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| PRACTICAL DENTISTRY A MASS IS NOT ALWAYS WHAT IT SEEMS In my experience, approximately 1% of "very benign" oral growths in the dog turn out to be malignant (Figures A and B). Furthermore, it is not uncommon to see very destructive benign growths, such as eosinophilic granulomas (Figure C). Finally, osteomyelitis (Figure D) may demon- strate the same radiographic findings as malignant tumors, and aggressive tumors may show no bone involvement early in the course of disease. It is crucial to interpret histopathology results in light of radiographic findings. The prudent practi- tioner will note the type and extent of bony involve- ment (if any) on the histopathology request form (and may include copies of the radiographs and pictures) to aid the pathologist. A diagnosis of a malignancy without bony involvement should be questioned prior to initiat- ing definitive therapy, such as aggressive surgery, radiation therapy, or chemotherapy. Conversely, a benign tumor diagnosis with significant bony reac- tion should be further investigated prior to assum- ing the tumor is not malignant. Figure A. Figure B. Figure C. Figure D. Figure A. Intraoral picture of the left buccal mucosa of a dog with a small, soft mass. Histopathology revealed high-grade mela- nosarcoma, which was successfully treated (5-year survival) with only local resection. This case highlights the importance of early detection. Figure B. Intraoral picture of the left buccal mucosa of a dog with a small, soft mass. Histopathology revealed low-grade fibro- sarcoma, which was successfully treated (5-year survival) with a maxillectomy. Figure C. Intraoral picture of the palate of a cat with significant soft tissue and bony destruction/infection. Histopathologic evalua- tion revealed eosinophillic granuloma, which was successfully treated with a combination of medical and surgical interventions. Figure D. Intraoral picture of the left maxilla of a dog with significant soft tissue and bony destruction/infection. Histopathologic evaluation revealed osteomyelitis, which was successfully treated with a maxillectomy. UÊ1Àin>lÞÃià UÊ >VÌiÀi>lÊ>n`ÉoÀÊvÕn}>lÊVÕlÌÕÀi UÊ Õn}>lÊÃiÀolo}Þ UÊ om«ÕÌi`Ê Ìomo}À>«hÞÉm>}niÌiVÊ ÀiÃon>nViÊ im>}- ing to determine surgical margins. TREATMENT Benign Masses Peripheral Odontogenic Fibromas A surgical cure can be achieved by: UÊ,imoÛ>lÊovÊÌhiÊm>ÃÃÊÜiÌhÊn>ÀÀoÜÊm>À}inà UÊ ÝÌÀ>VÌionÊovÊ ÌhiÊ ÌooÌhÊ oÀÊ ÌiiÌh®Ê vÀomÊÜhiVhÊ ÌhiÊ mass has arisen UÊ iLÀi`iminÌÊovÊÌhiÊ«iÀio`onÌ>lÊli}>minÌ°1 However, since benign masses are typically slow growing and noninvasive, I tend to take a more conser- vative approach, especially when large teeth are involved. Conservative treatment involves: UÊ ÝViÃionÊovÊÌhiÊm>ÃÃÊÌoÊ«hÞÃiolo}iVÊm>À}inà UÊ oniÌoÀin}ÊÌhiÊ>Ài>°ÊÊÊ If the mass regrows quickly, treat as discussed earlier. If regrowth takes a year or two, then reexcise at annual (or semi-annual) dental cleanings. Acanthomatous Ameloblastomas After quality dental imaging, these tumors can be removed 56 Today's Veterinary Practice July/August 2012 EDUCATING CLIENTS ABOUT ORAL NEOPLASIA Client education about oral neoplasia encourages them to embrace the importance of proper dental care. Carefully explain that: r Prevention: Every dental cleaning (prophylaxis) includes a complete oral examination, which also screens for oral neoplasia r Detection: Early detection and treatment decreases the odds for tumor metastasis r Therapy: Prompt surgery to address an oral mass decreases the risks of the procedure since it is much less invasive as well as less painful for the pet. r Monitoring: Encourage clients to perform dental homecare, including an oral examination for growths or masses. If they suspect anything is out of the ordi- nary, instruct them to contact the clinic immediately. r Feline Fundamentals: Benign tumors are extremely rare in cats; therefore, counsel cat owners that any oral masses should be immediately evaluated and biopsied at the clinic. r Education: Use photos and radiographs (see Furthering Your Knowledge: Oral Neoplasia, page 57) to illustrate the different types of oral masses, which helps clients identify masses early and portrays how these masses can proliferate and metastasize.