Five most commonly misdiagnosed pathologies - DVM
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Five most commonly misdiagnosed pathologies
Radiographs, metal hand explorers can supplement visual clues to dental health.


DVM InFocus


3. The number and severity of Feline Resorptive Odontoclastic Lesions (FROL) FROLs are, due to their nature, extremely hard to evaluate by visualization alone. The lesion, as a small area, usually starts at the junction of the enamel with the root. This location often is hidden by the gingiva, making detection without probing almost impossible. This is especially true due to the tendency for feline gingiva to migrate into the cavities created by the odontoclastic lesions. The lesion then tends to destroy the tooth from inside out by extending both into the root and under the enamel of the crown. Often the crown is affected visually only after the tooth has been destroyed internally.

Due to the hidden nature of this pathology, the evaluation of the entire tooth through radiology and probing plays an extremely important part of the diagnostic approach in the evaluation of these often painful lesions. An early detection, extent of the lesion and determination of treatment options are desirable.

4. Prognosticating teeth without radiographs. It is common for the practitioner to be called upon to evaluate and handle a myriad of dental situations, such as:

  • Extraction of a permanent tooth due to mistaking it for a deciduous tooth,
  • Determination of whether all the permanent teeth are present in a puppy prior to their eruption,
  • Is there an unerupted permanent tooth below the surface where there is an apparent missing tooth?
  • Is an erupted tooth deciduous or permanent?

All of these scenarios can be answered readily with confidence by the use of dental radiography.

5. Endodontically involved teeth. The endodontic system's integrity of a tooth can be exposed to the oral environment in a number of ways. The most common in veterinary dentistry is a fracture of the tooth's crown deep enough to expose the root chamber and its pulp. Deep carious lesions, FROLs, congenital malformations of the tooth and idiopathic pulpal necrosis also can create endodontic disease. (See related story)

Unlike the four previous misdiagnoses, usually the fact that the tooth's pulp has been exposed to the environment is enough, in itself, to diagnose endodontic disease. Radiographs of the tooth are indicated to demonstrate how advanced the pathology has progressed. But lack of radiographic evidence of endodontic disease does not rule out endodontic involvement, especially if pulpal exposure is evident. It simply means there has not been enough boney change to been seen on the radiograph yet. It often requires about 40-percent bone loss to be detectable upon X-ray.

Occasionally, the opening into the pulp is so small it has to be demonstrated with a small diameter explorer or endodontic file. In the case of malformation of the tooth, it might not be possible to demonstrate the breach into the root system. In these cases of very small outward exposure, there is usually a relatively obvious radiographic evidence of endodontic disease to confirm the suspected diagnosis.

It has been said often but cannot be over emphasized: The recognition of endodontic disease is important because ignoring the problem is not an option. The tooth either should be treated and saved or extracted. Otherwise the infection is progressive and relentless as well as leaving the patient at risk for anachoretic infections.

Dr. Mulligan is a founding diplomate of the American Veterinary Dental College. A frequent lecturer and author, he is retired and based in El Cajon, Calif.


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Source: DVM InFocus,
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