Today's Veterinary Practice

MAY-JUN 2013

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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| DENTAL DIAGNOSIS Continued from page 79. Answer The radiographic image reveals an unerupted mandibular first premolar tooth (white arrow). In addition, there is a significant, smooth-edged lytic lesion surrounding the tooth (red arrows). Finally, many of the teeth have been displaced (blue arrows). The primary diagnosis is a dentigerous cyst. Treatment recommendations include: • Surgical enucleation (removal) of the cyst and all affected teeth1 • Sampling and submitting the cyst lining for histopathology • Addition of an osseopromotive substance, which benefits treatment of 3 large lesions, such as this • Referral to a qualified veterinary dentist for best surgical outcome. What are dentigerous cysts? Dentigerous cysts arise from the enamel forming organ of the unerupted/impacted tooth. The incidence of dentigerous cyst development from impacted teeth is unknown in veterinary patients, but anecdotally is approximately 50%. In a human study, pathologic changes were noted in 32.9% of cases of unerupted/ impacted teeth.6 Do dentigerous cysts negatively impact dental health? As a dentigerous cyst grows, this pressure causes bone loss. Cysts can grow quite large in a short period of time, resulting in weakened bone and, possibly, pathologic fractures of the jaw. In addition, the cyst can become infected and create significant swelling and pain. Malignant transformation can also occur.7 What therapeutic measures should be pursued? Therapy for impacted teeth is surgical extraction. If cyst formation has occurred, en bloc removal or extraction of the tooth and meticulous curettage of the lining will prove curative. n References 1. niemiec BA. Pathology in the pediatric patient. in niemiec BA (ed). Small Animal Dental, Oral, and Maxillofacial Disease: A Color Handbook. London: Manson Publishing, 2010, pp 89-126. 2. neville Bw, damm dd, Allen CM, Bouquot Je. Abnormalities of teeth. Oral and Maxillofacial Pathology, 2nd ed. Philadelphia: wB saunders, 2002, pp 49-106. 3. Harvey Ce, emily PP. occlusion, occlusive abnormalities, and orthodontic treatment. Small Animal Dentistry. st. Louis: Mosby, 1993, pp 266-296. 4. niemiec BA. Dental Extractions Made Easier. san diego: Practical veterinary Publishing, 2012. 5. niemiec BA. Case based dental radiology. Top Companion Anim Med 2008; 24(1):4-19. 6. raghoebar GM, Boering G, vissink A. Clinical, radiographic, and histological characteristics of secondary retention of permanent molars. J Dent 1991; 19:164-170. 7. neville Bw, damm dd, Allen CM, Bouquot Je. odontogenic cysts and tumors. Oral and Maxillofacial Pathology, 2nd ed. Philadelphia: wB saunders, 2002, pp 609. 80 Today's Veterinary Practice May/June 2013

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