Medicina pediĂĄtrica en pequeĂąos animales
PrESEnTATIon BroChurE Javier Collados Soto
Visual atlas of dental pathologies in dogs Javier Collados Soto
Visual atlas of dental pathologies in dog
Dental care is essential to prevent dental and oral health problems in dogs. It is nowadays a routine procedure for most veterinary practices. However, some dental pathologies are sometimes really difficult to diagnose and treat. This atlas occupies a very valuable place in veterinary medicine literature thanks to its extensive collection of the most representative images of dental pathologies in dogs. With almost 400 high-quality images, clear anatomical illustrations, and descriptions of numerous diagnostic tests, this atlas constitutes a reference handbook for a quick visual identification with a clear orientation towards a precise diagnosis and treatment. In short, this is an essential tool for a better understanding of dental pathologies in dogs.
Javier Collados Soto
Visual atlas of dental pathologies in dogs Javier Collados Soto
Visual atlas of dental pathologies in dog
Visual atlas of dental pathologies in dogs
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Author: Javier Collados Soto. FormAt: 22 x 28 cm. Number oF pAges: 144. Number oF imAges: 390. biNdiNg: hardcover.
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Dental care is essential to prevent dental and oral health problems in dogs. It is nowadays a routine procedure for most veterinary practices. However, some dental pathologies are sometimes really difficult to diagnose and treat. With almost 400 high-quality images, clear anatomical illustrations, and descriptions of numerous diagnostic tests, this atlas constitutes a reference handbook for a quick visual identification with a clear orientation towards a precise diagnosis and treatment. In short, this is an essential tool for a better understanding of dental pathologies in dogs.
Presentation of the book This Atlas constitutes a new and valuable contribution to the literature of Veterinary Dentistry. It is not a text book; rather it uses a wide spectrum of well-organised visual material to clearly explain different dental pathologies in dogs. The Spanish author has selected well-known international collaborators to contribute to a comprehensive range of high-quality visual material comprising almost 400 pictures arranged on more than 100 pages. The chapters and pages are laid out in a clear and interesting format that communicate information effectively and retain the reader’s interest on a voyage of discovery. The overall organisation in terms of aetiology, clinical and diagnostic features together with well-labeled diagrams and illustrations is a format that allows the reader to quickly delve down to whatever level of detail is required. In particular, the juxtaposition of different visual formats provides a multidimensional insight. For example, well-selected clinical photographs and matching radiographs highlight the value of radiography in diagnosis. The Atlas is both a well-conceived idea and a well-executed project. This one book has such a broad coverage of dental pathologies in dogs that it constitutes a uniquely valuable addition to the library of any veterinary surgeon.
Cecilia Gorrel
BSc, MA, Vet MB, DDS, MRCVS, Hon FAVD, Dipl EVDC RCVS-recognised Specialist in Veterinary Dentistry
Visual atlas of dental pathologies in dogs
The author Javier Collados Soto Javier Collados Soto graduated in Veterinary Medicine from the Complutense University of Madrid (UCM) in 1994. Specialising exclusively in Veterinary Dentistry and Oral Surgery, he works in numerous veterinary practices and hospitals in Spain, concentrating his services in Madrid. He is responsible for the Dentistry and Oral Surgery service at the Sierra de Madrid Veterinary Hospital. He was a lecturer and subject coordinator in Animal Dentistry at the Faculty of Veterinary Medicine of the Alfonso X el Sabio University of Madrid. Always showing his interest for his specialisation, he has had several stays at the Dentistry and Oral Surgery Service of the University of California (UCDavis) Veterinary Medical Teaching Hospital, USA. He has been member of the European Veterinary Dental Society (EVDS) since 1999 and he is also one of the founder members of the Spanish Society of Veterinary Experimental Dentistry and Maxillofacial Surgery (SEOVE, Sociedad Española de Odontología-Cirugía Maxilofacial Veterinaria y Experimental).
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He has published many articles in this specialty and has participated as a speaker in conferences and national and international courses in the field of Veterinary Dentistry.
Communication services Web site Online visualisation of the sample chapter. Presentation brochure in PDF format. Author´s CV. Sample chapter compatible with iPad.
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Visual atlas of dental pathologies in dogs Javier Collados Soto
06/02/15 08:49
Table of contents 1. introduction dental positioning terms histological structure of the tooth in dogs and cats dog and cat teeth diagrams
Alteration of dental development and eruption dental agenesis unspecific tooth alterations Non-physiological diastema impacted teeth impacted (embedded) teeth incomplete eruption
example of periodontal probing
Fusion
Classification of periodontal diseases (AVdC, 2007)
germination
Classification of the bacterial plaque and dental calculus indices (Logan & boyce, 1994) Classification of the gingival index (Wolf et al., 2005)
hyperdontia (supernumerary teeth) hypodontia hypoplasia-hypomineralization of enamel microdontia odontodysplasia oligodontia dentigerous cyst
Classification of tooth mobility (AVdC, 2007)
iatrogenic alterations
Classification of furcation defects (AVdC, 2007)
dental absence
Classification of dental fractures (AVdC, 2007) endoperiodontal lesions Classification of dental resorptions (AVdC, 2007)
2. dental and oral cavity pathologies in the dog oral pathology in dogs permanent teeth permanent teeth deciduous teeth Normal tooth eruption dog dental radiography models dental abrasion
pathological attrition
dental caries dental discoloration dental fracture enamel fracture uncomplicated crown fracture Complicated crown fracture Complicated crown-root fracture Complicated crown-root fracture root fracture
dental luxation-subluxation pulp pathology dental resorption dental stains
3. references 4. Alphabetical index
Visual atlas of dental pathologies in dogs
Dental positional terminology Midline
CAUDAL
ROSTRAL Palatal Lingual
Midline Vestibular or buccal
IAL
MES
AL DIST
Dental positional terminology
4
Dental positional terminology is used to determine the location of the different surfaces and directions of each tooth or dentition:
1
5
3
1 Apical: towards the apex of the root. 2 Coronal: towards the crown of the tooth.
6
3 Vestibular-buccal-facial-labial: the surface of a tooth facing the
vestibule or lips. 4 Lingual (mandible)/Palatal (maxilla): the surface of a tooth facing
2
the tongue (mandible) or the palate (maxilla). 5 Mesial: the surface of a tooth towards to the first incisor. 6 Distal: the surface of a tooth away from the first incisor.
Interproximal: the adjacent surfaces between teeth.
x
Incisal: the biting surface of incisors. Occlusal: the chewing surface of the premolars and molars. This terminology can be combined in the different dental anatomic regions to locate exact anatomical points in the tooth. For example, the area represented with the letter x is the mesial surface of the coronal third of the mesial root of the lower first molar.
2
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Visual atlas of dental pathologies in dogs
Dental fracture classification (AVDC, 2007)
Infractions and enamel fractures have limited clinical importance, except for those causing rough surfaces that can provoke lesions in adjacent soft tissues. Uncomplicated crown fractures are significant as exposure of the dentinal tubules can cause dental hypersensitivity. In complicated crown fractures, pulpitis or pulp inflammation is caused by exposure of the pulp. Without adequate treatment (endodontic treatment or tooth extraction), this may lead to the appearance of pulp necrosis that will progress towards the apical delta and ultimately cause periapical pathology. In complicated crown-root fractures, this situation will be complicated with a greater risk of periodontal disease in those areas where the fracture affects the gingival region, due to a greater deposit of bacterial plaque caused by the fracture. Root fractures are usually candidates for tooth extraction, especially those found in the coronal third of the root. Special precaution should be taken in cats to differentiate the advanced stages of tooth resorption (very frequent pathology) with the strict root structures (less frequent and usually from traumatic or iatrogenic causes).
Enamel infraction: incomplete fracture (“crack�) of the enamel without loss of tooth substance.
Uncomplicated crown-root fracture: fracture of the crown (enamel and dentin) and root (dentin and cementum) that does not expose the pulp.
Complicated crown fracture: fracture of the crown (enamel and dentin) that exposes the pulp.
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Introduction
Enamel fracture: fracture with loss of crown substance confined to the enamel.
Complicated crown-root fracture: fracture of the crown (enamel and dentin) and root (dentin and cementum) that exposes the pulp.
Uncomplicated crown fracture: fracture of the crown (enamel and dentin) that does not expose the pulp.
Root fracture: fracture involving the root (dentin and cementum). 11
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Visual atlas of dental pathologies in dogs
K
K
V
X
X
Y
K
X
U
Y
Permanent teeth Physiological findings in dental and oral anatomy in dogs (adults). Presence of permanent teeth. K Soft palate.
X Left buccal caudal mucosa.
U From right to left: foliate papillae and conical papillae of the tongue.
Y Epiglottis.
V Left tonsil, partially exposed outside of the tonsillar fossa.
18
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Dental physiological and radiological oral cavity in dogs
B C
A
D
F
G
E
J
H
I
Deciduous teeth Physiological findings in dental and oral anatomy in dogs (puppies). Presence of deciduous teeth. A From right to left, all deciduous: RmaxI1 (501), RmaxI2 (502), RmaxI3
(503) and RmaxC (504); rostral view. B From top to bottom, all deciduous: RmaxI1 (501), RmaxI2 (502), RmaxI3
(503) and RmaxC (504); palatal view. C Incisive papilla. D Hard palate (ridges). E From right to left, all deciduous: RmaxI3 (503), RmaxC (504), RmaxP2
G From right to left, all deciduous: RmaxP4 (508), RmaxP3 (507), RmaxP2
(506); palatal view. H From right to left, all deciduous: RmandI3 (803), RmandC (804),
RmandP2 (806), RmandP3 (807), and RmandP4 (808); vestibular view. I From right to left, all deciduous: RmandC (804), RmandP2 (806),
RmandP3 (807), and RmandP4 (808); vestibular-coronal view. J Sublingual caruncle.
(506), RmaxP3 (507) and RmaxP4 (508); vestibular view. F Muco-gingival junction.
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Visual atlas of dental pathologies in dogs
B
A
C
Dental abrasion Moderate to severe abrasion without pulp exposure of LmandC (304), formation of tertiary dentin. A Moderate to severe abrasion of LmandC (304) and LmaxC (204).
C Image of tertiary dentin in LmandC (304) without pulp exposure.
B Formation of tertiary dentin due to abrasion in LmandC (304).
Key diagnostic/treatment points In this case, the abrasion seems to have been progressive over time, for which the odontoblasts have had time to produce tertiary dentin. As the abrasion has continued, this dentin has deposited itself and has thus pulp exposure had been avoided. The use of a dental explorer is indicated in this patient to confirm the absence of said alteration, as well as the regional dental radiology to confirm the absence of pulp and periapical pathology. 26
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Dental pathologies
D B E
C
A
G
H
F
Dental abrasion Severe abrasion without pulp exposure of LmandC (304) and RmandC (404); formation of tertiary dentin. A Moderate abrasion of the lower incisors.
F Moderate abrasion of LmandI3 (303).
B Severe abrasion of LmandC (304) and RmandC (404), rostral view.
G Image of the confirmation of the absence of pulp exposure in RmandC
C Image of the severe abrasion of LmandC (304) and RmandC (404), coronal view. D Moderate abrasion of LmandP2 (306) and RmandP2 (406).
(404), using a dental explorer. H Tertiary dentin in RmandC (404).
E Orifice of the sublingual gland duct.
Key diagnostic/treatment points In this clinical case, we have detected moderate abrasion in the incisors and rostral mandibular premolars, and severe abrasion in the lower canines, with no pulp exposure. Treatment of this clinical situation is based on the elimination of the cause that produces the abrasion (eliminate play with tennis balls, with very abrasive surfaces). 27
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Visual atlas of dental pathologies in dogs
B
A C
D
Alteration of dental development and eruption
E
Impacted teeth
Suspicions of impacted teeth and partially erupted teeth in the left maxilla, of unknown aetiology. A Bilateral conjunctivitis, more accentuated in the left eye.
D Absence of LmaxC (204).
B Image of ocular pathologies in the left eye.
E Absence of LmaxP2 (206) and LmaxP3 (207).
C From right to left: cusp of LmaxP4 (208), cusp of LmaxP1 (205), and LmaxI3
(203).
Key diagnostic/treatment points In this clinical case, an 8-month-old Rottweiler presents with a history of conjunctivitis and ectropion, especially accentuated in the left eye. Severe follicular conjunctivitis, which is more evident in the left eye due to ectropion, is observed in the eye examination. The presence of several impacted teeth is suspected in the initial oral examination and partially erupted (minimal eruption) teeth are observed in the left maxilla with a mild alteration of the bone. A dental radiological examination is essential for the confirmation and differential diagnosis of the dental pathology of unknown aetiology. Ocular and dental pathologies on the left side are closely related which makes a complementary oral examination fundamental in those cases that are presented for an eye examination. 34
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Dental pathologies
B
A
C
D
Alteration of dental development and eruption
Impacted teeth
Impaction of LmandP1 (305). A From right to left: LmandP3 (307), LmandP2 (306), LmandC (304) and
LmandI3 (303). B Absence of LmandP1 (305); vestibular view. C Image of the absence of LmandP1 (305). D Dental X-ray: signs compatible with embedded LmandP1 (305).
Key diagnostic/treatment points Dental impaction (embedded) of the lower first premolar is relatively frequent, especially in German Shepherds. The detection of these missing, but impacted teeth should be done by dental radiology. Adequate treatment should be established as this situation could potentially lead to a dentigerous cyst. 35
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Visual atlas of dental pathologies in dogs
B
A
D
E
C
D
F
G
Alteration of dental development and eruption
Dentigerous cyst
Dentigerous cyst in the area of LmandI1 (301) (histopathological confirmation). A Extra-oral view of dentigerous cyst.
E From right to left: persistence of deciduous RmandI1 (801) and RmandI2 (802).
B From right to left: persistence of deciduous LmaxC (604), LmaxC (204),
F Dental X-ray: radiological signs compatible with the presence of a dentiger-
LmaxI3 (203), and LmaxI2 (202). C From right to left: LmandC (304), LmandI3 (303), LmandI2 (302). D Dentigerous cyst in the area of LmandI1 (301) (absent).
ous cyst and LmandI1 (301). G Dental X-ray: radiological signs compatible with osteolysis in the root area
of LmandI2 (302) and LmandI1 (301).
Key diagnostic/treatment points When we locate oral inflammations in the areas of dental eruption, with absence of eruption of one or more teeth, we must consider a dentigerous cyst as a possible diagnosis. Although this pathology is infrequent, it can be detected in young animals. The macroscopic suspicion must be confirmed histopathologically. Treatment consists of the complete elimination of the cyst including its capsule to avoid recurrence of the process. 54
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Dental pathologies
A
B
D
E
F
C Alteration of dental development and eruption
Dentigerous cyst
Dentigerous cyst in the area of absent LmandP1 (305) (histopathological confirmation). A Macroscopic suspicions of dentigerous cyst due to inflammation of the
area of absent LmandP1 (305); vestibular view. B Macroscopic suspicions of dentigerous cyst due to inflammation of the
area of absent LmandP1 (305); coronal view. C Dental X-ray: radiological signs compatible with the presence of a dentiger-
ous cyst in the area of LmandP1 (305).
D Dental X-ray: radiological signs compatible with root resorption of
LmandP1 (305). Class 3 of dental resorption. E Dental X-ray: radiological signs compatible with root resorption in the
mesial root of LmandP2 (306). Class 3 of dental resorption. F Image of root resorption of LmandP1 (305) and root resorption of the
mesial root of LmandP2 (306) after extraction.
Key diagnostic/treatment points The dentigerous cyst is one of the processes that should be suspected in regions of dental eruption where eruption has not occurred but there is inflammation of the soft tissues, especially in young animals. A dental radiological study will serve as a guide to confirm the process, however, macroscopic suspicions must be confirmed histopathologically. 55
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Visual atlas of dental pathologies in dogs
Dental caries Class I caries (Black classification) in RmaxM1 (109).
A
A Class I caries in RmaxM1 (109).
Key diagnostic/treatment points Caries is a microbial disease of the calcified tissues of teeth, characterized by the demineralization of the inorganic part and the destruction of the organic part of a tooth. Class I caries (Black classification) or caries that affects the occlusal surface of the tooth, is one of the most frequent presentations of caries in dogs. Assessment of the depth of the caries and dental radiology will be indispensable to decide on a treatment plan. Common errors Treatment should be implemented in the present moment; waiting to see the course of the process will only lead to the caries having a greater diameter and depth that could affect the pulp if (if it had not initially been affected), complicating therapeutic options.
A
Dental caries Class I caries (Black classification) in LmaxM1 (209). A Class I caries in LmaxM1 (209).
Key diagnostic/treatment points This class I caries (Black classification) is deep and at an advanced stage; it is likely that it affects the pulp cavity of LmaxM1. Dental radiology is clearly indicated to assess the degree of dental destruction and extension of the cavity. 64
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Dental pathologies
A
B
C
D
Dental caries Class I caries (Black classification) in RmaxM1 (109), RmandM2 (410), and RmandM3 (411). A Class I caries in RmaxM1 (109), affecting the pulp chamber and cavities.
C Image of class I caries in RmandM2 (410) and RmandM3 (411).
B From right to left: class I caries in RmandM2 (410) and RmandM3 (411),
D Suspicions of class II caries in the distal area of RmandM1 (409), detected
due to close contact with RmaxM1 (109).
using a dental explorer.
Key diagnostic/treatment points The caries in RmaxM1 (109) is deep, affecting the pulp chamber and cavities. The teeth that are in close contact with this tooth in the mandible (RmandM2 and RmandM3) have also been affected. We find a suspicious cavity, compatible with a class II caries, on the distal surface of the crown of RmandM1 (409). In this area, as well as in the rest of the teeth, dental radiology is indicated. 65
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Visual atlas of dental pathologies in dogs
C A
B
D
Dental fracture
Complicated crown fracture
Complicated crown fracture in LmandC (304). A Enamel (fractured).
C Pulp tissue exposed.
B Dentin (fractured).
D Image of the enamel fractured to the gingival border in the distal region
of LmandC (304). Key diagnostic/treatment points In crown fractures with pulp exposure, we must assess the amplitude of the fracture to differentiate a “crown” fracture from a “crown-root” fracture. In this case, the fracture is on the limit of complicated crown fractures as the fracture reaches the gingival margin (D) in its distal region. The pulp tissue is still alive judging by its pink colouring, although it is impossible to determine when the fracture actually happened; a partial coronal pulpectomy would not be indicated in this case as conservative treatment; however, a pulpectomy would be (with previous dental radiological control to discard root fracture). Tooth extraction would be an adequate non-conservative treatment. 84
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Dental pathologies
A
C
B
E
D
Dental fracture
F
Complicated crown fracture
Complicated crown fracture in deciduous LmaxC (604) with absence of LmaxC (204). A Fistulous tract in the gingiva of the apical region in deciduous LmaxC (604).
D Absence of LmaxC (204).
B Discoloration of deciduous LmaxC (604) due to pulp necrosis.
E Dental X-ray: confirmation of the existence of unerupted LmaxC (204).
C Complicated crown fracture in deciduous LmaxC (604).
F Dental X-ray: radiological signs compatible with area of fracture/resorption
in deciduous LmaxC (604). Key diagnostic/treatment points Occasionally, when there is a complicated crown fracture in the deciduous canine, and the tooth is not immediately extracted, pulp necrosis may occur with associated periapical pathology (fistulous tract). In this case, the periapical pathology of the fractured deciduous tooth has affected the definitive canine, causing an alteration in its eruption. When there is a deciduous tooth with a complicated fracture, it must be extracted immediately to avoid collateral damage to the permanent teeth in the same area. 85
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Visual atlas of dental pathologies in dogs
B
C
A
E
D
Dental fracture
Complicated crown-root fracture
Complicated crown-root fracture in RmandM1 (409); history of recent trauma (being run over). A Complicated crown-root fracture in RmandM1 (409).
D Image of the fracture line; rostral view.
B Image of the complicated crown-root fracture; vestibular view.
E Dental X-ray: radiological signs compatible with complicated crown-root
C Image of the severe inflammation of the pulp in the pulp chamber of
fracture of RmandM1 (409).
RmandM1 (409); vestibular view. Key diagnostic/treatment points This type of dental fractures with significant destruction of dental tissue, is frequently detected after a history of recent trauma. In these cases, we frequently detect severe acute inflammation of the pulp that overlaps to the exterior above the margins of the chamber and pulp cavity. Treatment in this clinical case is based on dental extraction. 100
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