Dentistry

Non-cosmetic caries cavity restoration makes it easy to see

Tooth related surgery

Treatment of dental problems is frequently required for dogs and cats. Unlike the situation in man, caries (above) is not a major problem but does affect dome dogs. There is also a high incidence of problems in large and small herbivores, insectivores and basically all species with teeth get dental problems.

Tooth damage

Teeth are frequently damaged during use and in accidents. Occasionally they are knocked part way or completely out of their sockets. If they were healthy at the time of injury, and they have not been too badly contaminated, such subluxated and luxated teeth can often be repositioned and splinted in place.

If all goes well splinting will allow their periodontal attachment will heal, but the pulp within the teeth will have lost its blood supply and become necrotic, requiring endodontic treatment.

Fractured teeth are also likely to require treatment. Even a minor chip exposing the inner dentine structure of a tooth is likley to be painful and leave the tooth sensitive to touch for weeks to months afterwards.

Minor damage can be treated by smoothing the surface and sealing the porous dentine surface. If damage is more extensive as in the photograph to the right, the defect requires surface restoration.

More extensive damage is likley to lead to compromise of the pulp blood supply (movement of the tooth within its socket tears some or all of the blood vessels entering the pulp at the tip of the root).

Bruising to the pulp and/or its necrosis after vascular compromise often causes a pink to brown discoloration which cannot be easily corrected despite appropriate treatment.

Loss of more than a tiny amoung of tooth substance commonly exposes the pulp causing immediate acute pain that dulls to a constant throbbing over time. Tooth ache rarely causes dramatic signs in animals so it is very difficult to assess, but following treatment most animals are obviously happier!

Providing the tooth is otherwise sound, endodontics (root treatment) eliminates infection and pain and permits retention of a functional, though shorter than normal, tooth. In a case lik ethe one illustrated here a root filling is placed following cleaning, shaping and disinfection of the root canal. A surface restoration is then placed to seal the tooth and prevent further contamination of the root canal.

Diagrammatic illustration of conventional root treatment

Cosmetic restoration of endodontivally treated incisor
Restorations are not builtup tothe original length as
damaged teeth are weak and may break again

Immature teeth

It is not possible to perform conventional endodontic treatment on teeth that have not yet forme the end of their root and even once the root has closed, it takes time for the wall sof a tooth to strengthen. Because of this, immature teeth that are damaged need a different type of treatment to try to keep the pulp alive at least for a while.

Partial pulpectomy, to remove exposed contaminated pulp tissue, if performed early following pulp exposure is often successful ate keeping the remaining pulp alive. New dentine is then deposited on teh walls of teh tooth and beneath the pulp dressing. This can be seen on follow-up radiographs and decisions made as to when and whether further treatment is needed.

Developmental abnormalities

Tooth deformities are seen occasionally. Some can be dealt with by surface restoration but many deformities compromise other teeth so extraction is necessary.

Malocclusion is much more common thatn tooth deformity. When the teeth do not meet satisfactorily there are several options. Extraction of unimportant teeth often helps. When strategic teeth (i.e. canines and big chewing teeth) are involved then it is preferred to retain them. This may involve orthodontic movement of teeth, but as this requires multiple procedures and appliances, and may involve a long period of discomfort/pain it is rarely done.

A quick and more satisfactory solution for one of the more common malocclusions commonly referred to a "base narrow " mandibular canines is to surgically shorten the teeth taht are damaging the opposite jaw. This is illustrated above right.

Teeth are like icebergs!

Dental radiograph - cat mandible

The largest part of a tooth is generally the root. As this is embedded in the jaw with gingiva covering the lower part of teh crown, only a small part can be seen visually. Radiography is essential for a full dental assessment.

Periodontal disease

For teeth to function effectively they need support from teh jaw bone. In periodontal disease the infection on the teeth causes the bone to recede. The associated inflammation causes tissue destruction and allows infection plus inflammatory mediators into the blood stream risking disease spreading elsewhere.

Once established, it is difficult to eliminate periodontal infection, though thorough scaling and polishing of teh teeth followed by thourough daily toothbrushing will minimise its progression. Many teeth though become compromised and need extracting. This is not that easy, particularly when the tooth concerned is large or has more than one root!

Immature mandibular molar 1in a dog