Transforming Veterinary Dentistry with Digital Radiology
Dental disease is the most prevalent condition in dogs and cats presenting to small animal primary care veterinarians.
Periodontal disease is listed as the most common oral issue observed.
In recent years, digital radiology has revolutionized dental procedures in veterinary practice.
Accessing detailed images of what is lingering below the gingival surface at the click of a button can prove crucial in time-dependent clinical decision-making.
Digital dental radiology can vastly increase procedure efficiency, reduce serious complications, and improve the welfare of many veterinary patients.
Dental radiographic equipment is considered essential in the U.S. veterinary hospital according to the WSAVA global dental guidelines.
However, to appreciate the importance of dental radiology, it is essential to understand its clinical application in treating different dental conditions.
This article explores the use of digital dental X-rays in practice through specific clinical examples and how this technology might benefit your team and your patients.
Periodontal disease
Periodontal disease occurs when subgingival plaque and bacteria cause inflammation of the soft tissue and alveolar bone supporting the tooth.
Common sequelae include oronasal fistulae, abscessation, osteomyelitis, pathological mandibular fractures, and ocular disease.
Evidence is also growing to support the notion that periodontal disease contributes to systemic conditions in some patients.
Periodontal disease is most easily identified in anesthetized patients and has been observed in 44-100% of dogs as young as the age of two years in various studies.
The condition is identified by probing for periodontal pockets around each tooth. However, for teeth with a tight interproximal space (e.g., molars), pathological pockets cannot be reached with a probe and will only be detected via dental radiographs.
Without radiology, several teeth affected by periodontal disease could be missed entirely, with serious consequences for that patient.
Additionally, dental X-rays must be performed in small-breed and toy-breed dogs.
Their mandibular molars occupy a larger area of the jaw than other breeds and severe periodontal disease can cause areas of bone lysis that dramatically weaken the mandible, causing pathological fractures in some cases.
Dental extractions without radiographs risk iatrogenic mandibular fractures in these dogs and cats.
Feline resorptive lesions
Dental radiology is integral to determining the appropriate treatment in cases of TR or tooth resorption.
Where roots are retained without evidence of replacement resorption (dentoalveolar ankylosis), the roots remain painful, and there is a risk of an endodontic infection developing.
However, where a dental X-ray identifies roots that are completely resorbed and replaced by bone, infection is unlikely to occur, and extraction is not recommended.
In these cases, crown amputation is an acceptable treatment. For those feline patients with resorptive lesions where some evidence of the root and periodontal ligament remains, or signs of infection or stomatitis, coronectomy is unsuitable, and surgical extraction may be necessary.
Without dental radiographs, it is impossible to determine the condition of the tooth root and the appropriate course of action.
Performing coronectomy inappropriately can lead to extensive oral pain, root infections, and the requirement for revision dentistry.
In addition, identifying the best approach for extracting affected teeth can save considerable time during a dental procedure and avoid the need for salvage procedures.
PDT or persistent deciduous tooth
Deciduous teeth that fail to exfoliate can lead to overcrowding, malpositioning of permanent adult teeth, and increased plaque build-up, with all the consequences that this entails.
In addition, fractures and pulp exposure of deciduous teeth can cause endodontic disease and osteomyelitis, damaging the adjacent adult teeth in the process. Retained deciduous teeth, similar to FT, should be assessed for root resorption before extraction.
In many cases, where the root is partly resorbed, a surgical extraction approach is required. Non-surgical extraction without radiography risks tooth fracture and retained roots, leading to painful endodontic infections.
Where the root is entirely ankylosed, the clinician can be confident in their decision to amputate the crown, saving them time and stress and eliminating any unnecessary trauma to the patient.
Tooth trauma
Crown fractures with Dentin exposure can be painful and lead to root infections in the same way that pulp exposure can.
But, due to the subtle presentation, clients often chose to ignore these innocuous injuries.
In these cases, dental radiographs can assess the deeper structures for signs of inflammation and infection and demonstrate to the client when further action is warranted. Interventions include root canal therapy or tooth extraction.
However, when the tooth is viable, the exposed dentine can be sealed, and regular dental radiology can be used to monitor for future issues.
Similarly, where teeth are worn down due to excessive chewing, the viability of each tooth can only be assessed through dental radiology.
Other dental anomalies
The application of dental radiology is extensive.
Other uses include the assessment of ‘missing teeth’ for retained roots or unerupted teeth, dentigerous cysts, oral tumors (where CT is not available as a first-line assessment), and in cases of persistent oral pain.
In addition, digital dental radiology can be useful in cases of dental trauma where advanced imaging is not available.
Conclusion
Visual dental assessment is no longer acceptable to assess the extent of dental disease a patient is suffering.
And in many veterinary clinics, it is hard to imagine the future of veterinary dental care without digital radiology.
The WSAVA advises that dental radiographs are essential before and after all dental extraction procedures, allowing rapid assessment of whether tooth extraction is required, the most suitable technique, and the potential risks the clinician might face.
Through dental radiology, complications are reduced, vets work more efficiently, reasons for clinical decisions are evidenced, and the outcome of a procedure is visually documented.
But, most importantly, patient welfare is prioritized in therapeutic planning, and dental radiology is a huge step forward in reducing life-long dental disease and oral pain in veterinary patients.
References:
Fulton, A.J., Fiani, N., Verstraete, F.J. (2014). Canine pediatric dentistry. Veterinary Clinics of North America Small Animal Practice 44(2), 303-24
Gorrel, C. (2015). Tooth resorption in cats: pathophysiology and treatment options. Journal of Feline Medicine and Surgery 17(1), 37-43
Lund, E.M., Armstrong, P.J., Kirk, C.A. (1999). Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States. Journal of the American Veterinary Medical Association. 214(9), 1336-41
Niemiec, B., Gawor, J., Nemec, A., et al. (2020). World Small Animal Veterinary Association Global Dental Guidelines. Journal of Small Animal Practice. 61(7), E36-E161
O'Neill, D.G., James, H., Brodbelt, D.C., et al. (2021). Prevalence of commonly diagnosed disorders in UK dogs under primary veterinary care: results and applications. BMC Veterinary Research 17(1), 69
Wallis, C., Holcombe, L.J. (2020). A review of the frequency and impact of periodontal disease in dogs. Journal of Small Animal Practice 61(9), 529-540
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