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.
| PRACTICAL DENTISTRY
tinal exposure, and exposed dentinal tubules likely create significant pain (or sensitivity) for the patient (as discussed earlier). In addition, some of these teeth become nonvital due to the traumatic incident and/or associated inflammation. Therefore, it is recommended that these teeth be
radiographed to ensure vitality (Figure 6, page 43). If teeth are found to be nonvital, they must be treated with root canal therapy or extraction. If teeth appear vital, the application of a bonded sealant is recommended to decrease sensitivity (see More at Todaysveterinarypractice.com).
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Interested in finding out more information about crown fractures and bonded sealant application? Read Dr. Niemiec's articles, Diagnosis & Treatment of Crown Fractures and Bonded Sealant Application for Crown Fractures (both in the July/ August 2011 issue), which are available at todaysveterinarypractice.com by selecting Back Issues from the top navigation bar.
ABSCESSED TEETH In addition to long-term, low-grade systemic infec- tion, over time an infected tooth may eventually cause swelling or an abscess (Figure 7, page 43).12,20
This
is also a very painful situation, demanding prompt therapy. Unfortunately, in many cases, abscessed teeth have existed for years prior to the appearance of clini- cal signs. Furthermore, tooth abscesses typically wax and wane until they are definitively treated. For example, facial swelling may temporarily resolve
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(especially if treated with antibiotics), but will even- tually recur. The animal's immune system can often temporarily control the local infection, but ultimately the swelling/abscess cannot be cured until definitive therapy is performed. Definitive therapy is either root canal or extraction.
Figure 9. (A) Mandibular left first molar (309) with a normal appearance; there is no probing depth, fracture, or color change; (B) However, the dental radiograph revealed severe periapical rarefaction (yellow arrows), indicating significant infection. This tooth was successfully treated with root canal therapy; the owner noted a marked increase in the dog's activity 1-week post surgery.
DISCOLORED TEETH Discoloration is another clinical sign of tooth death and potential secondary infection (Figure 8, page 43). Affected teeth can appear pink, purple, yellow, or grey. A study showed that 92.7% of these teeth are nonvital, despite the lack of clinical or radiographic signs of disease.21 Nonvital teeth lose their natural defense ability and
are often infected via the bloodstream, which is known as anachorisis. Therefore, most veterinary dentists do not rely on radiographic appearance to determine vital- ity of stained teeth. All intrinsically stained teeth should be treated the same way as a fractured tooth—with root canal
therapy or extraction.
Intrinsic staining differs from extrinsic staining (eg, coffee stains in humans) because it is caused by blood product breakdown from pulp hemorrhage.
NONVITAL TEETH Another case of camouflaged endodontic disease is a nonvital tooth that appears completely normal (Figure 9).12
Figure 10. Postoperative dental radiograph of properly performed root canal therapy on the max- illary left fourth premolar (208) of a dog; note that all canals are well filled with lack of defects.
44 Today's Veterinary Practice January/February 2012
some outward sign of disease and will show evidence of nonvitality if transilluminated.22
The vast majority of these cases have However, some
cases can only be diagnosed with dental radiology. This highlights the importance of full-mouth dental radiology as part of all patients' dental prophylaxis.23,24