The modified Triadan system: nomenclature for veterinary dentistry.

Recently the issue has been raised concerning the nomenclature for describing dentition in the veterinary dental patient. Several methods for referencing teeth have been utilized, leading to confusion concerning an acceptable system that is interchangeable between species. The Modified Triadan System is introduced and offers a simple, accurate, "userfriendly" veterinary dental nomenclature system. This article describes how the system evolved and its advantages for the veterinary dentist.     

World Small Animal Veterinary Association Global Dental Guidelines

Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un- and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three-tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well-being of our patients, and how this equates to an animal welfare issue, is discussed.     

Prevalence and risk factors for dental disease in captive Central bearded dragons (Pogona vitticeps) in the United Kingdom

Despite periodontal disease being recognized as a common condition in captive bearded dragons, there is a lack of data regarding the prevalence. A soft diet has previously been cited as the main risk factor linked to the disease, although there has been little research conducted into the etiology since the disease was first described. The aims of this study were to investigate the prevalence of dental abnormalities and disease in captive Central bearded dragons in the United Kingdom, and to begin to investigate the risk factors affecting the presence and increased severity of disease in this species. Data collection was conducted from 20 veterinary practices across the United Kingdom from March to October 2018. All bearded dragons presented to participating practices during this time period were assessed for the presence of dental disease, and for each animal a standardized data collection form was completed to provide information concerning the animal's signalment, diet, and health status. Severity of any dental disease was also graded in a subset of bearded dragons (n = 147) by two of the authors using a grading system from 0 to 5. The prevalence of dental abnormalities and disease was 50% in the sampled population of 304 bearded dragons. Increasing age, an abnormal body condition score, presence of concurrent disease, as well as presence of fruit in the diet were all significant risk factors for the presence of dental abnormalities and disease. Contrary to previous reports, neither presence of different live foods in the diet, nor presence of vegetable matter in the diet had any significant associations with dental abnormalities and disease, challenging some of the assumptions made to date about the etiology of dental disease in Central bearded dragons. This study instead found that fruit could be the main dietary risk factor for dental disease and should be excluded from the captive diet of these animals. This study has found a strong association between increasing age and presence of dental abnormalities and disease, and stresses the importance of a thorough oral exam, especially in older individuals.     

Fatal venous air embolism in a cat undergoing dental extractions

A five‐year‐old domestic shorthair cat underwent general anaesthesia and tooth extractions. Immediately after use of a high‐speed, air‐driven, water‐cooled dental drill, the cat suffered cardiac arrest and attempted resuscitation was unsuccessful. Post‐mortem radiographs showed air in the vena cava, right atrium, right auricle and right ventricle, hepatic and renal veins. These findings were confirmed at post‐mortem examination. The cause of death was massive air embolism. There are reports of fatal venous air embolism in the human literature from the use of high‐speed, air‐driven, water‐cooled dental drills. In this case, we believe that the air jet from the cooling system provided an enormous pressure gradient allowing air entry through an alveolar bone fracture or the inflamed gingival tissues. This is the first report of fatal venous air embolism associated with the use of a high‐speed dental drill in the veterinary literature.     

The Progressive Syndrome of Acquired Dental Disease in Rabbits

Dental disease is one of the most common reasons for pet rabbits to need veterinary treatment. The continual eruption and growth of the teeth predispose rabbits to dental problems. Any abnormality in the shape, position, or structure of the teeth interferes with normal wear and can lead to malocclusion and crowns that are no longer functional, and may grow into surrounding soft tissue causing pain and eating or grooming difficulties. Root elongation is a feature of dental disease in rabbits and can lead to a number of clinical problems such as epiphora, dacrocystitis, or abscesses. Repeated examination of rabbits with dental problems alongside skull radiography and visual examination of prepared skulls from affected cases has shown that the majority of rabbits with dental problems are suffering from progressive changes in the shape, structure, and position of the teeth. The nature of the abnormal dental changes suggests that underlying metabolic bone disease is a possible cause. This progressive syndrome of acquired dental disease can be staged. This article describes the clinical and pathological features of each stage of progressive syndrome of acquired dental disease and provides recommendations for the treatment of cheek teeth malocclusion.     

Effects of a dental food on plaque accumulation and gingival health in dogs

Recent studies have demonstrated that typical dry dog foods have significantly less efficacy in reducing accumulation of dental substrates compared to a specifically formulated and processed dental food. This study compared the effects of a typical dry food and a dental food on plaque accumulation and gingival inflammation in dogs during a 6-month period. Daily feeding of the dental food significantly reduced plaque and gingivitis by 39% and 36%, respectively, compared with daily feeding of the typical dry food. Feeding a food that decreases plaque accumulation and reduces gingivitis contributes to canine oral health maintenance.     

Effect of a dental chew on dental substrates and gingivitis in cats

The use of special diets or dietary adjuncts, although not eliminating the need for regular professional therapy, may serve to improve gingival health during the interval between professional oral health assessments and intervention. This study was performed to determine the effect of a dental chew on dental hygiene and gingival health in cats. The accumulation of dental substrates and the development of gingivitis were assessed in cats fed either a dry diet only or a dry diet supplemented with dental chews. A two-period, crossover design was used with the test phase lasting 4-weeks. Results indicated that the daily addition of dental chews to a dry diet was effective in reducing plaque and calculus accumulation on tooth surfaces in cats, as well as reducing the severity of gingivitis.     

The sharpening and polishing of dental instruments

This article describes the maintenance of dental instruments in a companion animal practice, in particular the correct sharpening techniques for tartar scrapers, curettes, excavators, and elevators. Sharp instruments are essential for the quality and speed of dental care.     

Bacterial Isolates From Plaque and From Blood During and After Routine Dental Procedures in Dogs

Objective — This study evaluates the association between dental procedures and bacteremia in dogs, including a comparison of bacteria isolated from plaque and blood, severity of the bacteremia versus the severity of dental disease, and the longevity of bacteremia.
Study Design — Bacteria cultured from the blood over time were compared with those isolated from the plaque and crevicular fluid and in relation to severity of dental disease.
Animals or Sample Population — Twenty adult greyhounds.
Methods — Blood samples were collected for culture before induction of general anesthesia, immediately after intubation, 20 minutes after initiation of the dental procedure, and at 10-minute intervals until 10 minutes after the dental procedure was completed. Samples of plaque were taken for microbiological culture.
Results — Sixty to ninety percent of the bacterial genera isolated from the plaque were present in the blood. Dogs classified according to severity of dental disease showed no difference in the total number of different species or number of different Gram-negative, Gram-positive, or anaerobic bacteria isolated from plaque or blood (P <.05). Bacteremia was present in all of the dogs studied, within 40 minutes from the initiation of the dental procedure, regardless of the severity of oral disease.
Conclusions — Gram-negative, Gram-positive, and anaerobic bacteria are present in blood during dental procedures; the bacteremia can persist beyond the dental procedure, and is not associated with the severity of dental disease.
Clinical Relevance — The nature and extent of bacteremia occuring during routine dental procedures is important in understanding a potential risk to dogs.     

Equine developmental dental disorders

The true prevalence of developmental dental disorders in horses is unknown, but from a clinical perspective, dental dysplasia of varying degrees of severity appears to be far more common than developmental abnormalities of tooth numbers. The latter includes the presence of increased numbers of teeth (supernumerary teeth), which in turn appears more prevalent than reduced numbers of teeth (hypodontia or anodontia). This clinical commentary briefly reviews all three types of developmental dental disorders from a clinical viewpoint.     

Dental bridging as a treatment for large oral fistulae in two horses

Chronic orocutaneous, oronasal, or orosinus fistulae can be challenging to repair. This report describes placement of a dental bridge as a treatment for oral fistulae and outcome in two horses. A 12-year-old, Westphalian gelding was presented for nasal discharge because of an oromaxillary fistula after dental repulsion of the Triadan 209 4 years earlier. The second case, a 5-year-old Oldenburg mare was presented for an orocutaneous fistula 7 weeks after dental repulsion of the Triadan 208. Both were treated by placing an 8-shaped cerclage wire, inserted through the rostral and caudal interdental spaces and crossing at the level of the missing tooth. Polymethylmethacrylate (PMMA) was then used to seal the fistula. No significant complications occurred during or after the surgery. In both cases clinical signs did not recur. In the first case the dental bridge is currently (5 years after the intervention) in place. In Case 2 the construction was removed after 1.5 years and the fistula had healed completely. This case report suggests that placing a dental bridge composed of cerclage wire and PMMA should be considered as an easy, noninvasive and efficient way to manage large oromaxillary or orocutaneous fistulae.     

Temporomandibular joint cytokine profiles in the horse

It has been suggested that dental abnormalities lead to temporomandibular joint inflammation and pain that may be mitigated by regular dental care. There is considerable literature on the pathophysiology of equine joint disease including studies on cytokine profiles in diseased appendicular joints. This study examined the effects of age and dental malocclusions summarized as a dental pathology score on equine temporomandibular joint cytokine (IL-1, IL-6, IL-8, TNF alpha and TGF-beta1, -beta2, -beta3) concentrations. TGF-beta3 was not detected in any joint sample. IL-1, IL-6 and TNF alpha were not influenced by age. Foals had significantly lower concentrations of lL-8 and TGF-beta1, and higher levels of TGF-beta2 compared with older horses. Age did not effect cytokine concentration in older horses although there was a trend towards increasing 1L-8 with age. The dental pathology score increased with age in mature horses, however there was no effect of dental pathology score on cytokine concentration. There was no effect of incisor eruption, and presence or number of periodontal lesions on temporomandibular joint cytokine concentration. Our findings indicate that age but not dental pathology affected temporomandibular joint proinflammatory cytokine concentration in this population of horses.     

Effective periodontal disease control using dental hygiene chews

This study evaluated the effectiveness of a newly developed dental hygiene chew for dogs, with and without a natural antimicrobial additive, compared with a reference diet. Efficacy was determined by measuring the severity of gingivitis and the accumulation of dental plaque and calculus in dogs after 4-weeks of being fed the different dietary regimens. Dogs fed a single daily dental chew had significantly less gingivitis (P = 0. 02), plaque (P = 0. 0004), and calculus (P = 0.0001) compared with dogs in the control group that were fed an identical diet but received no chews. The inclusion of the antimicrobial agent did not improve the efficacy of the product. The dental hygiene chews tested in this study have potential to help reduce the incidence of periodontal disease in dogs.     

Benefits of a 'dental hygiene chew' on the periodontal health of cats

A study was undertaken to determine the clinical efficacy of a chew designed to improve dental hygiene in the cat. The accumulation of dental deposits (plaque and calculus) and the effect on gingival inflammation were assessed in 15 client-owned cats while on two different regimens. In the first leg of the study, the cats were fed a nutritionally complete dry diet supplemented with one dental hygiene chew. In the second leg of the study, the same cats were fed only the nutritionally complete diet. This study demonstrated that the daily addition of the chew to the dry diet resulted in significantly less plaque and calculus accumulation on tooth surfaces. It was our experience that daily feeding of the chew helped maintain dental hygiene in cats; however, regular professional therapy is still indicated.     

Evaluation and optimisation of a target-controlled infusion system for administering propofol to dogs as part of a total intravenous anaesthetic technique during dental surgery

The performance of a modified target-controlled infusion system was investigated in 16 dogs undergoing routine dental work, by comparing the predicted concentrations of propofol in venous blood samples with direct measurements; the optimum targets for the induction and maintenance of anaesthesia were also identified. The performance of a target-controlled infusion system is considered clinically acceptable when the median prediction error, a measure of bias, is not greater than +/-10 to 20 per cent, and the median absolute performance error, a measure of the accuracy, is not greater than 20 to 30 per cent. The results fell within these limits indicating that the system performed adequately. The optimal induction target was 3 microg/ml, and anaesthesia of adequate depth and satisfactory quality was achieved with maintenance targets of between 2.5 and 4.7 microg/ml propofol. The system was easy to use and the quality of anaesthesia was adequate for dental work.     

Recent developments in equine dentistry

ABSTRACT

Equine dentistry is a rapidly developing clinical specialty. It has benefitted from key advances in anatomical and physiological research, development of equipment and instrumentation, utilisation of standing sedation and anaesthesia protocols, a change towards minimally invasive surgical techniques, and the introduction of restorative and endodontic techniques translated from techniques used in human and canine dentistry. Anatomical research has provided further insight into the endodontic system of incisors and cheek teeth and how it changes throughout development with age. Studies of the periodontium have demonstrated a rich vascular supply and repair capacity. Routine dental visits are increasingly being performed utilising sedation and clinical instruments for routine examinations. Equipment has become more efficient, battery-operated and miniaturised giving benefits to both equine dental maintenance work and advanced techniques, assisting the transition to minimally invasive techniques, and the development of endodontic and restorative dentistry. Diagnosis has also benefitted from advances in equipment such as patient-side digital radiography systems, high definition oroscopy, and small diameter flexible fibrescopes that are capable of visualising inside a pulp canal. Dental units combining endodontic high- and low-speed drills, suction and air or water flush are becoming increasingly used and adapted for equine use. Sedative combinations and standing anaesthesia protocols have meant that revisions of traditional techniques, as well as novel techniques, can be performed with almost no requirement for general anaesthesia. Equine dentistry can only continue to advance in this way if there is early identification of dental disease through clinical oral examinations, leading to a system based on prophylaxis, as in human dentistry. This necessitates a change in attitude of the public and industry in general to a proactive approach, with early intervention based on examination and diagnostic findings of practitioners and not necessarily based on the clinical signs displayed by the patient.     

The possibilities and limitations of animal dentistry in the small animal practice

This paper points out, which dental diseases can be treated successfully in the general veterinary practice and which patients should be assigned to a veterinary dental referral practice. Furthermore, the occurrence and shape of defects in the enamel and cementum are discussed, which can be caused by incorrect use of ultrasonic scalers or sharp edges of the instrument tips.     

Head and neck abscessation and thrombophlebitis following cheek tooth extraction in a pony

Due to their long hypsodont reserve crowns, extraction of equid cheek teeth can be difficult and result in more complications than the extraction of their shorter brachydont counterparts although the more recent resumption of oral extraction has greatly reduced such complications. The more common post-extraction sequelae in equids include non-healing alveoli due to retained dental or alveolar sequestrae which may lead to oromaxillary or oronasal fistula formation, chronic external sinus tract formation or osteomyelitis of the supporting bones. Collateral damage to adjacent teeth has also occasionally been reported during dental repulsion. Systemic complications following equine cheek tooth extraction have been infrequently described, including a small number of cases of exodontia-related bacterial meningioencephalitis. This is surprising, as dental manipulation can lead to bacteraemia in many species, including horses. Infections at distant sites related to the spread of dental pathogens have been well described in humans and in small animals. This report describes deep abscessation of the masseter muscles followed by extensive thrombophlebitis of the jugular, facial and rostral cervical veins following oral cheek tooth extraction in a pony affected by pituitary pars intermedia dysfunction (PPID) that was successfully treated by abscess drainage and thrombectomy of the affected veins.     

Treatment of traumatic dental displacement in dogs: six cases of lateral luxation

In dogs and cats, the most common causes of dental injury are fights with other animals, car accidents, falls from a height, and chewing on hard materials such as bones or rocks. The trauma more often causes fracture of the teeth, but sometimes avulsion or luxation can occur. Avulsion is the complete displacement of the tooth out of the alveolar socket and luxation is the partial displacement of the tooth. Tooth luxation and avulsion represent dental emergencies. Time is an important factor for successful treatment; the prognosis becomes poorer the longer the tooth is out of the socket. This paper describes the guidelines for treatment of dental displacement in cats and dogs and presents six cases of dental lateral luxation in dogs seen at the Veterinary Hospital of the University of Pennsylvania (VHUP) in the period from May 1996 to September 1997.     

Prosthodontic treatment of trauma to the nasus externus, premaxilla and maxilla of a dog

This is a clinical report which presents a prosthodontic treatment for a trauma case in a dog with multiple dental, skeletal and soft tissue problems. The treatment resulted from investigations into prosthodontics with the assistance of a prosthodontic dental laboratory. The prosthesis which was fabricated solved the problem of obstructed airflow through an injured nares, and provided for an esthetic result. Treatment required intermittent procedures over a one year period.