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.
Issue link: http://todaysveterinarypractice.epubxp.com/i/321264
| PracTical DenTisTry Today's Veterinary Practice May/June 2014 102 tvpjournal.com • Chewing on a chain link fence damages the distal aspect of the canines (Figure 19). Treatment Options All teeth with attrition or abrasion should be radiographed to ensure tooth vitality. If there are signs of endodontic disease (clinical or radio- graphic), required treatment is root canal therapy or extraction. Treatment of dental attrition is generally not necessary—unless there is evidence of endodontic disease (clin- ical or radiographic)—because slow- ly exposed dentin generally becomes sclerotic and subsequently impervious to pain and bacterial invasion. • Slight odontoplasty with a fine diamond or white stone bur should be performed to alleviate any con- tact, followed by application of a bonded sealant. • Extraction or odontoplasty with restorative or endodontic treat- ment should be performed before restoration of deep defects, such as those on the mandibular canines caused by maxillary third inci- sors, because the malocclusion has reached equilibrium—any restor- ative creates new contact and dis- comfort. Treatment of dental abrasion, such as restorative therapy, is not generally indicated because slow pro- gression of abrasion typically results in sclerotic dentin. Behavior modification is the most important form of therapy, and may include: • Supervising play time • Changing toys to less abrasive ones • Modifying the cage • Treating allergic dermatitis. Cast metal crowns can help "build up" canine teeth if behavior modifi- cation is not possible and the client wishes to protect the tooth and pro- vide more tooth surface (Figure 20). Full-coverage cast metal crowns are strongly recommended to strength- en teeth in dogs that have significant damage on the distal aspect due to fence chewing, as they are in great danger of fracturing if not protect- ed (Figure 21). 1 I have had excellent long-term success with this technique in military and police dogs. However, some veterinarians favor a three-quar- ter crown to decrease the amount of tooth structure removed. 26 IN SuMMARY Any time dentin is exposed, tooth sensitivity and inflammation results. In addition, teeth with direct pulp exposure are initially exceedingly painful, and then invariably become infected. These teeth can and should be restored. Common options for restoration in- clude bonded sealants, composite res- toration, and crowns. Most of these techniques are easy to learn, taught at certain training centers, and inex- pensive to initiate in practice. When the pulp is involved (including discol- oration), treatment is directed at re- moving the infected root canal system, which can be accomplished by root canal therapy or extraction. Client education is the key to gain- ing acceptance of treatment recom- mendations. The article Dental Ser- vices: Good Medicine for Patients & Practices (September/October 2011), available at tvpjournal.com , discuss- es the client education process with regard to dentistry. n FIGURE CREDITS Figure 1: reprinted with permission from Small Animal Dental, Oral, and Maxillofa- cial Disease—A Colour Handbook. Nie- miec BA (ed). London: Manson, 2010. Figures 2 to 7, 20, and 22: reprinted with permission from Restorative Dentistry for the General Practitioner. Niemiec BA. Tustin, CA: Practical veterinary Publish- ing, 2013. Figures 12 and 13: Courtesy dr. Jerzy Gawor. Figures 14 and 15: reprinted with permis- sion from Veterinary Dental Applications in Emergency Medicine & Critical or Compromised Patients. Niemiec BA (ed). Tustin, CA: Practical veterinary Publish- ing, 2012. Figures 16 to 18: Provided by rob Yelland and reprinted with permission from Veteri- nary Orthodontics. Niemiec BA (ed). Tustin, CA: Practical veterinary Publishing, 2012. Brook A. Niemiec, DVM, FAVD, Diplomate AVDC, is chief of staff of Southern California Veterinary Dental Specialties, with offices in San Diego and Murrieta, California, and Las Vegas, Nevada. Figure 19. Severe distal abrasion to right canines (maxillary > mandibu- lar), secondary to dog chewing on a chain link fence; these teeth, espe- cially the maxillary, are very prone to fracture, and should be protected (see Figure 21). Figure 20. Postoperative picture of cast metal crown placed on the abraded canines in Figure 17B; these teeth are well protected and should last for the life of the patient. Figure 21. Postoperative picture of cast metal crown placed on the abraded canine in Figure 19; the tooth is well protected and should last for the life of the patient. TVP_2014_0506_PD_HardTissue-Periodontal.indd 102 5/23/2014 6:35:59 PM