Disease|periodontal disease]], tumours and periapical inflammation'''. [[Bones - Anatomy & Physiology#Cells|Osteoclasts]] resorb the tooth structure.

===Medications===
'''Tetracycline''': binds to [[calcium]] and forms a calcium orthophosphate complex that is laid down into the collagen matrix of the enamel.
It results in a yellow-brown discolouration. This can only occur when the enamel is being formed.

'''Amalgam'''

'''Iodine or essential oils'''

'''Macrolide antibiotics''': hypocalcification leading to white lesions with horizontal stripes on the enamel

==Clinical Signs==
There will be abnormal colouration of a tooth or teeth.

There may only be rings or lines of discolouration.

==Diagnosis==
There may be a '''history of treatment''' with a particular drug or supplement, or a history of trauma.

If the animal is '''young''' this may indicate a developmental process.

Food or plaque-related discolourations should be obvious on close dental examination and probing.

'''Radiographs''' should be performed to assess the viability of the tooth.

==Treatment==
For '''extrinsic staining''', internal or external bleaching can be performed, or veneers or crowns can be placed on the tooth.

For '''intrinsic staining''', endodontic treatment is often the treatment of choice.

Restorative procedures such as crowns or veneers will protect both the tooth and the pulp.

Unfortunately, the discolouration '''often persists''' following treatment.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 04]]
}}

==References==
Verstraete, F. (1999) '''Veterinary Dentistry Self-Assessment Colour Review''' ''Manson Publishing''

Lobprise, H. (2007) '''Blackwell's Five Minute Consult Clinical Companion: Veterinary Dentistry''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Cat]]
[[Category:Dental Diseases - Dog]]
[[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]

Dental Discolouration

2014-08-03T13:50:01Z

LisaMilella: /* Intrinsic Staining */

{{OpenPagesTop}}
==Introduction==
[[File:Dental discoloration.jpg|right|200px|thumb|Tooth discolouration following trauma]]
The normal colour of teeth varies and depends on the shade, translucency and thickness of the [[Enamel Organ#Enamel|enamel]].

Teeth can discolour following trauma to the tooth. It can be any colour from pink to black, resulting from the haemoglobin breakdown products settling in the dentinal tubules. Studies show that 92% of discoloured teeth have irreversible pulpitis. The pulp may then get secondary infected by anachoresis.

There are two basic kinds of discolouration:
:'''Intrinsic staining''': secondary to endogenous factors discolouring the underlying [[Enamel Organ#Dentine|dentine]]
:'''Extrinsic staining''': from surface accumulation of exogenous pigment

Discolourations can also be generalised or local, and pseudodiscolourations refer to extrinsic staining by dental plaque or agents in foods.

Discolouration of teeth is '''extremely common in all animals''' and affects all species and all breeds.

==Aetiology==
===Extrinsic Staining===
'''Bacterial stains''': green to black-brown to orange colour, from chromogenic bacteria.

'''Plaque-related''': black-brown stain, due to the formation of ferric-sulfide from interaction of bacterial ferric sulfide and iron in the saliva.

'''Foods''': charcoal biscuits can penetrate pits and fissures in the enamel, green from foods containing abundant chlorophyll.

'''Dental restorative materials''': black-grey from amalgam (rare in animals)

'''Medications''': most commonly tetracyclines given prior to development of the permanent teeth.

'''Metal''': wear from chewing on cages or from removed endodontic bands or wires

'''Discoloured restorations'''

'''Tooth wear and dentin exposure''': secondary dentin, tertiary dentin, reparative dentin

===Intrinsic Staining===
'''Red blood cell destruction''': following traumatic injury to the tooth. Haemoglobin breakdown in the pulp from a pulpitis, which progresses from pink to grey to black.

'''Amelogenesis imperfecta''': developmental alteration in the structure of the enamel, giving a chalky appearance. The teeth may appear pinkish in colour due to the visible pulp through the poor quality enamel.

===Internal Resorption===
'''Pulpal injury''' causes vascular changes with increased oxygen tension and a decreased pH, resulting in destruction of the tooth from within the pulp from dentinoclasts.

The tooth has a pinkish hue.

===External Resorption===
This is caused by many conditions such as '''trauma, orthodontic treatment, [[Periodontal Disease|periodontal disease]], tumours and periapical inflammation'''. [[Bones - Anatomy & Physiology#Cells|Osteoclasts]] resorb the tooth structure.

===Medications===
'''Tetracycline''': binds to [[calcium]] and forms a calcium orthophosphate complex that is laid down into the collagen matrix of the enamel.
It results in a yellow-brown discolouration. This can only occur when the enamel is being formed.

'''Amalgam'''

'''Iodine or essential oils'''

'''Macrolide antibiotics''': hypocalcification leading to white lesions with horizontal stripes on the enamel

==Clinical Signs==
There will be abnormal colouration of a tooth or teeth.

There may only be rings or lines of discolouration.

==Diagnosis==
There may be a '''history of treatment''' with a particular drug or supplement, or a history of trauma.

If the animal is '''young''' this may indicate a developmental process.

Food or plaque-related discolourations should be obvious on close dental examination and probing.

'''Radiographs''' should be performed to assess the viability of the tooth.

==Treatment==
For '''extrinsic staining''', internal or external bleaching can be performed, or veneers or crowns can be placed on the tooth.

For '''intrinsic staining''', endodontic treatment is often the treatment of choice.

Restorative procedures such as crowns or veneers will protect both the tooth and the pulp.

Unfortunately, the discolouration '''often persists''' following treatment.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 04]]
}}

==References==
Verstraete, F. (1999) '''Veterinary Dentistry Self-Assessment Colour Review''' ''Manson Publishing''

Lobprise, H. (2007) '''Blackwell's Five Minute Consult Clinical Companion: Veterinary Dentistry''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Cat]]
[[Category:Dental Diseases - Dog]]
[[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]

Dental Discolouration

2014-08-03T13:47:52Z

LisaMilella: /* Extrinsic Staining */

{{OpenPagesTop}}
==Introduction==
[[File:Dental discoloration.jpg|right|200px|thumb|Tooth discolouration following trauma]]
The normal colour of teeth varies and depends on the shade, translucency and thickness of the [[Enamel Organ#Enamel|enamel]].

Teeth can discolour following trauma to the tooth. It can be any colour from pink to black, resulting from the haemoglobin breakdown products settling in the dentinal tubules. Studies show that 92% of discoloured teeth have irreversible pulpitis. The pulp may then get secondary infected by anachoresis.

There are two basic kinds of discolouration:
:'''Intrinsic staining''': secondary to endogenous factors discolouring the underlying [[Enamel Organ#Dentine|dentine]]
:'''Extrinsic staining''': from surface accumulation of exogenous pigment

Discolourations can also be generalised or local, and pseudodiscolourations refer to extrinsic staining by dental plaque or agents in foods.

Discolouration of teeth is '''extremely common in all animals''' and affects all species and all breeds.

==Aetiology==
===Extrinsic Staining===
'''Bacterial stains''': green to black-brown to orange colour, from chromogenic bacteria.

'''Plaque-related''': black-brown stain, due to the formation of ferric-sulfide from interaction of bacterial ferric sulfide and iron in the saliva.

'''Foods''': charcoal biscuits can penetrate pits and fissures in the enamel, green from foods containing abundant chlorophyll.

'''Dental restorative materials''': black-grey from amalgam (rare in animals)

'''Medications''': most commonly tetracyclines given prior to development of the permanent teeth.

'''Metal''': wear from chewing on cages or from removed endodontic bands or wires

'''Discoloured restorations'''

'''Tooth wear and dentin exposure''': secondary dentin, tertiary dentin, reparative dentin

===Intrinsic Staining===
'''[[Hyperbilirubinaemia]]''': affects all teeth, occurs when dentin is being formed and [[bilirubin]] accumulates in the tooth. Lines of resolution may be seen on the teeth if the problem is solved during dentin development

'''Red blood cell destruction''': following traumatic injury to the tooth. Haemoglobin breakdown in the pulp from a pulpitis, which progresses from pink to grey to black.

'''Amelogenesis imperfecta''': developmental alteration in the structure of the enamel, giving a chalky appearance and a pinkish colour to all teeth.

'''Infectious agents''': [[:Category:Parvoviridae|parvovirus]] and [[Canine Distemper Virus|distemper virus]] especially affect the formation of enamel. There is '''enamel hypoplasia''' and the pitted areas have black edges and the dentin is brownish.

'''Dental fluorosis''': excess fluoride consumption leads to enamel hypoplasia with black edges. The enamel is lusterless and has yellow-brown zones of discolouration.

===Internal Resorption===
'''Pulpal injury''' causes vascular changes with increased oxygen tension and a decreased pH, resulting in destruction of the tooth from within the pulp from dentinoclasts.

The tooth has a pinkish hue.

===External Resorption===
This is caused by many conditions such as '''trauma, orthodontic treatment, [[Periodontal Disease|periodontal disease]], tumours and periapical inflammation'''. [[Bones - Anatomy & Physiology#Cells|Osteoclasts]] resorb the tooth structure.

===Medications===
'''Tetracycline''': binds to [[calcium]] and forms a calcium orthophosphate complex that is laid down into the collagen matrix of the enamel.
It results in a yellow-brown discolouration. This can only occur when the enamel is being formed.

'''Amalgam'''

'''Iodine or essential oils'''

'''Macrolide antibiotics''': hypocalcification leading to white lesions with horizontal stripes on the enamel

==Clinical Signs==
There will be abnormal colouration of a tooth or teeth.

There may only be rings or lines of discolouration.

==Diagnosis==
There may be a '''history of treatment''' with a particular drug or supplement, or a history of trauma.

If the animal is '''young''' this may indicate a developmental process.

Food or plaque-related discolourations should be obvious on close dental examination and probing.

'''Radiographs''' should be performed to assess the viability of the tooth.

==Treatment==
For '''extrinsic staining''', internal or external bleaching can be performed, or veneers or crowns can be placed on the tooth.

For '''intrinsic staining''', endodontic treatment is often the treatment of choice.

Restorative procedures such as crowns or veneers will protect both the tooth and the pulp.

Unfortunately, the discolouration '''often persists''' following treatment.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 04]]
}}

==References==
Verstraete, F. (1999) '''Veterinary Dentistry Self-Assessment Colour Review''' ''Manson Publishing''

Lobprise, H. (2007) '''Blackwell's Five Minute Consult Clinical Companion: Veterinary Dentistry''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Teeth - Pathology]]
[[Category:Dental Diseases - Cat]]
[[Category:Dental Diseases - Dog]]
[[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]

Dental Caries

2014-08-03T13:44:27Z

LisaMilella: /* Clinical Signs */

{{OpenPagesTop}}
== Introduction ==
[[File:Dental Caries.jpg|200px|thumb|right|Dental caries]]
Caries = tooth decay.

Dental caries is a plaque-induced demineralization of the teeth caused by the action of cariogenic bacteria on fermentable carbohydrates. The acid which is produced demineralizes the [[Enamel Organ#Enamel|enamel]] and [[Enamel Organ#Dentin|dentine]]. Bacteria is then able to invade the dentine and dentinal tubules, undermining the enamel and eventually causing the collapse of the enamel and cavitation of the tooth. The occlusal surfaces of the molar teeth are particularly prone to caries.

Dental caries is a multi-factorial disease which requires all four of the following:

#Susceptible tooth surfaces
#Fermentable carbohydrate source
#Cariogenic bacteria (ie. Streptococci and ''Lactobacillus'')
#Time

The occurence of dental caries is low in dogs when compared with humans. There are thought to be several reasons for this such as the fact there are fewer cariogenic bacteria in the normal oral flora and a higher salivary pH, acting to neutralize acid produced by the bacteria. Also, canine tooth surfaces are not prone to food impaction and their diets are normally low in fermentable carbohydrates. Dogs also have a lower frequency of food intake compared with humans.

==Aetiology==

Caries is an organic demineralization of tooth substance. It is caused initially by acidic metabolites produced during breakdown of simple sugars by specific bacteria (''Streptococcus mutans'' and ''S.sanguis''). Once the enamel has been eroded and the dentine is reached, the destructive process seems to be enhanced. Caries most frequently occurs in the pits and fissures of the molar teeth .

== Signalment ==
Not uncommon in dogs and never really been diagnosed in cats.
Dental caries can occur in any breed or size of dog. There is a greater risk of the condition with salivary gland dysfunction or dehydration as well as with diets high in fermentable carbohydrates or simple sugars.

== Clinical Signs ==

These may include dysphagia, reluctance to eat, tooth pain and thermal sensitivity, excessive salivation, bad breath and pain on mastication. There may also be weight loss and the dog may appear generally depressed and lethargic.

== Diagnosis==

Clinical signs and history will indicate an oral issue. A full physical examination should follow. If a full dental examination is required to examine the extent of the problem, this is usually done under anaesthesia.

Dental examination will show the tooth surface to have the presence of a 'white spot' (early lesions) or a brown/grey discolouration (advanced lesions) of the tooth surface. Severe lesions may present with a cavitation of the tooth surface. A sharp dental probe can be gently used to identify defects in the tooth surface. The probe will stick when removed from a carious lesion due to the softened dentine.

Radiographs of the tooth may show a radiolucency within the tooth or below the occlusal surface. The extent of lesions may be underestimated as a 40% loss of mineral content is required before a radiolucency is seen on a radiograph. In addition this means that advanced lesions are also more difficult to interpret.

== Treatment ==

Factors that have contributed to the formation of the caries should be assessed and addressed. These may include diet (reduce amount of fermentable carbohydrate), salivary gland dysfunction and the anatomical structure of the tooth such as deep pits and fissures on the tooth surface.

'''Non-cavitated white spot lesions''' may remineralise and require conservative treatment such as dietary advice and home dental care focusing on plaque control by methods such as brushing teeth or using dental chews. These dogs will also require regular check-ups and assessments.

'''Cavitated lesions''' may require restorative treatment, which may involve removal of diseased enamel and dentine and the placement of restorative material such as composite resin or glass ionomer. Extraction may be required if there is extensive loss of the tooth structure.

== References ==

Blood, D.C. and Studdert, V. P. (1999) '''Saunders Comprehensive Veterinary Dictionary '''(2nd Edition) ''Elsevier Science''

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

{{review}}

{{OpenPages}}

[[Category:Teeth_-_Inflammatory_Pathology]] [[Category:Oral_Diseases_-_Dog]] [[Category:Oral_Diseases_-_Cat]] [[Category:LisaM reviewing]]
[[Category:Endodontic Conditions]]

Craniomandibular Osteopathy

2014-08-03T13:40:43Z

LisaMilella: /* Introduction */

{{OpenPagesTop}}
Also known as: '''''Lion jaw'''''

==Introduction==
Craniomandibular osteopathy is a '''non-neoplastic, proliferative disease of the bones of the head'''.

Primary bones affected include the mandibular rami, occipital and parietal bones, tympanic bullae and the zygomatic portion of the temporal bone.

'''Symmetrical''' involvement is common.

The aetiology is unknown but there may be a link with infection.

==Signalment==
Craniomandibular osteopathy is seen most commonly in West Highland White Terriers, Scottish, and Cairn terriers although it has been reported in other breeds too.

The condition is believed to be hereditary, and it is an autosomal recessive trait in '''West Highland White Terriers''' and possibly in '''Scottish Terriers'''. It has been reported in other breeds such as the '''Labrador, Great Dane and Doberman'''.

The condition usually occurs in growing puppies between the age of '''4 and 8 months'''.

==Clinical Signs==

Puppies present with swollen mandibles, inappetance and reluctance to open, and pain on opening the mouth. The owner may report that the dog has '''difficulty in prehension, mastication and swallowing of food''', and that it has pain around the mouth area.

Temporal and masseter '''muscle atrophy''' are common.

There may be '''palpable irregular thickenings''' of the mandibular rami or the temporomandibular joint caused by periosteal proliferation of the body of the mandible, sometimes incorporating the tympanic bullae or temporomandibular joint.

The dog will be unable to fully open its jaw, even under anaesthesia. There may be bilateral exophthalmos and pyrexia, up to 40°C. Less commonly, there may be swelling and lameness in one or several limbs.

==Diagnosis==
Clinical signs and radiography are used to diagnose the condition.

'''Radiographic findings''' include: uneven, beadlike osseous proliferation of the mandible or tympanic bullae, extensive periosteal new bone formation affect the temporomandibular joint, fusion of the tympanic bullae and angular process of the mandible.

'''CT''' may help evaluate the osseous involvement of the temporomandibular joint.

'''Bone biopsy''' may reveal osteogenesis and resorption of periosteum, endosteum and trabeculae of the mandible, variable infiltration of [[lymphocytes]], [[Neutrophils|neutrophils]] and [[Plasma Cells|plasma cells]], mosaic appearance.

'''Bone culture''' may help to rule out [[osteomyelitis]] if the diagnosis is uncertain.

==Treatment==
Craniomandibular osteopathy follows an intermittent progressive course but is '''self-limiting''' and treatment is only '''palliative'''. The condition usually regresses at about a year of age, corresponding with the completion of jaw growth and ossification.

Analgesics and anti-inflammatories form the mainstay of therapy, and may include [[NSAIDs]] such as carprofen.

'''High-calorie, protein-rich food''' should be provided to help maintain adequate nutrition, and feeding tube placement may be considered in severe cases.

The animal should be reexamined frequently to ensure adequate nutritional balance and pain control.

Pain and discomfort may diminish at skeletal maturity at approximately '''12 months'''.

Lesions may then '''regress completely'''.

'''Prognosis''' depends on the involvement of the temporomandibular joint, as ankylosis and adhesions may '''permanently restrict jaw movement''' and eating.

'''Rostral mandibulectomy''' may be a useful salvage procedure.

'''Euthanasia''' may be the only option in severely affected animals.

Affected animals should not be used for breeding.

{{Learning
|flashcards = [[Small Animal Orthopaedics Q&A 09]]
}}

==References==
Niemiec, B. (2010) '''A colour handbook of small animal dental and maxillofacial diseases''' ''Manson Publishing''

Lobprise, H. (2007) '''Blackwell's Five Minute Veterinary Consult: Small animal dentistry''' ''Wiley-Blackwell''

{{review}}

{{OpenPages}}

[[Category:Musculoskeletal Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Bones - Hyperplastic Pathology]]
[[Category:Developmental Dental Conditions]]
[[Category:To Do - Dentistry Images]]
[[Category:LisaM reviewing]]

Cleft Palate

2014-08-03T13:37:19Z

LisaMilella: /* Closure of Primary Clefts */

{{OpenPagesTop}}
Also known as: '''''Congenital Oronasal Fistula — Palatoschisis

[[Image:Cleft-palate.gif|right|thumb|300px|<center>A congenital cleft palate defect (Courtesy of Alun Williams (RVC))</center>]]
==Introduction==
An abnormal communication between the [[Nasal Cavity - Anatomy & Physiology| nasal]] and [[Oropharynx - Anatomy & Physiology| oral]] cavities involving the [[Soft Palate| soft palate]] , [[Hard Palate| hard palate]], premaxilla and or [[Lips|lip]] . Abnormalities arise during foetal development where there is incomplete closure of the primary palate, secondary palate or both.
The primary palate develops into the premaxilla and lip. If closure is not complete this will result in a primary palate or cleft lip (harelip).
The secondary palate forms the hard and soft palate and incomplete closure of either of these results in a secondary palate or cleft palate.

Possible causes may include administration of [[Antifungal Drugs#Griseofulvin|griseofulvin]] to queens during pregnancy, certain viral infections or ingestion of toxic plants.

==Aetiology==
The facial part of the dorsal surface of the skull is formed by parts of the [[Skull and Facial Muscles - Anatomy & Physiology|frontal, nasal, maxillary, and incisive bones]]. Problems, such as a cleft palate, can arise if the fusion of these bones does not occur properly. It is also important to note that each quadrant of the skull and jaw develops independent of the other three quadrants. If there is an abnormality on one side, it does not necessarily mean the other side is also affected.

'''Primary cleft palate''': defect between the incisive bone and maxilla. This type of cleft is often associated with a harelip or cleft lip. (2 pictures)

'''Secondary cleft palate''': defect in the maxilla that may or may not extend to involve the soft palate. (1pic)

==Signalment==
Dogs are more commonly affected than cats. In particular brachycephalic breeds are more commonly affected due to the intra-uterine growth characteristics of the skull. Other at risk [[Canine Breeds - WikiNormals| dog breeds]] include, Boston Terriers, Pekingese, Minature Schnauzers, Beagles and Cocker Spaniels.
Siamese are the most commonly affected [[Feline Breeds - WikiNormals|cat breed]].
Present at birth but not always noticed straight away.
In large animals, cleft palate has been reported in foals, calves, lambs and kids.
The primary cause of this condition is often hereditary but maternal nutritional deficiencies, toxins and viral exposure have also been implemented.

==Diagnosis==
===History and Clinical Signs===
Failure to thrive with signs such as nasal discharge, nasal milk regurgitation, halitosis, gagging, coughing or sneezing during nursing, and respiratory infection due to aspiration pneumonia or rhinitis.

Diagnosis is made on physical exam. A cleft lip can be easily identified, however, a full oral examination is needed to diagnose incomplete closure of the premaxilla, hard and soft palate.
In some instances [[Anaesthesia|anaesthesia]] may be required to diagnose a soft palate problem.
If a primary palate problem is recognised always check for a secondary palate problem.
Increased noise over lung fields may be heard if aspiration pneumonia is present.
Affected animals often have other concurrent congenital abnormalities and hence a thorough physical exam should be undertaken.

===Laboratory Tests===
Often normal unless aspiration pneumonia is present.

===Radiography===
Radiographs of the skull are unnecessary however thoracic radiographs are useful to check for the presence of aspiration pneumonia.

==Treatment==
A large proportion of animals with primary or secondary palate defects die or are euthanased. In some cases however the defects can be managed medically until the patient is old enough for surgery.

Affected animals should gain nutritional support via a feeding tube to avoid [[Aspiration Pneumonia|aspiration pneumonia]] until surgery can be undertaken.
Aspiration pneumonia should also be treated with appropriate antibiotics, expectorants and oxygen.
Surgery should be delayed until the animal is 12-14 weeks old or longer if possible in order to get the best possible post surgical outcome. More mature tissue is less friable and holds suture better.
Surgical correction is normally only carried out if the defect is small and owners must be warned that more severely affected animals may need multiple procedures.

===Closure of Primary Clefts===
Often very difficult to correct surgically, and requires planning and often multiple surgeries.

===Closure of Secondary Clefts===
====Hard palate defects====
Three procedures have been described firstly, the '''Lagenbeck''' or '''sliding pedicle technique''' whereby longitudinal strips of mucosa are released from the hard palate and slid together at the midline. Hard palate bone is exposed laterally however granulation and epithelisation occur quickly.
The second technique is the '''Sandwich''' or '''overlapping flap technique''' where by a recipient bed is created by splitting the mucous membrane at the edge of the defect. A donor bed is created by releasing strips of mucosa from the opposite mucous membrane which is then sutured into place.
Thirdly a '''combination technique''' can be applied where both of the above techniques are used to produce a double layer of mucosa over the cleft.

====Soft Palate defects====
An overlapping flap technique, flaps from the hard palate and nasopharangeal mucosa flaps can be used to repair soft palate deformities. It is important to reduce tension on suture lines, preserve the connective tissue and vascular supply and have good apposition of tissue to promote rapid healing of the wound.

Post operatively patients should be fed via a tube to prevent trauma to the surgical site and to maintain nutritional intake. Dehiscence and recurrence can occur following movement, tension and growth.

==Prognosis==
Historically, surgical correction of these conditions had a low success rate. More recently new surgical techniques can result in a good prognosis, however, multiple surgeries may be required and aspiration pneumonia must be treated.

{{Learning
|flashcards = [[Oral_Cavity_Flashcards_-_Pathology|Oral Cavity Pathology Flashcards]] [[Equine Internal Medicine Q&A 10]] [[Small Animal Soft Tissue Surgery Q&A 01]]
|literature search = [http://www.cabdirect.org/search.html?start=0&q=%28%28od%3A%28dogs%29%29%29+AND+%28%28title%3A%28%22Cleft+Palate%22%29%29%29 Cleft palate in Dogs publications]

[http://www.cabdirect.org/search.html?q=%28%28od%3A%28horses%29%29%29+AND+%28%28title%3A%28%22Cleft+Palate%22%29%29%29 Cleft palate in Horses publications]

[http://www.cabdirect.org/search.html?q=%28%28od%3A%28cats%29%29%29+AND+%28%28title%3A%28%22Cleft+Palate%22%29%29%29 Cleft palate in Cats publications]

[http://www.cabdirect.org/search.html?q=%28%28od%3A%28cattle%29+OR+od%3A%28sheep%29+OR+od%3A%28goats%29%29%29+AND+%28%28title%3A%28%22Cleft+Palate%22%29%29%29 Cleft palate in Farm Animals publications]
}}

==References==
Fossum, T. W. et. al. (2007) '''Small Animal Surgery''' (Third Edition) ''Mosby Elsevier''

Gilson, SD (1998) '''Self-Assessment Colour Review Small Animal Soft Tissue Surgery''' '' Manson''

Merck & Co (2008) '''The Merck Veterinary Manual''' (Eighth Edition) ''Merial''

{{review}}

{{OpenPages}}

[[Category:Nasal Cavity - Developmental Pathology]]
[[Category:Respiratory System - Developmental Pathology]]
[[Category:Oral Cavity - Developmental Pathology]]
[[Category:Oral Diseases - Cattle]][[Category:Oral Diseases - Horse]][[Category:Oral Diseases - Goat]][[Category:Oral Diseases - Pig]][[Category:Oral Diseases - Sheep]]
[[Category:Oral Diseases - Cat]][[Category:Oral Diseases - Dog]]
[[Category:Expert_Review - Farm Animal]][[Category:Expert Review - Small Animal]][[Category:Expert Review - Horse]]
[[Category:Developmental Dental Conditions]]
[[Category:To Do - Dentistry Images]]
[[Category:LisaM reviewing]]

Amyloid-producing Odontogenic Tumour

2014-08-03T13:34:47Z

LisaMilella: /* Typical Signalment */

{{OpenPagesTop}}
Also known as: '''''Calcifying epithelial odontogenic tumour

==Introduction==
The lesions are slow growing and locally invasive.The most prominent feature of this type of tumour is that it produces amyloid which tends to calcify.

==Typical Signalment==
This is a rare tumour seen more often in cats and than in dogs.

==Diagnosis==
===Clinical Signs===
Include halitosis, oral bleeding, dental disruption or loss, facial or mandibular deformity, excessive salivation, growth protruding from the mouth and rarely dysphagia.

===Diagnostic Imaging===
Skull radiography may show a soft tissue opacity with mineralization within the mass. Periosteal reaction of the adjacent bone may be visualised. If a malignant neoplasm is a diagnostic possibility, thoracic radiography should be carried out to evaluate for lung metastases.

===Biopsy===
Biopsy is required for a definitive diagnosis.
Incisional biopsy is the best option, when undertaking cytological or grab procedures it is difficult to obtain a representative sample.

Histologically, the tumour appears to be well demarcated from the surrounding tissue but is not encapsulated.

==Treatment==
Surgical excision with narrow margins is normally sufficient.
Radiation therapy should be considered in cases of incomplete surgical excision.

==Prognosis==
Good following complete surgical excision however recurrance following incomplete surgical excision is possible.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=%28%28%28%22Amyloid+producing+Odontogenic+Tumor%22%29+OR+%28%22Calcifying+epithelial+odontogenic+tumor%22+%29%29%29+OR+%28%28%28%22Amyloid+producing+Odontogenic+Tumour%22%29+OR+%28%22Calcifying+epithelial+odontogenic+tumour%22+%29%29%29 Amyloid-producing Odontogenic Tumour publications]
}}

==References==

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

{{review}}

{{OpenPages}}

[[Category:Oral Diseases - Cat]][[Category:Oral_Cavity_-_Proliferative_Pathology]][[Category:Teeth_-_Proliferative_Pathology]]

[[Category:Neoplasia]]

[[Category:Oral Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Oral Proliferations]]
[[Category:LisaM reviewing]]

Amyloid-producing Odontogenic Tumour

2014-08-03T13:34:01Z

LisaMilella: /* Introduction */

{{OpenPagesTop}}
Also known as: '''''Calcifying epithelial odontogenic tumour

==Introduction==
The lesions are slow growing and locally invasive.The most prominent feature of this type of tumour is that it produces amyloid which tends to calcify.

==Typical Signalment==
This is a common odontogenic tumour in cats and more rarely found in dogs.

==Diagnosis==
===Clinical Signs===
Include halitosis, oral bleeding, dental disruption or loss, facial or mandibular deformity, excessive salivation, growth protruding from the mouth and rarely dysphagia.

===Diagnostic Imaging===
Skull radiography may show a soft tissue opacity with mineralization within the mass. Periosteal reaction of the adjacent bone may be visualised. If a malignant neoplasm is a diagnostic possibility, thoracic radiography should be carried out to evaluate for lung metastases.

===Biopsy===
Biopsy is required for a definitive diagnosis.
Incisional biopsy is the best option, when undertaking cytological or grab procedures it is difficult to obtain a representative sample.

Histologically, the tumour appears to be well demarcated from the surrounding tissue but is not encapsulated.

==Treatment==
Surgical excision with narrow margins is normally sufficient.
Radiation therapy should be considered in cases of incomplete surgical excision.

==Prognosis==
Good following complete surgical excision however recurrance following incomplete surgical excision is possible.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=%28%28%28%22Amyloid+producing+Odontogenic+Tumor%22%29+OR+%28%22Calcifying+epithelial+odontogenic+tumor%22+%29%29%29+OR+%28%28%28%22Amyloid+producing+Odontogenic+Tumour%22%29+OR+%28%22Calcifying+epithelial+odontogenic+tumour%22+%29%29%29 Amyloid-producing Odontogenic Tumour publications]
}}

==References==

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

{{review}}

{{OpenPages}}

[[Category:Oral Diseases - Cat]][[Category:Oral_Cavity_-_Proliferative_Pathology]][[Category:Teeth_-_Proliferative_Pathology]]

[[Category:Neoplasia]]

[[Category:Oral Diseases - Dog]]
[[Category:Expert Review - Small Animal]]
[[Category:Oral Proliferations]]
[[Category:LisaM reviewing]]

Alveolar Periostitis

2014-08-03T13:24:13Z

LisaMilella:

*Infection and inflammatory mediators usually spreads from [[Enamel Organ#Pulp|pulp]] to produce the periostitis.
*This may then affect the surrounding bone causing [[Osteomyelitis|osteomyelitis]].
**Sometimes seen when infection of carnassial teeth in dogs results in a chronic sinus discharging below eye. So called 'malar' abscess.
*Only treated by removal of [[:Category:Teeth - Anatomy & Physiology|tooth]].
*Hard to evaluate on [[Skull and Facial Muscles - Anatomy & Physiology#Mandible (mandibula)|mandible]], may produce fistula that also needs tooth removal.
[[Category:Teeth_-_Inflammatory_Pathology]]
[[Category:To_Do_-_Clinical]]
[[Category:LisaM reviewing]]

Acanthomatous Ameloblastoma

2014-08-03T13:16:37Z

LisaMilella: /* Description */

{{OpenPagesTop}}
Also known as: '''''Acanthomatous Epulis — Peripheral Ameloblastoma — Basal Cell Carcinoma — Adamantinoma

==Description==
[[Image:ameloblastoma.gif|right|thumb|125px|<center>Ameloblastoma (Courtesy of Alun Williams (RVC))</center>]]
This is a benign but locally invasive odontogenic tumour that appears in the [[Gingiva|gingiva]], often surrounding and displacing the adjacent teeth. The lesions have a raised and sometimes cauliflower appearance and are slow growing. Eventually the lesions can become very large and involve the jaw bone.

==Signalment==
Common oral tumour in dogs but rarely occurs in cats.

==Diagnosis==
===Clinical Signs===
Include halitosis, oral bleeding, dental disruption or loss, facial or mandibular deformity, excessive salivation, growth protruding from the mouth and rarely dysphagia.

===Diagnostic Imaging===
Standard [[Skull and Facial Muscles - Anatomy & Physiology|skull]] radiography is often unrewarding and of low diagnostic yield. Skull computed tomography (CT) provides much greater detail and is frequently employed in preoperative planning (in combination with standard dental intra-oral radiographs). Odontogenic neoplasms frequently are found to involve multiple teeth, contrast enhance, involve lysis of the alveolar bone and demonstrate mass-assoicated tooth displacement. Acanthomatous ameloblastomas may appear as extra-osseous or intra-osseous masses; intra-osseous masses are more likely to have mass-associated cyst-like structures and are subjectively more aggressive as compared to extra-osseous acanthomatous ameloblastomas. In many cases mandibular lymphadenopathy is also observed. In cases where a malignant neoplasm is suspected, complete staging should be performed to look for metastatic disease, including 3-view thoracic radiographs (or thoracic CT) and abdominal imaging (abdominal ultrasound or abdominal CT)<ref>Amory JT, Reetz JA, Sanchez MD, et al. ''Computed tomographic characteristics of odontogenic neoplasms in dogs.'' Vet Radiol Ultrasound, Vol. 00, No. 00, 2013, pp 1–12.</ref>.

===Biopsy===
Required for a definitive diagnosis and incisional biopsy is the technique of choice. When undertaking cytological or grab procedures it is more difficult to obtain a representative sample.

'''Pathology''':
Islands and sheets of mature odontogenic epithelium within a collagenous fibrous connective tissue stroma of low/moderate cellularity will be noticed. Each of the islands is bounded by a row of tall columnnar cells. These palisading cells exhibit polarisation away from the basement membrane and have cytoplasmic vacuolation. Central cells have a basaloid appearance. The tumour is often infiiltrating into the underlying bone.

==Treatment==
Surgical resection is the best option with margins of at least 1cm. Radiation therapy may be considered in patients where wide surgical excision is not possible, however there is a risk of malignant transformation of the tumour at a later stage.

==Prognosis==
Good following complete surgical excision.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=title%3A%28%22Acanthomatous+Ameloblastoma%22%29+OR+title%3A%28%22Acanthomatous+epulis%22%29+OR+title%3A%28%22Peripheral+ameloblastoma%22%29+OR++title%3A%28Adamantinoma%29 Acanthomatous Ameloblastoma publications]
}}

==References==
<references />

Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''

Merck & Co (2008) '''The Merck Veterinary Manual'''

With thanks to Andrew Jefferies (Cambridge) and Alun Williams (RVC) for providing access to their lecture materials

{{review}}

{{OpenPages}}

[[Category:Oral_Cavity_-_Proliferative_Pathology]][[Category:Oral Diseases - Dog]]
[[Category:Neoplasia]]
[[Category:Oral Diseases - Cat]]
[[Category:Expert_Review - Small Animal]]
[[Category:Teeth_-_Proliferative_Pathology]]
[[Category:Oral Proliferations]]
[[Category:LisaM reviewing]]

Modified Triadan System

2013-07-28T22:17:34Z

LisaMilella: /* References */

{{OpenPagesTop}}
==Introduction==
The modified Triadan system provides a '''consistent method of numbering teeth''' across different animal species.

The system is based on the permanent dentition of the pig, which has 11 teeth in each quadrant - three incisors, one canine, four premolars and three molars. The grand total is 44 teeth.

==Quadrant==
The first digit of the Triadan numbering system refers to the '''quadrant''': right maxilla, left maxilla, left mandible, right mandible.

The quadrants are '''numbered 1-4''' starting with the right maxilla and ending with the right mandible in a clockwise direction as viewed from the front of the animal.

For deciduous dentition, '''numbers 5-8''' are used in the same way.

==Tooth position==
The second and third digits refer to the '''tooth position''' within the quadrant, with the sequence always starting at the '''midline'''.

Certain rules should be followed in species that have fewer teeth, such as cats, rabbits and horses.

'''The central incisor is always 01''' and the following incisors are 02 and 03.

'''The canines are always 04'''.

The premolars are 05 to 08 and the last premolar is always 08.

'''The first molar is always 09''' and the following molars are 10 and 11.

The '''carnassials''' of carnivores can be used as landmarks to help number the teeth, as the upper carnassials are always the last premolars (108 and 208) and the lower carnassials are always the first molars (309 and 409).

The numbers of the other teeth can then be determined from there.

==Examples==
'''In the dog''': the mandibular left canine is 304 for the permanent tooth and 704 for the deciduous tooth.

The mandibular right first molar is 409.

'''In the cat''': the "second" mandibular left premolar is 308. (1 tooth forward from the lower left carnassial which is always 09).

The "first" maxillary right premolar is 106. (the largest cheek tooth in the cat maxilla is the fourth premolar 108, 2 teeth rostrally from this is the first premolar 106. There is no 105 in the cat)

'''In the rabbit''': the second incisor in the left maxilla (the peg tooth) is 202. There is no third incisor or canine in the rabbit maxilla, so these numbers are missing.

{{Learning
|flashcards = [[Veterinary Dentistry Q&A 03]]
}}

==References==
Tutt, C. (2006) '''Small animal dentistry: a manual of techniques''' ''Wiley-Blackwell''

Johnston, N. [http://www.rvc.ac.uk/review/dentistry/index.htm Veterinary Dentistry interactive programme]

{{review}}

{{OpenPages}}

[[Category:Teeth - Anatomy & Physiology]]
[[Category:Expert Review]]
[[Category:Dentistry]]
[[Category:LisaM reviewed]]

Modified Triadan System

2013-07-28T22:17:01Z

LisaMilella: /* Examples */

Dental Formula - Dog

2013-07-28T22:10:24Z

LisaMilella: /* Breed Differences */

{{OpenPagesTop}}
==Overview==
[[Image:Aspinall Slide12.JPG|thumb|right|300px|Image from [http://www.elsevierhealth.co.uk/veterinary-nursing/spe-60136/ Aspinall, The Complete Textbook of Veterinary Nursing], Elsevier Health Sciences, ''All rights reserved'']]

Dogs are toothless at birth. Their '''deciduous''' teeth are complete and functional within 2 months of birth in most breeds. '''Permanent''' teeth are complete and funtional by the end of the 7th month.

The formula for '''deciduous''' teeth: 2 (i3/3 c1/1 p3/3)

The formula for '''permanent''' teeth: 2 (I3/3 C1/1 P4/4 M2/3)

===Canine teeth===

The canine teeth are large, curved and laterally compressed. Their [[Enamel Organ#Root|root]] is longer than their [[Enamel Organ#Crown|crown]]. They have a single [[Enamel Organ#Root|root]].

[[Image:Dog Dentition.jpg|thumb|right|300px|Dog Dentition - Copyright Nottingham 2008]]

===Molars===

The molars are broader than the premolars. The large flat surface is used for grinding.
===Incisors===

The incisors are '''tricuspid''' in the upper jaw and '''bicuspid''' in lower jaw. They have a single [[Enamel Organ#Root|root]].

===Premolars===

The premolars are irregular and closely-spaced. They are more complex and larger caudally.

==Breed Differences==

Eruption times differ between breeds so it is difficult to age dogs by their teeth.
{{OpenPages}}
[[Category:Teeth - Anatomy & Physiology]]
[[Category:Dog - Alimentary System]]
[[Category:A&P Done]]
[[Category:Dentistry]]
[[Category:LisaM reviewing]]