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.
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.
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.
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.
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.
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.
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.
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.
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.
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.