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Dr Amanda Hulands-Nave has generously shared some of the information she discussed at her session in the dental stream of the 2016 AVA Conference.
There is evidence in the literature that more than 60% of dental pathology in dogs and cats is below the gum line.1 It has also been reported that in animals with clinical findings of dental disease, full mouth radiographs showed other undetected pathology in about half the cases.2 In those with no clinical findings, radiographs showed clinically-important pathology in 28% of dogs and 42% of cats.2 Dental disease has been linked to renal, hepatic, pulmonary and cardiac disease, osteoporosis, adverse pregnancy effects and diabetes mellitus.1
With tooth resorption (TR) in cats there is a need to distinguish between type I and II resorption as this affects how the tooth will be extracted. Type I TR is characterized by the presence on an intact periodontal ligament and requires a full tooth extraction technique. Type II TR is characterized by root resorption into the alveolar bone and is treated by crown amputation. Type III TR can occasionally exist and this is where Type I and II TR occur simultaneously within the same tooth, requiring different roots to be treated in different ways.3
Consideration of root morphology and pathology is essential for planning extractions, or else you are working blind. If you break a root and you want to make sure that you have removed it entirely, then take a radiograph. If you have a fractured tooth and you want to see if the fracture extends beyond the gingival margin or is a candidate for root canal therapy, take a radiograph. If you are trying to save a tooth suffering from periodontal disease, you can evaluate the extent of the disease and also monitor its progress post-therapy.
To ensure that the correct number of teeth are present and they are coming up in the correct location, especially in breeds that are prone to malocclusion.
How invasive is that mass? Do you need to remove the tooth when you remove the mass? Radiographs assist in developing a differential list. Why is that tooth missing? Has it been extracted? Was it ever formed? Did it not erupt? Is there a dentigerous cyst brewing below the surface? Is there an abscess on that tooth root?
Dental radiography will help to establish if you are cleaning out the entire length of the pulp cavity whilst performing root canal therapy and will allow you to determine of the seals are adequate on the crowns.
In addition to performing all your existing dental work better, intraoral dental radiography will allow you to improve the quality of other services such as intraoral mass assessments and nasal radiography which allow for superior images when intraoral techniques and equipment are employed which enables more confident diagnoses.
New services can also be added to the practice such as endodontics, eriodontics and general exotic medicine and surgery. Your staff will develop new skills that make them proud and contribute to higher overall job satisfaction.
If you are missing pathology that you should be treating, not only are you missing performing services that could be charged for but you are also causing pain to persist for the pet. You may also be extracting teeth that don’t need to be extracted causing unnecessary pain for the pet. If you are not treating all the disease that is present, then you and the client will not see the dramatic improvement in the pet’s condition that will astound the owner and make them the best advocates to other clients of your services. If you miss this, then you will also miss the improved job satisfaction of your vets that would normally result.
Dental procedures can often be the cause of frustration as poor dental grading results in often inadequate time to be allocated for procedures. Poor decision making within a procedure due to inadequate information about what lies beneath the gum and poor extraction techniques can also cause time blow outs. Staff will often miss lunch breaks due to this and it can lead to fatigue and burnout. Not only are the dental procedures taking longer, but you are often not charging appropriately, your staff are getting run down and the inefficiency will flow on through the afternoon and may even contribute to overtime for staff at the end of the day, not to mention increase the stress levels. You may find that staff are reluctant to book dental cases in for treatment, especially multiple procedures on a single day, which is not only bad for your patients but also bad for your practice turnover.4
If you have any questions you would like to ask Amanda, just add them into the Comments section below.
References :
1. Niemiec, BA Periodontal Disease, Topics in Companion Animal Medicine, 23 (2); 72-80, 2008
2. Verstraete, et al Diagnostic value of full-mouth radiography in dogs. American Journal of Veterinary Research,59 (6) ; 686-691, 1998
3. Dupont, GA and DeBowes, LJ Comparison of Periodontitis and Root Replacement in a Cat with Resorptive Lesions, J Vet Dent 19 (2); 71-75, 2002
4. Personal experience
Amanda graduated from the University of Queensland with a Bachelor of Veterinary Science in 1999 and from Murdoch University with a Masters of Veterinary Studies in Small Animal Medicine and Surgery in 2005. Amanda also has been admitted (by examination) to both the Small Animal Internal Medicine and Dentistry Chapters of the Australian College of Veterinary Scientists.
Amanda has worked in mixed rural practice, exotic practice and small animal practice in capital cities and regional areas and she has been at Bellarine Veterinary Practice in Geelong since 2005. Her special interests are dentistry, endocrinology, intensive care, ultrasonography, reproduction services, dermatology and behaviour.
She is the proud owner of a cheeky chocolate labrador called Lochie and a black and white cat named Rupert who holds the obstructive FLUTD world record.
Connect with Dr Amanda Hulands-Nave BVSc(Hons) MVSt MACVSc (SA Med) MANZCVS (SA Dent):
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