Veterinary Dentistry

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Update on Severe Stomatitis, CUPS and Tongue Masses in a Boxer Dog

2010-02-23T09:15:00.001-08:00

UPDATE: Lymphoma was the diagnosis based upon histopathology. Further staging would involve immunohistochemical stains to determine B cell vs T cell lymphoma. Chemotherapy is an option in these cases. This dog was humanely euthanized.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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Severe Stomatitis, CUPS and Tongue Masses in a Boxer Dog

2010-02-13T04:43:00.001-08:00

This 7 year old boxer dog presented with severe generalized stomatitis. CUPS lesions were also present. The tongue had multiple raised masses with palpable densities throughout. Biopsies were taken. Neoplasia is suspected. I will update this post when pathology is complete.

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2010-02-06T05:34:00.001-08:00

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Cat Mandibulectomy

2010-02-06T03:43:00.001-08:00

This cat presented with profound disfigurement from a rostral mandibular mass. Salvage excision and euthanasia were the options provided. The mass was excised and postoperative and next day images shown. This cat has full tongue function despite taking the mandible back to the level of the first molars at the base of the tongue. He is learning how to eat and doing quite well 3 days postop.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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Gingival Hyperplasia, Ossifying Epulis and a Jaw Cyst in a Boxer Dog

2010-01-31T12:07:00.001-08:00

This 4 ½ year old boxer was referred for excision of gingival hyperplasia. Both mandibular canines had gingival enlargement as did the maxillary premolars. Treatment pending biopsy was excision with a scalpel and contouring with a #12 fluted finishing bur. Biospy revealed an ossifying epulides on the right canine definitive therapy would be removing the mass and extracting the canine. Closure will be a problem due to the involvement of the entire attached gingiva adjacent to the canine.

Unfortunately the left mandible has a large cyst forming. See caption below for details.

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Jaw Fracture Repair in a Dog Utilizing Titanium Mesh

2010-01-30T05:27:00.001-08:00

This dog had a right mandibular fracture secondary to chronic periodontal disease. The jaw fractured spontaneously. It was repaired utilizing a titanium mesh material and bone regenerative putty.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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http://veterinarydentistry.net/blog/wp-content/uploads/2010/01/Sliding-Pedicle1.pdf

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Jaw Fracture Repair in a Dog Utilizing Titanium Mesh

2010-01-30T05:26:00.001-08:00

This dog had a right mandibular fracture secondary to chronic periodontal disease. The jaw fractured spontaneously. It was repaired utilizing a titanium mesh material and bone regenerative putty.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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Sliding Pedicle Flap for Repair of V-shaped Gingival Recession in a Dog

2010-01-27T14:27:00.001-08:00

This is a (very sweet) middle aged miniature schnauzer with v-shaped gingival defects. Surgery is required to regenerate attachment and slow or prevent further compromise of the periodontal tissue associated with this canine (both were affected) and the 4^th premolar. Rostral and caudal sliding pedicle flaps were utilized to repair the canine defect. Donor tissue was taken rostral for the 4^th premolar.

For a link to the article describing this procedure Step By Step from the Journal of Veterinary Dentistry please follow this link:

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http://veterinarydentistry.net/blog/wp-content/uploads/2010/01/Sliding-Pedicle1.pdf

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Sliding Pedicle Flap for Repair of V-shaped Gingival Recession in a Dog

2010-01-27T14:21:00.001-08:00

For a link to the article describing this procedure Step By Step from the Journal of Veterinary Dentistry please follow this link:

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Stomatitis in a dog responds to home care avoiding full mouth extractions.

2010-01-26T06:19:00.001-08:00

This middle aged dog presented with severe oral pain and halitosis. Visual examination could only be done with sedation. Note the attached gingival is severely inflamed. Biopsy showed changes consisitent with stomatitis. Prednisone ½ mg/kg BID was initiated following a thorough prophy in the hospital. The results can be seen in the recheck picture one week post initiation of predisone. The dog allowed the owner to brush once the inflammation resolved. Prednisone was then tapered to discontinue.

Daily brushing with adjunctive care such as wax sealants, water additives, dental diets and chews, chlorhexidine and sub antimicrobial doses of doxycycline aid in home care efforts. Unfortunately most of these cases must have all full mouth extractions eventually or are euthanized. Full mouth extractions is curative. Most patients get 3 months at best before prophy in the hospital is needed.

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Malloclusion in a Dog Causing Trauma to Canine Tooth

2010-01-23T05:17:00.001-08:00

This left lateral incisor has been traumatizing the mandibular canine tooth since the teeth erupted. Note the size of the root canal in the affected tooth vs. the normal canine on the other side. The dentin stops growing in teeth when they lose vitality causing this incongruity. The treatment of choice in teeth like this is either root canal therapy +/- crown placement or extraction. Due to a likely open apex and severe periapical changes noted by the bone lucency at the root tip this tooth was extracted.

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Rim mandibulectomy for an acanthomatous ameloblastoma in the mandible of a dog

2010-01-14T13:46:00.001-08:00

Jessie had an oral mass adjacent to the left mandibular canine tooth. The referring veterinarian biopsied it revealing acanthomatous ameloblastoma. A rim mandibulectomy was performed to remove the mass with minimal margins of 1.5 cm.

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Enamel hypocalification and hypoplasia in a dog.

2010-01-06T04:57:00.001-08:00

This 7 month old terrier presented with generalized enamel hypocalcification and hypoplasia. Both the quantity and the quality of the enamel were compromised. Dentin exposure was significant for all teeth. Scaling removed a good portion of the diseased enamel. The remainder was carefully removed with an aluminum oxide bur being careful not to extend past dentin. Dentinal bonding was performed and will need to be repeated periodically to maintain closure of the dentinal tubules to prevent sensitivity and microbe invasion into the pulp.

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Dog with Persistent Suborbital Abscess

2009-12-24T04:05:00.001-08:00

This dog was treated with antibiotics only to have the abscess recur over the weeks prior to presentation. The tooth and gum tissue looks fairly normal. The x-ray shows a decrease in the periapical bone density on the fourth premolar. The right first molar has an obvious periapical lucency on the palatal root. Those two teeth and the second molar were extracted.

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Suborbital Tooth Abscess in a Dog

2009-12-18T09:21:00.001-08:00

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Root canal and crown prep for canine tooth in a dog

2009-12-16T06:32:00.001-08:00

This patient had what appears to be a normal right mandibular canine tooth. The left mandibular canine was fractured with pulp exposure. The radiograph shows root resorption and a large pulp cavity with a periapical lucency. Periapical changes are also present on the right mandibular canine tooth. The final root canal procedure, the crown prep and crown placement are demonstrated.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM

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Squamous cell carcinoma in a cat mandible

2009-12-15T14:18:00.001-08:00

This middle aged cat presented with drooling and a rostral oral mass. Further evaluation revealed severe mandibular inflammation with “floating teeth” present. Radiographs reveal destruction of bone surrounding the teeth of the left mandible. The mass crosses the midline in the caudal oral cavity partially displacing the tongue. Surgical cure is not possible. Analgesic management has been instituted to provide a good quality of life until discomfort or anatomical problems warrant euthanasia.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM

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Periodontal Disease in a Young Cat Canine Tooth

2009-12-13T09:06:00.001-08:00

This is a 4 year old cat with extrusion, 3 mm pockets. Radiographic changes show increased PDL space apical to the marginal bone, consistent with periodontal disease. Other teeth show no changes. Likely this cat traumatized the tooth predisposing it to periodontal changes.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM

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Fistula in a Dog Associated with the maxillary fourth premolar abscess

2009-12-10T12:52:00.001-08:00

Brett Beckman, DVM, FAVD, DAVDC, DAAPM

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Additional Images of the Previous Patient with Canine Tooth Resorption

2009-12-01T13:54:00.001-08:00

This is the same patient from the prior post. This is an example of Type I tooth resorption on the mesial root and Type II resorption on the distal root.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM

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Untitled

2009-11-30T11:48:00.001-08:00

Hi All,

If you get an email message from someone that you know on a social media site that says something like “is this you dancing on this video” or some other similar message don’t open it. It will start a program that simulates a massive computer virus attack that looks like a Microsoft security box asking you to stop it by clicking ok. If this happens don’t click it. Go to task manager and shut down all of those pages. Then run your normal virus software to ensure no breaches.

Brett

Brett Beckman, DVM, FAVD, DAVDC, DAAPM

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Tooth Resorption in the Canine Tooth of a Cat

2009-11-25T13:45:00.001-08:00

This 10 year old domestic short haired cat was referred for oral evaluation and likely tooth resorption and missing teeth this week. The procedure for crown amputation show here applies to only Type II resorption. As you can see there is no discernable periodontal ligament space around the root that is in the final stages of replacement with bone. 5-0 monocryl was used to close. As always regional nerve blocks are employed.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM

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Hard and soft palate secondary cleft puppy dog

2009-11-20T10:13:00.001-08:00

This 8 week old puppy presented with a cleft palate involving the hard and soft palate, also know as a secondary palatal defect. Due to minor signs at the time the surgery was delayed until 16 weeks of age to provide more tissue for closure.

The soft palate is closed in two layers, nasal and palatal after splitting the two with metzenbaum scissors.

The palatal mucosa is dissected off of the bone. A 1 mm debridement of the margin with a diamond bur allows for healing prior to epithelial migration into the defect. An incision is made as shown and a full thickness palatal graft obtained sparing the major palatine artery.

The edges are opposed and sutured, burying the simple interrupted knots.

Healing at 2 weeks is complete.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM

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Generalized Tooth Wear in a Pit Bull Attrition vs. Abrasion

2009-11-13T06:45:00.001-08:00

This is a Pit Bull rescue and foster that presented for evaluation last week. Note the severe generalized wear. The wear is due to abrasion (tooth on anything but other teeth) vs attrition tooth on tooth) All of the teeth were worn with multiple teeth severely affected. The right mandibular first molar and the right maxillary fourth upper premolar were the most severely affected and causing the most pain and were extracted. Multiple additional teeth are causing pain and must be addressed at a separate visit due to finances. We are blessed with those that take on these burdens for the sake of our abused and unfortunate pets.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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Maxillary Canine Extraction Site Trauma Secondary to the Mandibular Canine Treated by Crown Reduction, Vital Pulpotomy and Pulp Therapy

2009-10-23T08:42:00.001-07:00

This cat had a maxillary canine tooth extracted. Upon recheck at the referring veterinary hospital the mandibular canine was causing a mucosal defect at the extraction site. Options for therapy were crown reduction and vital pulpotomy followed by vital pulp therapy or extraction.

The crown was reduced to the level of the incisors. Several millimeters of pulp and dentin were removed with a small diamond bur. Bleeding was minimal and controlled with a paper point. Mineral trioxide aggregate was placed over the pulp followed by glass ionomer and composite as shown on radiographs. The purple is the acid etchant applied prior to the composite. The patient will be checked radiographically in a year to ensure success of the procedure. The ulcer will heal within 10 days.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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Response to the Question Concerning the Dog with a Class III Malocclusion (Underbite) with Incisors Causing Lingual Floor Trauma

2009-10-22T12:58:00.001-07:00

Hi Dr. Gonzalez,

Glad to hear from you. The approach to this case is one of selective extractions to eliminate the trauma caused by the maxillary incisors digging holes in the floor of the oral cavity. The central 101, 201 and the intermediate 102, 202 incisors should be extracted. Once complete extubate with caution and check to ensure that that lateral incisors are not hitting the canines. If they are then extract those as well. Keep up the good work.

Take care,

Brett

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Dog with a Class III Malocclusion (Underbite) with Incisors Causing Lingual Floor Trauma

2009-10-22T12:53:00.001-07:00

Hi,

Thank you for signing me up on the blog. I been diagnosing dental disease daily and recommending treatments with true conviction. I even did a cat extraction!

I actually had an interesting case today and I was wondering if anything can be done with orthodontics to help him. Or whether he will need extractions.

Cody presented for his neuter today and on oral exam I noted:

1. Underbite

2. The left maxilla is longer than the right.

3. The left upper incisors are pressing on the lower gingiva and creating depressions.

(please see attached pictures)

Thank you,

Joanne Gonzalez

Town and Country Animal Hospital

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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Puppy Tooth Trauma

2009-10-20T07:45:00.001-07:00

Hi David,

There appears to be a lucency surrounding the canine tooth apex. The pulp chamber is large indicating the dentin formation has ceased indicating a dead tooth. The incisor appears to have that same pulp cavity diameter but I can't tell for sure with the rads. There is increased radiodnesity at the apical 1/3 of the canine and possibly the incisor that is likely abnormal dentin production initiated by the original insult. Extraction of the canine and the incisor is indicated. The discoloration indicates that there is pulp death. Please let me know if you have any questions.

Brett

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Puppy Tooth Trauma

2009-10-20T07:42:00.001-07:00

Dr. Beckman,

This is Sadie, a 6 year old JRT presented for OVH. An incompletely erupted crown of #204 was noticed. Also seen was discoloration of crown of #203. Lateral and lateral-oblique dental radiographs were taken after dental prophylaxis performed. The record indicates she may have suffered facial trauma (hit w/ golf ball) as puppy. Thanks! David Kane, dental tech @ Woodworth Animal Hospital (Waynesboro, VA)

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Tooth Resorption and Periodontal Disease in a Cat

2009-10-16T07:36:00.001-07:00

The 4th premolar has type II resorption. Crown amputation will resolve the inflammation around 408 and is indicated. 407 shows severe inflammation secondary to peridontal disease. All teeth were treated with flouride to decrease sensistivity. The patient will return next month for reevaluation.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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Periodontal Disease and Tooth Resorption in a Cat

2009-10-16T07:33:00.001-07:00

Early extrusion and vestibular bone expansion is present. An article published recently by John Lewis showed a correlation between extrusion tooth resorption in cats.

J Vet Dent. 2008 Jun;25(2):86-95. Links

Significant association between tooth extrusion and tooth resorption in domestic cats.Lewis JR, Okuda A, Shofer FS, Pachtinger G, Harvey CE, Reiter AM.

Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA 19104-6010, USA. jrlewis@vet.upenn.edu

Abnormal extrusion of canine teeth is often noted in middle-aged and geriatric domestic cats. The same age group of cats also is commonly affected by tooth resorption (TR). This study explored the relationship between these two phenomena of unknown etiology. Using digital radiography, the distance between the alveolar margin (AM) and cementoenamel junction (CEJ), referred to as the AM-CEJ distance, was measured in clinically and radiographically healthy maxillary canine teeth of 24 TR-affected and 29 TR-free cats. The mean AM-CEJ distance of maxillary canine teeth of cats with and cats without TR was 2.68-mm and 2.22-mm, respectively. An analysis of covariance adjusting for age revealed a significant correlation (p = 0.02) between tooth extrusion and TR. Extrusion of the maxillary canine teeth became clinically apparent when an AM-CEJ distance of 2.5-mm or greater was evident in the absence of horizontal or vertical alveolar bone loss. Based on this criterion, 15 of 24 cats with TR (63.0 %) exhibited extrusion of maxillary canine teeth, compared to 9 of 29 cats without TR (31.0 %). Four extruded and five non-extruded maxillary canine teeth were evaluated histologically. Cementum of extruded teeth was significantly thicker compared to that of non-extruded teeth. Four of 4 canine teeth with extrusion (100 %) showed histological evidence of resorption, compared to 1 of 5 canine teeth without extrusion (20.0 %). These results suggest that tooth extrusion is linked to or may be caused by similar factors responsible for the development of TR.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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Periodontal Disease and Tooth Resorption

2009-10-16T07:23:00.001-07:00

This 11 year old cat has gingival recession associated with 309. Extraction is warranted to eliminate progression and discomfort. A pain response is present under light general anesthesia.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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Severe Periodontal Disease in a Dog - Mandibular Incisors 6 Weeks Postop

2009-10-13T09:03:00.001-07:00

Healing is complete. The right canine has reestablished gingiva. Food debris is accumulating on the right. Owners cannot brush but will use a water additive and chlorhexidine gel. A 3 month recheck is scheduled. Depending on gross and radiographic findings 304 may require extraction.

Brett Beckman, DVM, FAVD, DAVDC, DAAPM
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