Page 474 - WSAVA2018
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 25-28 September, 2018 | Singapore
C. Chest radiographs
HCM is often not ausculted
Over 50% of patients over 6 have significant findings on chest films
1. Provide superior (and necessary!) post-operative treatment
1. Pain management: Opiates, NSAIDS, Local Anesthetics (nerve blocks)
2. Homecare products such as tooth brushes, rinses, and dental diets
3. Rechecks
5. Specific cases where income can be increased
A. Persistent deciduous teeth are a very common problem in small animal patients, especially toy breeds. Most clinics will do this and charge for it, but in general they will way under charge and under treat. These are large teeth that are time consuming extractions.
By keeping the teeth, the clients can understand why the extraction is expensive. In addition, proper pain medication and radiology will increase the fee to a reasonable level.
B. Fractured teeth with pulp exposure are a very common occurrence in veterinary medicine (approximately 10% of dogs have a broken tooth with pulp exposure). All teeth that are fractured with pulp exposure are either painful, infected, or both. Therefore, all teeth need to be treated via root canal therapy or extraction. This does “bother the dog” and therapy is critical. If a minor tooth, extraction is a viable option. If it is a major tooth and the client is to be referred for root canal therapy, the patient should be placed on pain medications and/or antibiotics and a minimum database performed.
C. Worn teeth with root canal exposure need to be treated with root canal therapy or extraction. Teeth without root canal involvement should be radiographed to ensure lack of endodontic infection and then treated with composite bonding if indicated.
D. Discolored (intrinsically stained) teeth. A study by Hale in 2001 reported that only 40% of discolored teeth have radiographic signs of endodontic disease. However, when physically examined, it was discovered that 93% of the teeth were in fact non-vital. Therefore all discolored teeth should be treated as dead and infected (root canal therapy or extraction).
E. Feline tooth resorptive lesions are reported to be present in up to 60% of all cats greater than 6 years of age. These are VERY painful lesions and require therapy.
These are diagnosed with an explorer along the gingival margin. Full mouth dental radiographs are indicated when lesions are found as they will generally have additional lesions. These teeth need to be extracted.
F. Periapical Abscess can be treated by root canal therapy or extraction. If electing to perform an extraction, remember that they are surgical procedures and should be charged as such. By calling it oral surgery it changes client perception of the procedure. Dental Radiographs and pain management including local anesthetics should be administered.
G: Oral masses are incredibly common in small animal dentistry (especially dogs). All growths no matter how small and normal appearing should be sampled and submitted to the lab for histopathologic analysis. In my experience about 1% of these biopsies will turn out to be malignant and need additional therapy. In addition they should all be radiographed to evaluate for bony involvement. This will help the pathologist to determine level of aggressiveness.
H. Uncomplicated Crown Fractures are a very common finding in large breed dogs (at least 50%). This occurs when a piece of the crown is broken, which exposed
the dentin, but not the root canal. Occasionally, these teeth can become infected through the dentinal tubules which will go undiagnosed without dental radiology. However, teeth with no to small pulpal exposures tend to be the ones with clinical abscessation. Even if these are not infected, they are at least transiently sensitive and require restoration.
· Ø Treatment
· Ø Dental radiographs are WNL
ØBonded sealant
ØRecheck radiographs in 9-12 months
· Ø Radiographic evidence of endodontic disease
ØRoot canal therapy
Key Points of periodontal disease from the DG
· Periodontal disease is by far the most common medical condition in small animal veterinary patients.
· Plaque forms within 24 hours, calculus within 3 days and gingivitis begins as early as 2 weeks.
· Periodontal inflammation is caused by subgin- gival plaque; therefore, control of plaque needs to address both supra- and more importantly subgingival plaque to be effective at controlling disease.
· Calculus (or tartar) is essentially non-pathogenic · The first sign of periodontal disease is bleeding

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