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

DVM InFocus


  • Blood work and urinalysis results were within normal limits.
  • Dental radiographs revealed severe mandibular destruction.
  • CT scan was performed to help determine that the mass was resectable and whether there was evidence of lymphatic or pulmonary metastatic disease. The CT scan demonstrated no metastatic disease and the tumor appeared contained within the right mandible.

DIAGNOSIS: Osteosarcoma with no evidence of metastatic disease.

TREATMENT PLAN: A hemimandibulectomy was performed on the affected side and histologic examination confirmed complete excision of the tumor.

RESULT: The owner was very pleased with the decision for hemimandibulectomy. Marla showed no evidence of postoperative pain or swelling. Her tongue protrudes from her mouth on the right side, but this was predicted and is very acceptable to the owners.

Marla was eating very well within 24 hours of the surgery. The owner has reported that Marla is back to playful activity within a week after the surgery.

COMMENT: Patients that require hemimandibulectomies or mandibulectomies typically experience an immediate improvement in their quality of life. For Marla, the osteosarcoma caused substantial bone destruction and was definitely painful. Immediately before the surgery and after the hemimandibulectomy, the owner recognized that Marla had been painful. Pain recognition is very difficult in veterinary patients, and possibly more difficult in older patients with multiple chronic problems.

CASE 6: Tiny, an 11-year-old female Great Pyrenees, presented with a moderate right mandibular swelling and severe pain. Tiny seemed particularly painful when attempting to chew food. She would chew primarily on the left side, and food would fall out of the mouth on the right side.


  • Blood work and urinalysis results were within normal limits.
  • An oral exam was not possible due to the degree of patient discomfort. Under anesthesia, a severe periodontal defect was evident. The local tissue appeared discolored and had a tremendous malodor.
  • Dental radiograph revealed a poorly developed tooth with a wide root canal system.
  • Periodontal probing revealed deep 8 to 12 mm periodontal defect.

DIAGNOSIS: Severe periodontal defect, stage 4 (of 4) periodontal disease with a nonvital tooth.

TREATMENT PLAN: Dental extraction to alleviate pain and stop further local destruction.

RESULT: Immediate improvement in eating and return to playful activity.

COMMENT: Periodontal disease is an infectious, inflammatory, and destructive process. Pain is often associated with periodontal disease. Although this patient presented as having an acute problem, she had an unusual chronic disease. Treatment was very rewarding for the patient and owner.

These oral surgery and dental cases illustrate the need to fully evaluate the geriatric patient and to clearly understand the client's priorities for their companions.

Prioritization of concurrent problems is important to optimize patient comfort, safety, and quality of life. Accurate diagnosis allows for appropriate treatment planning based on the patients' and clients' needs. Failure to establish an accurate diagnosis can lead to inappropriate therapy. Advanced imaging techniques can be utilized to help with the diagnosis, to better understand the prognosis, and to determine whether oral surgery is feasible.

Treating the treatable problems is not always logical, as geriatric patients sometimes have treatable conditions that may not significantly improve the patient's quality of life. Some nonpainful conditions may be monitored using periodic dental radiographs.

Dental problems are often painful and may create problems with food prehension or mastication. These conditions should be treated because such treatments can dramatically improve the quality of life for these animals.

Dr. Kressin operates the Animal Dental Center in Oshkosh, Wis. He is a diplomate of the American Veterinary Dental College and provides a conforming residency recognized by the American Veterinary Dental College.


Source: DVM InFocus,
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