Veterinary Medicine - July 2008 - (Page 363)

Dental Corner polish your dental skills PEER-RE VIE WED Dental fracture treatment options in dogs and cats Matthew Lemmons, DVM, DAVDC, and Daniel T. Carmichael, DVM, DAVDC ogs’ and cats’ teeth are perpetually at risk of being chipped, worn, or fractured because of chewing activities or external trauma. Fractured teeth have been reported in 10% to 29% of patients in small-animal practice1-3 and in 25% of working military dogs.4 Many patients with dental fractures do not exhibit obvious clinical signs of pain or infection, and their appetites may remain unchanged. This lack of obvious harm has often led practitioners to take a wait-and-see approach to diagnostic work-up and timely therapeutic intervention. However, left untreated, fractured teeth can be a source of chronic pain and can lead to pulpitis, pulpal necrosis, osteitis, tooth root resorption, draining sinus tracts, facial swelling, and tooth loss. An understanding of pertinent dental anatomy, fracture diagnosis, radiographic interpretation, and the pathologic consequences of fractured teeth should prompt you to aggressively assess and treat or refer dental fracture cases. D In a detailed study of dental pathology in feral cats, both the maxillary canine teeth and the carnassial teeth were most at risk for fracture.6 In addition to many other problems, most notably thoracic trauma, 17% of cats with high-rise syndrome had dental fractures.7 Abrasion and attrition Abrasion and attrition are two other causes of tooth structure loss that can predispose teeth to fracture. Abrasion is the mechanical wearing away of teeth caused by chewing on hard objects, while attrition is the wearing away of teeth caused by tooth-on-tooth contact (Figure 1). CAUSES OF FRACTURES Dental fractures have two common causes—chewing hard objects and direct force trauma. Other causes are abrasion and attrition. PREVENTION AND EARLY RECOGNITION Preventing dental fractures in the ﬁrst place is ideal. Proper husbandry practices such as avoiding certain hard chew objects (e.g. nylon bones, animal bones, cow hooves, rocks) and preventing cage chewing are essential for reducing the incidence of dental fractures. When dental fractures do occur, early recognition, correct diagnosis, and adequate treatment are necessary to prevent pain and secondary disease and to save teeth when possible. Because early recognition is important, a conscious oral examination should be part of every physical examination. Additionally, comprehensive anesthetized oral examinations are recommended every 12 to 18 months or if any abnormalities are noted. Chewing Dogs can generate tremendous biting forces with their carnassial teeth. If the object a dog is biting is as hard as or harder than the tooth, a fracture can occur. Materials that have caused dental fractures include animal bones (cooked or raw), nylon or hard plastic toys, cow hooves, and some of the harder compressed treats. Cage bars, metal collars or fences, and rocks are other obvious culprits. Direct force trauma Direct force trauma, such as from motor vehicle accidents, ﬁghting (clicking teeth), bite work, kicks from farm animals, catching ﬂying objects with teeth, falling, or sporting accidents (e.g. hit with a golf club or baseball bat), accounts for a marked number of dental fractures. Even without fractures, impact trauma may lead to pulpitis (see the boxed text “Pulpitis: Another outcome of trauma” on page 367). COMMONLY FRACTURED TEETH The teeth most susceptible to fracture vary according to the population studied. In millitary dogs trained in apprehension, the canine teeth appear to be most at risk, whereas in pet dogs, the maxillary fourth premolar teeth (carnassial teeth) appear to be at a greater risk of fracture than are other teeth.4,5 Matthew Lemmons, DVM, DAVDC Circle City Veterinary Specialty and Emergency Hospital 9650 Mayﬂower Park Drive Carmel, IN 46032 Daniel T. Carmichael, DVM, DAVDC Veterinary Medical Center 75 Sunrise Highway West Islip, NY 11795 VETERINARY MEDICINE July 2008 363

Table of Contents Feed for the Digital Edition of Veterinary Medicine - July 2008

Veterinary Medicine - July 2008 Contents Leading Off Practical Matters Idea Exchange Clarification Dental Corner The Diagnostic Approach to Hematuria Guidelines for Evaluating Hypercalcemic Cats CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - July 2008

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