To extract or not to extract that tooth root?

Is a crown amputation all that’s needed?

When it comes to feline odontoclastic resorptive lesions (FORLs), these may be the questions you’re asking yourself.

FORLs can cause loss of the protective surfaces (enamel, cementum, and dentin) of both the crown and the root(s) of a tooth, resulting in pain.

These lesions come in two varieties:

• Type 1: Where the root appears radiographically normal.

• Type 2: Where the root is radiographically hard to distinguish from the surrounding bone, with loss of visibility of the periodontal ligament space.

As you know, the treatment for these lesions is different—full extraction of the root(s) for Type 1, versus just a crown amputation for Type 2.

Performing a crown amputation and leaving a root in place for Type 1 could result in problems or complications, not to mention continued pain for the patient.

On the other hand, trying to extract the root of a true Type 2 lesion could be a monumental task and a big headache.

So, it’s very important to determine what type of lesion you’re dealing with. Here’s how…

Diagnosing FORLs

Patient presentation

A client brings their pet to you because of halitosis, food dropping, and occasional jaw chattering. 

During the physical exam, you notice bright red, inflamed gums and gingival hyperplasia near one of the mandibular premolars. 

You suspect a FORL—and given that FORLs are one of the most common dental problems in cats, you’re probably right.

You suggest a dental procedure, including dental radiographs, a full cleaning, oral exam, and possible extraction. The client agrees with the plan.

The day of the procedure

After the patient is anesthetized, your technician obtains radiographic images of the entire mouth, which takes just a few minutes to perform.

Then, you look at the radiographs in conjunction with your oral exam.

While probing the tooth in question, you feel a rough patch under the gingival hyperplasia, consistent with a resorptive lesion.

The x-ray confirms your diagnosis. 

Determining the best treatment plan

In this case, the patient’s tooth is clearly Type 1, with a periodontal ligament space still visible. So, you perform a full extraction.

While evaluating the dental rads, you also notice the premolar on the opposite side is starting to show radiographic evidence of a lesion.

Even though it’s mild, you call the owner and inform them of the likelihood of progression. 

To prevent a painful lesion from developing between dentals, the owner decides to go forward with a pre-emptive extraction of that tooth as well.

Documenting the extraction

In addition to being an integral part of your treatment plan decisions, dental radiographs can also help you document that extraction was performed successfully.

A post-procedure x-ray image is a great way to document that there are no root tips left behind.

And, in cases where a crown amputation was indicated, dental rads provide visual proof that this was an appropriate treatment course.

In this way, dental radiographs not only help you to plan and implement a very high quality of medicine—but they also give you peace of mind and are a valuable part of your medical records.

Talking to clients about dental radiographs

Maybe you already know the benefits of dental radiography—but you’re concerned about discussing the additional cost with clients. 

Often, it helps to include the x-rays as part of the dental procedure package. List them on the estimate so the client understands the value they are receiving—just don’t itemize the cost of the radiographs separately. 

Be sure to adjust the estimate of the dental package accordingly, to cover your costs. And remember, with a monthly payment plan for your dental radiography system, just a couple of dental procedures per month can cover your investment.

Client education also helps. Explain how the results of the radiographs allow you to provide the best possible treatment and reduce the likelihood of future complications.

With clients who want the best for their pets, it’s a win-win for both of you.

Written by: Dr. Tammy Powell, DVM