Veterinary Dentistry Today

A large breed dog presented for a periodontal cleaning. During a periodontal examination how many surfaces of the tooth should be evaluated with a periodontal probe?

Answer:

Minimally 6 surfaces should be probed (mesial-buccal, buccal, distal-buccal, distal-lingual, lingual, mesial-lingual) by walking, not dragging, the periodontal probe around the tooth.

Question:

During the periodontal examination a 12 mm+ distal-lingual periodontal pocket is identified. What is the next diagnostic step?

Answer:

Intraoral Radiography

Question:

What is the radiographic interpretation and diagnosis?

Answer:

There is widening of the distal periodontal ligament space of tooth the right mandibular first molar (tooth 409) associated with vertical bone loss estimated to be approximately 75% (stage 4 periodontal disease). Vertical bone loss results in an intrabony periodontal pocket.

Treatment options for tooth 409 include:

1. Guided tissue regeneration of tooth 409
2. Hemisection of the distal root of tooth 409 with root canal treatment of the mesial root.
3. Surgical Extraction.

This dsh cat had a chronic nasal discharge.  Oral exam demonstrated a fractured right maxillary canine tooth (tooth 104).  Radiographs show a large pulp cavity and a diffuse periapical lucency extending from the distal portion of the tooth apex.  Extraction was curative.

This post is by request from the officers at Hendry County Sheriff’s Department demonstrating possible changes that occur with tooth fractures.

This fourth premolar demonstrates dark areas around each root tip.  This is a result of the tooth dying and the bone being destroyed around the root.  Once the pulp dies these changes occur over a period of months.  The patient is painful but most of the time does not show a distinct pain response to the handler or owner.  A root canal can be done to save a tooth even at this stage.  Allowing this to progress may result in further pain and compromise to other body systems.

This mandibular canine tooth has had a root canal procedure and a crown placed.  This radiograph was taken at the time of the crown placement and you can see the area around the root tip here is dark as well, indicating bone destruction.  This will heal as the source of the infection is removed with the root canal procedure.  The diseased pulp is replaced with gutta percha, which represents the white material within the root canal.

This is a patient following placement of four cast metal alloy crowns.  Crowns are placed to protect the integrity of root canal therapy and to protect the tooth from excessive wear like cage chewing and other trauma.  One last comment, the tooth does not have to be exposed by fracture for this to occur.  Dentin exposure due to wear or blunt trauma can also result in the same outcome.  Only x-rays can determine if this is occurring in these cases.