Only 40% of the Story

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Amos Barber
5 years ago
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1 X-RAY, X-RAY, READ ALL ABOUT IT! The Use and Utility of Dental Radiographs in Practice Lisa Fink, DVM, DAVDC Dentistry & Oral Surgery Service October 4, 2015 Only 40% of the Story Radiographs of teeth with clinical lesions had clinically important information in 22.6% of dogs 204 Radiographs of teeth without clinical lesions had clinically important information in 27.8% of dogs Radiographs of teeth with clinical lesions had clinically essential information in 32.2% of cats Radiographs of teeth without clinical lesions had clinically important information in 41.7% of cats Source: Clinical Canine Dental Radiography, K. Bannon, VCNA 2013

2 Other Uses TMJ Films Nasal Films *Small exotic animals whole body studies *Pediatric animals *Limb/Digit radiographs Periodontal Disease Pico the Italian Greyhound Pico Pico Jaw Fracture City The smaller the dog, the smaller the Mandible:M1 ratio No association between age, sex, or body condition 308, 309, 310

3 Aging Aging Aging Tooth Maturation Image from Niemiec: A Color Handbook Small Animal Dental, Oral, & Maxillofacial Disease

4 ALWAYS X-RAY A MISSING TOOTH! Dentigerous Cyst Dentigerous Cysts Associated with an unerupted tooth Arise from proliferation of the embryonic remnants of the reduced enamel epithelium and enamel organ Osmotic fluid accumulation 2-3 years of age May malignantly transform carcinoma or ameloblastoma Always submit the cyst lining for histopath Maxilla Maxilla

Maxilla Next Case Supernumerary Root Anatomic Variations

Veterinary Dentistry 1997 Tooth Absent 1 root Fused

3% 207, 208, 209 Radiographs Guide Treatment Root

5 Maxilla Next Case Supernumerary Root Anatomic Variations In the Domestic Cat FJM Verstraete, C Terpak Journal of Veterinary Dentistry 1997 Tooth Absent 1 root Fused Roots 2 Roots Maxillary PM2 7.9% 27.7% 55.1% 9.2% Maxillary M1 2.3% 35% 34.7% 28% Supernumerary Roots Maxillary PM3 10.3% 207, 208, 209 Radiographs Guide Treatment Root Dilaceration For extraction vs. crown amputation For endodontic therapy For oncologic surgery and planning Hooked root

$Disease within the pulp cavity Via direct or indirect pulp exposure Tooth fracture Complicated vs.$ uncomplicated Concussive damage Irreversible pulpitis Can also be present with very little clinical

uncomplicated Concussive damage Irreversible pulpitis Can also be present with very little clinical

! Radiographic Signs of Endodontic Disease Periapical lucency Increased width of the apical PDL space

Changes in the periapical bone Pulp canal obliteration Reference: Atlas of Dental Radiography in Dogs

6 What is endodontic disease? Disease within the pulp cavity Via direct or indirect pulp exposure Tooth fracture Complicated vs. uncomplicated Concussive damage Irreversible pulpitis Can also be present with very little clinical evidence!! Radiographic Signs of Endodontic Disease Periapical lucency Increased width of the apical PDL space Loss of the lamina dura Root tip resorption, internal resorption Arrested pulp cavity development Changes in the periapical bone Pulp canal obliteration Reference: Atlas of Dental Radiography in Dogs and Cats, DuPont & DeBowes Wider pulp cavity than neighboring teeth! Periapical lucency! What about this tooth? Chevron Effect Normal triangular lucency at the apex Created by the radiolucent trabecular bone and denser cortical bone Canine teeth, maxillary incisors, mandibular first molars

7 The Mental Foramina Rostral Middle Caudal CAN ALL MIMIC LESIONS OF ENDODONTIC ORIGIN!

8 309 Dens Invaginatus Developmental anomaly Enamel and dentin invaginate into pulp Defect may be confined to crown only or involve the pulp The result is an increased susceptibility to endodontic and periodontal disease

Congenital Generalized Odontodysplasia Generalized enamel and dentin defects Short roots Evidence of endodontic disease Genetic, infectious, nutritional factors Canine distemper virus Most likely

304, 307, 308, 309 Tooth resorption in Cats Most common oral pathology in cats 28-75% show at least one lesion Osteoclasts/osteoblasts remodeling root Excess vitamin D proposed but hypothesis only

9 Congenital Generalized Odontodysplasia Generalized enamel and dentin defects Short roots Evidence of endodontic disease Genetic, infectious, nutritional factors Canine distemper virus Most likely infected at a young age during the formation of the tooth (bell stage) What s going on here? 304, 307, 308, 309 Tooth resorption in Cats Most common oral pathology in cats 28-75% show at least one lesion Osteoclasts/osteoblasts remodeling root Excess vitamin D proposed but hypothesis only further follow-up prospective studies necessary to truly determine if causative Tooth resorption in dogs 53.6% of dogs examined have TR External replacement resorption most common Increased age = Increased TR Tooth resorption Type 1 Type 1 Inflammatory resorption Pink spot on tooth Periodontal ligament space intact TREATMENT: Extraction 407, 408, 409

Tooth resorption Type 2 Root replacement

tooth is less than density of surrounding bone

401-404 Treatment for Tooth Resorption Crown

signs of a periodontal ligament NO stomatitis NO

A little bit of both 104-107 Take Home Point

10 Tooth resorption Type 2 Root replacement resorption No periodontal ligament Density of tooth is less than density of surrounding bone TREATMENT: Crown Amputation Type , Treatment for Tooth Resorption Crown Amputations NO signs of endodontic disease NO signs of a periodontal ligament NO stomatitis NO retrovirus + Type 3: Mixed! A little bit of both Take Home Point X-Rays are Essential to determine the Course of Treatment in Animals with Tooth Resorption!

plan and complete your oral examination Dental radiographs are the highest

11 Take Home Points Dental radiographs have a lot of uses! Dental radiographs can find surprises Dental radiographs guide your treatment plan and complete your oral examination Dental radiographs are the highest standard of care Thank you! Questions? Dentistry@cuvs.org Like Dentistry? Join the American Veterinary Dental Society!

You know you would like to stop swearing at the computer after each shot. Troubleshooting oral radiography

You know you would like to stop swearing at the computer after each shot Troubleshooting oral radiography Goals of oral radiology Achieve diagnostic images of the teeth and surrounding bone. Images should