Veterinary dentistry and oral surgery for geriatric patients - DVM
  • SEARCH:
News Center
DVM Featuring Information from:

ADVERTISEMENT

Veterinary dentistry and oral surgery for geriatric patients
Improvement in quality of life from optimal treatment

DVM InFocus


DIAGNOSTIC TESTING RESULTS

  • Dakota's blood work was normal. Dakota had a grade 5 (of 6) systolic heart murmur and has been doing well on enalapril and furosemide for the last 15 months.
  • Dental radiographs revealed a vital tooth (photo 7).


Photo 6: Retained root on the right side. The face was swollen.
DIAGNOSIS: Vital tooth was fractured with pulp exposure.

TREATMENT PLAN: Definitive therapy was to be performed. Options were to provide vital pulpotomy therapy, root canal therapy, or dental extraction. Root canal therapy is more predictable than vital pulpotomy therapy on a long-term basis. The owner elected vital pulpotomy therapy to reduce the duration of anesthesia and cost. The short duration of pulp exposure made this option a reasonable choice. A third option was dental extraction. In this specific case the owner did not want to have the tooth extracted, as the tooth was ankylosed and may have been difficult to extract.

RESULT: Dakota had a vital pulpotomy procedure performed. He was doing well immediately after the procedure, and he retained this functional tooth.

COMMENT: Dental radiographs were fundamental to treatment planning. The first determination was whether the tooth was vital. This is a requirement for a vital pulpotomy procedure. If the tooth was nonvital, root canal therapy or dental extraction would have been the only treatment options. The radiographs also helped in planning dental extraction. Tooth root ankylosis is diagnosed when there is a partial or total loss of periodontal ligament around the tooth. Teeth with ankylosis can be difficult to extract with a greater risk for complications.


Photo 7: Fractured vital tooth with pulp exposure and ankylosis
Successful vital pulp therapy is dependant on technique and time sensitivity. In this specific case, the early presentation of the patient improved the prognosis for vital pulp therapy. In older patients, the blood supply is reduced from dentin development. While reduced blood supply may adversely affect the long term prognosis, the various considerations were discussed with the client. If the tooth were to become nonvital (dead), root canal therapy or extraction could be performed.

CASE 4: Joey, a 12-year-old yellow Labrador retriever, had discolored upper canine teeth (photo 8). The left tooth was fractured and had a black discoloration over the central pulp canal (photo 9). Joey demonstrated no discomfort when chewing hard food. He would use both teeth for grasping objects. Joey had multiple worn teeth from chewing hard objects over several years.

DIAGNOSTIC TESTING RESULTS

  • Dental radiographs revealed no periapical changes of the discolored and worn teeth. The left tooth had an extremely wide root canal compared to the other teeth. This suggested the tooth was nonvital. Nonvital teeth serve as a bacterial reservoir and can result in systemic spread of bacteria.
  • Dental probing revealed no pulp exposure.
  • Periodontal probing demonstrated no significant lesions.

DIAGNOSIS: Right canine was discolored. The left canine was discolored and nonvital. Dental radiographs were used to help evaluate for evidence of periapical changes.


Photo 8: Discolored upper left canine tooth
TREATMENT PLAN: Treatment options were root canal therapy or dental extraction of both canine teeth or the left upper canine could be treated and the right upper canine tooth monitored on a six-month basis.

TREATMENT PERFORMED: Treatment was root canal therapy of the left upper canine tooth (photo 10).

RESULT: Joey experienced no problems from root canal therapy.


Photo 9: Fractured upper right canine tooth
COMMENT: To minimize cost, the owner elected to monitor the right upper canine periodically using dental radiographs. The endodontically treated tooth would also be monitored during the same anesthesia period.


Photo 10: Root canal therapy of left upper canine tooth
Animals with discolored and severely worn teeth need full mouth dental radiographs for a complete dental evaluation. Many discolored teeth are nonvital. Patients that have chewed hard objects over a long time period may have developed tertiary (reparative) dentin. These teeth may not require treatment, but decisions must be based on dental radiographs.

CASE 5: Marla, a 9-year-old, had an oral mass on the right mandible. The histologic diagnosis was osteosarcoma. The patient was showing no signs of discomfort; however, the mass was large and expansive.


ADVERTISEMENT

Source: DVM InFocus,
Click here