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 |
TREATMENT OPTIONS As stated previously, all teeth with direct pulp expo- sure as well as stained and/or nonvital teeth must be treated.12,20
The treatment options for these teeth are
root canal therapy or extraction. When properly per- formed, either treatment should result in resolution of pain and/or infection. There are advantages and disadvantages to each treatment, and recommenda- tions vary depending on which tooth is involved and the level of disease.
Root Canal Therapy Briefly described, root canal therapy involves removal of the nerve and associated structures, disinfection and filling of the canal, and restoration of the surface of the tooth (Figure 10, page 44).25,26 The advantages of root canal therapy compared to
complete extraction include: UÊ inimiâi`Ê«>inÊ>n`Ê`iÃVomvoÀÌ UÊ,iÌ>ini`ÊvÕnVÌionÊovÊÌhiÊÌooÌh UÊ >inÌ>ini`ÊÃÌÀin}ÌhÊovÊÌhiÊj>Ü UÊ iVÀi>Ãi`ÊÃÕÀ}iV>lÊVom«liV>ÌionÃ°Ê Although almost any tooth can be treated with root
canal therapy, it is specifically recommended for treat- ing larger, strategic teeth, such as the canine or car- nassial teeth. The lower canine teeth are specifically associated with jaw strength; avoiding extraction of these teeth, if possible, is optimal.
Extraction Extraction involves complete removal of the tooth and its root(s). This is an important point, as only com- plete extraction will resolve infection; retained
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.
He has authored many articles and chapters, including the recently published Small Animal Dental, Oral and Maxillofacial Disease: A Colour Handbook (Manson Publishing). Dr. Niemiec founded the veterinary dental telemedicine website vetdentalrad.com, which also offers instructional videos and educational posters. He lectures extensively at national and international conferences and is the coordinator and instructor of the San Diego Veterinary Dental Training Center (vetdentaltraining.com). Dr. Niemiec received his DVM from University of California–Davis.
A
B
Figure 11. (A) Dental radiograph of a retained, infected root from the maxillary left first incisor (201) (red arrow); in addition, a nonvital, infected right first incisor (101) (yel- low arrow) was found; (B) Dental radiograph of a dog with retained and infected roots of the maxillary left fourth premolar (208) (red arrows); the tooth had been "extracted" 3 years previously. This case confirms the importance of postoperative radio- graphs for all extrac- tion cases.
roots are a very common complication with extrac- tions (Figure 11). The advantages of extraction include: UÊ iVÀi>Ãi`ÊÃÕÀ}iV>lÊÌimiÊ>n`ÊiÝ«inÃiÊvoÀÊÃm>lliÀÊÌiiÌh® UÊ oÊlon}-ÌiÀmÊvolloÜ-Õ«°ÊÊÊ
ARTICLE SUMMARY Endodontic disease is a very common condition in small animal veterinary patients. Many of these condi- tions are easily diagnosed, such as complicated crown fractures and discoloration. Other conditions are less obvious (eg, uncomplicated crown fractures) and may require dental radiographs for definitive diagnosis. Therefore, a complete oral examination should
be performed on all patients and a thorough oral examination and radiographs completed during every dental procedure. Finally, teeth affected by in`o`onÌiVÊ `iÃi>ÃiÊ ÃhoÕl`Ê LiÊ ÌÀi>Ìi`°Ê ,ooÌÊ V>n>lÊ therapy (especially with strategic/large teeth) is ideal, but complete extraction is also acceptable. ■
FIGURE CREDITS
Figure 1: Reprinted from Small Animal Dental, Oral, and Maxillofacial Diseases—A Colour Handbook, Niemiec BA, London: Manson Publishing, 2010, with permission. Figures 2 and 3: Reprinted from Veterinary Endodontics, Niemiec BA, Tustin, CA: Practical Veterinary Publishing, 2011, with permission.
References
1. Theuns P. Endodontic anatomy. In Niemiec BA (ed): Veterinary Endodontics. Tustin, CA: Practical Veterinary Publishing, 2011.
2. Lewis JR, Reiter AM. Anatomy and physiology. In Niemiec BA (ed): Small Animal Dental, Oral and Maxillofacial Disease—A Colour Handbook, London: Manson Publishing Ltd, 2010.
January/February 2012 Today's Veterinary Practice 45
Proper Therapy for Endodontic Disease