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3-D Imaging

When people get sick, they can tell their doctor what they feel to help determine the best course of action. For pets, the veterinarian’s exam and diagnostic tests are even more important as pets cannot verbalize what’s wrong.

On a daily basis, veterinarians use tests such as bloodwork, x-rays, and ultrasounds to get information to help find solutions to pet ailments. Family Pet Veterinary Center and Animal Dentistry Referral Services in Norwalk, IA have new technology to help find answers faster: 3D imaging.

Our equipment is called the PICO. It is the smallest scanner currently made in the world and can image tissues as thin as 0.09mm! We are the third installed PICO in the USA and currently the only 3D imaging unit in Iowa.

3D imaging is like a human CT scan or MRI, but it uses 60-90% less radiation than conventional CT, takes 75% less time, and has up to 1481 times more detail than conventional CT. It can be used to image bone or soft tissue depending on the settings, then makes a true 3D image of the layers of the scan. This technology often allows veterinarians to run one or two tests to get more answers than 3-6 separate tests with the goal to get more accurate answers faster.

Read more about dentistry 3D imaging here. (LINK to 3D dental imaging.pdf) We are happy to answer any questions if you’d like to stop by our Norwalk office to see the technology.

Exotic Cheek Teeth

As noted in the 3D imaging of exotics post, the incidence of dental issues in small exotic mammals (rabbits, guinea pigs, chinchillas, rodents, hamsters, and ferrets) has been estimated near 90% in many studies. Sadly most exotic patients have hidden dental disease, which is difficult if not impossible to accurately assess during awake oral exams.

Anesthetized oral exams provide more information but imaging is necessary for the same reasons it is essential in dogs and cats. Due to small patient size, intraoral x-rays are less successful. Extraoral x-rays often have overlap of anatomic structures again making diagnosis challenging. With this in mind, it’s easy to see why 3D imaging needed in exotic patients. Read more about our high definition volumetric imaging capability with 0.09mm detail here.

The most common dental diseases in ferrets are periodontal disease and tooth fracture. One study showed 74% of ferrets fracture their canine teeth.

As for the almost 90% of rabbits and rodents (and chinchillas, guinea pigs), the most common dental disease is related to tooth alignment and resulting over growth of cheek teeth. These patients have continuously growing teeth that require free choice timothy hay and limited pellets so the natural act of chewing can keep the teeth aligned. The majority of these pets get cheek teeth overgrowth. As it progresses, hooks and sharp points develop on the opposing teeth. As the elongation continues, the roots project near the nose, eyes, and mandibles and can be the reason for eye and nasal issues. The incisors often elongate secondarily to cheek teeth elongation. Treatment to return the cheek teeth to appropriate height is done with fine grinding burs often to the level of the gums so that the gums will recede back to normal levels. The key is not to take too much away too fast as the internal aspect of the tooth can be exposed. Incisors should not be cut with nippers (single cut) as tooth fracture is a common occurrence.

Unfortunately, after grinding/smoothing/’floating’ regrowth will occur. Most cheek teeth need retreatment every 3-6 months. The first thing owners worry about with this condition is anesthesia. While anesthesia is not without risk, there are multiple cases of rabbits (and others) having 50+ anesthetic episodes for this condition over their lifetime and dying of unrelated causes.

As tooth elongation continues or trauma to teeth occurs, infection or disease often happens at the root tip. Extraction or surgical root tip resection is needed:

Contact us to learn more about exotic dentistry issues.

Exotics

As described in a recent post, dental conditions are often hidden and painful. The following posts are going to help describe conditions that pets can get as well as treatment. Many people I talk with are surprised how we can help pets with dental conditions and save teeth whenever possible.

As noted in the exotics post, the incidence of dental issues in small exotic mammals (rabbits, guinea pigs, chinchillas, rodents, hamsters, and ferrets) has been estimated near 90% in many studies. Sadly most exotic patients have hidden dental disease, which is difficult if not impossible to accurately assess during awake oral exams.

Anesthetized oral exams provide more information but imaging is necessary for the same reasons it is essential in dogs and cats. Due to small patient size, intraoral x-rays are less successful. Extraoral x-rays often have overlap of anatomic structures again making diagnosis challenging. With this in mind, it’s easy to see why one study showed the diagnostic accuracy of CT (3D imaging with less than 0.2mm detail) was superior in 80% of patients with regard to diagnosis and prognosis, and in over half of patients for guiding treatment.

Imaging exotic patients allows a three dimensional view of the patient as seen in this video:

For all species, imaging of ears and nasal structures is best with 3D imaging. One study of inflammatory rhinitis showed 55% of the cause was related to dental conditions.

Read more about our high definition volumetric imaging capability with 0.09mm detail here.

Oral Tumors

As described in a recent post, dental conditions are often hidden and painful. The following posts are going to help describe conditions that pets can get as well as treatment. Many people I talk with are surprised how we can help pets with dental conditions and save teeth whenever possible.

While only 6% of malignant tumors of the body occur in the mouth, additional growths classified as benign occur. The trouble with the benign classification is that although they may not spread to other parts of the body, they are often locally invasive, painful, and destructive. The other trouble with both benign, benign-locally invasive, and malignant tumors is that many types of them look quite similar. As stated in the prior section, all types of gingival enlargements should be biopsied to help ensure the best treatment. Biopsy samples should be sent to an ORAL pathologist. Dr. Cindy Bell (KSU) currently is the leader oral pathology. Speaking from experience, it appears her reads tend to be more definitive than others. She is down to earth and will actually talk to veterinarians about treatment or help provide connections to speak to a veterinary dentist about the case.

Classifications of the following image growths may be plasma cell tumor, peripheral odontogenic fibroma, focal fibrous hyperplasia, papillary squamous cell carcinoma, lymphoma, pyogenic granuloma, canine acanthomatous ameloblastoma. I’m sure there are a few I’ve missed as well. Take note – the word epulis was not used to describe any of the growths. Epulis is a poor descriptive term. Most previously classified epulides are either peripheral odontogenic fibromas or ossifying fibromas. Also note, that all of the below images look similar and most of them are severe, locally invasive, or symptoms of additional disease.

Many of these tumors require wide margined surgical excision; meaning large parts of the jaw(s) are removed. When taking off parts of the upper jaw, large holes can be made but the lip can cover and make the outcome be quite cosmetic for many cases.

A mandibulectomy finish is shown below.

Studies show client satisfaction following mandibulectomies and maxillectomies in dogs is 85%, and was proportional to the postoperative survival time. It has been thought that cats do not do well after these types of surgeries. Surprising to many, a similar percentage of clients with cats after a mandibulectomy procedure said they would choose the same course of action given the circumstance despite the fact that 75% of the cats had mild to moderate adverse effects (tongue location, drooling, difficulty grooming, jaw alignment issues) for the rest of their lives.

This mass (behind the canine and is subtle) was found very early and had a great outcome. Other larger ones of this type usually do better with adjunctive radiation therapy. Some masses even if found later in the course of disease have great surgical outcomes. For oral tumors it has been shown that all do much better with wide margined surgical excision with or without chemo therapy/radiation as compared to chemo therapy/radiation without surgical excision.

Determining surgical margins is important. 3D imaging with contrast can help make this determination in some cases. Read more about our high definition volumetric imaging capability with 0.09mm detail here. Information on 3D imaging of exotics and imaging of nasal issues can be found here.

Ginigival Hyperplasia

As described in a recent post, dental conditions are often hidden and painful. The following posts are going to help describe conditions that pets can get as well as treatment. Many people I talk with are surprised how we can help pets with dental conditions and save teeth whenever possible.

While the above images look drastic, this particular patient was much-improved 1 year later:

With the mild regrowth, retreatment is still needed, but there has not been destruction to the point of tooth loss. Left untreated the excess tissue traps food and hair between the tissue and the teeth resulting in loss of supporting structures and eventually teeth.

The above images and statements have been referring to gingival hyperplasia. Technically it cannot be said what this tissue is without biopsy results. We can say for certain is that there is gingival enlargement (GE). Whether the gingival enlargement is due to hyperplasia or hypertrophy, or whether the enlargement involves extensive thickening of the tissue, the goal is the same: return the structure and function of the area to a healthy sulcus (the space between the gum and the tooth).

Here are some additional examples of gingival enlargement before and after treatment.

Though sometimes quite focal, often these lesions are generalized, particularly in breeds that show a familial tendency, such as Boxers, Bulldogs, and Collies.

Gingival enlargement can also be caused by hormonal changes or different drug administration (e.g., cyclosporine, amlodipine) in some patients.

Some gingival enlargements may actually be growths or tumors and seem like other non-concerning changes seen in other patient. This is why all types of GE should be biopsied. Biopsy samples should be sent to an ORAL pathologist. Dr. Cindy Bell (KSU) currently is the leader oral pathology. Speaking from experience, it appears her reads tend to be more definitive than others. She is down to earth and will actually talk to veterinarians about treatment or help provide connections to speak to a veterinary dentist about the case.

Check out the oral tumor section to learn more.

Salivary Gland Issues

As described in a recent post, dental conditions are often hidden and painful. The following posts are going to help describe conditions that pets can get as well as treatment. Many people I talk with are surprised how we can help pets with dental conditions and save teeth whenever possible.

Accumulation of saliva or stones in the salivary ducts can occur due to trauma, foreign material, or infection. Many times these causes are unseen (and become termed idiopathic = unknown cause) and happen days to weeks earlier than the symptoms. Salivary duct stones (sialoliths) do not cause accumulation of saliva as seen in the image.

Surgical treatment is needed. The surgical approach can be a challenge and may not remove all of the salivary tissue as intended, though Main Street Dental Clinic and Animal Dentistry Referral Services have some ancillary techniques to treat these. Sometimes a second surgery is still needed.

Using the special techniques on a follow up surgery is less successful as anatomical landmarks are less visible hampering the outcome.

Contact us to learn more about salivary gland issues.

Special Flaps and Oral Nasal Fistulas

As described in a recent post, dental conditions are often hidden and painful. The following posts are going to help describe conditions that pets can get as well as treatment. Many people I talk with are surprised how we can help pets with dental conditions and save teeth whenever possible.

Sometimes these openings are large or easily seen as in the above images. Sneezing and occasional discharge are the common signs. Other times signs are subtler but systemic (body wide) effects are occurring without awareness.

Here is an inapparent oral nasal fistula:

They are not always this red.

This one is easier to guess an oral nasal fistula is present:

Tooth removed:

Unfortunately one can see the tissue quality is poor and doesn’t close easily. This is why the opening often happens. Special tissue flaps are created to close the defect to stop the communication between the nose and the mouth thus stopping subsequent infections. During veterinary dentistry residency training, we learn the periodontal classification as PE3 – a major flap procedure. Ie simple closure rarely is the solution due to local infection, tissue quality, and tissue quantity.

This video isn’t the best illustration but there is bone infection (osteomyelitis) and special techniques are need to close the defect:

Special flaps can be done for periodontal splinting, increased pocket depths, triangular gum recession – and much more. As long as there is sufficient healthy bone, we can save teeth with special flaps. Sometimes we can even add bone height with bone augmentation (guided tissue regeneration section) or Type II crown lengthening procedures. When teeth can not be saved, we have special flaps and techniques to return the mouth to a healthy state and avoid bone infection.

Contact us to learn more about saving teeth in pets.

Guided Tissue Regeneration

As described in a recent post, dental conditions are often hidden and painful. The following posts are going to help describe conditions that pets can get as well as treatment. Many people I talk with are surprised how we can help pets with dental conditions and save teeth whenever possible.

As the gum and bone surrounding the tooth margin (periodontium) have worsening poor health, extractions are often needed. These periodontal tissues usually have generalized disease and accompanying bone loss resulting in loss of tooth support. Other times the tooth has focal disease for which therapy can be successful in saving the tooth.

Vertical bone loss is a case in which deep pockets exist with supporting bone. A standard dental cleaning procedure cannot adequately clean deeper than 5 mm. The other concern with pockets greater than 3mm is that there is gingival downgrowth commonly reestablishing active disease as soon as 2-14 days after a cleaning procedure. Home care (daily or every other day) and anesthetic dental procedures (as often as every 3 months) can delay this process if it can get into the pocket but the pocket depth often prevents it. The solution becomes to surgically reduce the soft tissue pocket or, as pictured above, utilize a bone graft and biocompatible membrane to exclude the soft tissue from a bony pocket. The membrane is the most important feature to prevent tissue downgrowth perpetuating a pocket.

Here’s a hidden pocket:

Here’s the diseased tissue in the pocket removed:

A graft and membrane are needed/were used.

Contact us to learn more about saving teeth in pets.

Enamel Defects

As described in a recent post, dental conditions are often hidden and painful. The following posts are going to help describe conditions that pets can get as well as treatment. Many people I talk with are surprised how we can help pets with dental conditions and save teeth whenever possible.

The above image explains enamel defects well.

Some cases of enamel hypomineralization appear as discoloration. While this is not only cosmetic, it is important to help seal any access to the central aspect of the teeth.

Other cases have focal defects.

Once the defects have been sealed, the restorations will wear away as they are not as strong as natural enamel and there are inherent defects in the patient’s underlying tooth quality. In most cases, restorations can and should be reapplied.

Just as noted in other reasons for restorations such as caries and uncomplicated crown fractures, x-rays are needed before a restoration is applied and 6 months later. These patients, as well as every pet, should have intraoral x-rays with preventative cleaning procedures at least every 12 months.

Contact us to learn more about restorations in your pet.

Dentigerus Cysts

As described in a recent post, dental conditions are often hidden and painful. The following posts are going to help describe conditions that pets can get as well as treatment. Many people I talk with are surprised how we can help pets with dental conditions and save teeth whenever possible.

The above image explains dentigerous cysts well. It is important to remember unerupted teeth and retained tooth roots both are likely to cause problems. If you notice a tooth that does not have a matching tooth on the other side, make sure to ask your veterinarian to check it with intraoral x-rays. Should you own a breed with a short nose aka brachycephalic, missing teeth on both sides is more likely a problem thus may be easily overlooked. Please ensure your dog has full mouth intraoral x-rays or 3D imaging as it is shown intraoral x-rays reveal unexpected or additional new findings in 72% of dogs.

May be seen visually:

While an x-ray may look like this:

Contact us to learn more about dental care in your pet.