Question:
An 11-year-old small mixed breed dog presents for a professional dental cleaning. Your radiographs show severe bone loss.
What is your approach from here?
Answer:
Based upon the severity of the bone loss, referral to a board certified veterinary dentist may/should be considered for the patient depending on your surgical skill and comfort level with delicate surgical extractions.
Question:
What should you discuss with the pet guardian regarding treatment in your hospital or referral?
Answer:
The chance of mandibular fracture is possible in at least 4 separate locations. Doing nothing will only allow progression of the infection and bone destruction leading to likely mandibular fracture secondary to minor trauma or day to day activities, including mastication. Even if referred to a specialist, mandibular fracture is possible. However, if a mandibular fracture occurs during extraction, repair can be immediately performed by the specialist.
Question:
What if the client is not interested in the referral and the procedures pushes your surgical skills and comfort level?
Answer:
The responsibility is first to “do no harm.”
Fortunately careful open surgical extraction technique eliminated fracture in this case. The alveoli were debrided of granulation tissue and the remaining bone carefully contoured to remove rough edges. A blood clot or bone graft should occupy what is left of the alveolus prior to primary closure of the surgical flap. It should be noted that a bone graft provides no assurance of short term fracture as there is no additional inherent strength. New bone is required for increased strength.
